Robin Eaves
McKenzie,TN
Summary
Dynamic Claims Escalation Specialist with proven expertise at Fast Pace Urgent Care, adept at enhancing customer satisfaction through effective complaint resolution and process improvement. Skilled in medical coding and data management, I excel in high-pressure environments, fostering teamwork and delivering exceptional service while maintaining strict confidentiality and compliance. I dissect all claims fully, and find where the money needs to go.
Overview
11
11
years of professional experience
1
1
Certification
Work History
Claims Escalation Specialist/CPC-A
Fast Pace Urgent Care
Franklin, TN
09.2016 - Current
- Resolved complex patient inquiries to enhance service quality and customer satisfaction.
- Collaborated with clinical staff to address escalated concerns efficiently and effectively.
- Mentored junior staff on conflict resolution techniques, fostering a collaborative work environment.
- Safeguarded customer data privacy through strict adherence to company protocols when working with sensitive information.
- Contributed to a positive work environment by mentoring junior staff members on effective escalation management techniques.
- Delivered exceptional service even during high-pressure situations, maintaining professionalism and composure at all times.
- Supported company growth by assisting with the development of new processes to handle increased volume of escalations effectively.
- Responded proactively and positively to rapid change.
- Trained new personnel regarding company operations, policies and services.
- Enhanced productivity levels by anticipating needs and delivering outstanding support.
- Reviewed and coded medical records for accuracy and compliance with regulations.
- Utilized advanced coding software to enhance efficiency in claims processing.
- Collaborated with healthcare providers to resolve coding discrepancies promptly.
- Ensured precise documentation of patient diagnoses to support billing processes.
- Conducted regular audits on coding practices to maintain high standards of quality.
- Trained junior coders on best practices and updates in coding guidelines.
- Implemented process improvements that streamlined workflow within the coding department.
- Maintained strict confidentiality by adhering to HIPAA guidelines and ensuring sensitive patient information was protected at all times.
- Managed high-volume workloads effectively by prioritizing tasks according to urgency and importance while maintaining strict attention to detail.
- Conducted thorough research on complex cases, applying advanced knowledge of medical terminology, anatomy, physiology, and pharmacology to accurately assign codes as needed.
- Identified opportunities for process improvement, leading to a more efficient workflow within the coding department.
- Utilized advanced computer skills to navigate various software programs, further enhancing the efficiency of coding processes.
- Provided comprehensive training for junior coders, resulting in increased productivity and skill development.
- Served as a reliable resource for both clinical teams and administrative staff by offering expert advice on proper code selection based on diagnosis or treatment specifics provided in the documentation received.
- Optimized revenue cycle management with timely and precise code assignment for various medical procedures.
- Participated in regular performance evaluations and provided constructive feedback for continuous improvement within the team.
- Enhanced coding accuracy by implementing quality assurance checks and conducting regular audits.
- Coordinated with other departments to address any discrepancies or issues arising from billing-related matters promptly and professionally.
- Streamlined billing processes for improved efficiency and reduced errors in claims submissions.
- Assisted with the preparation of annual budgets by providing accurate projections based on historical data analysis.
- Reduced claim denials by attentively reviewing medical records and addressing discrepancies prior to submission.
- Developed strong working relationships with insurance companies, facilitating smoother communication and quicker claim resolutions.
- Participated in ongoing professional development opportunities to stay current on changing coding requirements and advances in healthcare technology.
- Correctly coded and billed medical claims for various hospital and nursing facilities.
- Verified signatures and checked medical charts for accuracy and completion.
- Trained and mentored junior coders to support growth and development amd apply high-quality coding practices.
- Resourcefully used various coding books, procedure manuals, and on-line encoders.
- Reviewed, analyzed, and managed coding of diagnostic and treatment procedures contained in outpatient medical records.
- Reviewed patient charts to better understand health histories, diagnoses, and treatments.
- Interacted with physicians and other healthcare staff to ask questions regarding patient services.
- Monitored changes in coding regulations to provide recommendations for compliance.
- Communicated with insurance companies to research and resolved coding discrepancies.
- Followed up with medical staff regarding missing information in patient records.
- Maintained accuracy, completeness, and security for medical records and health information.
- Input data into computer programs and filing systems.
- Assisted in training new staff on medical record processing and filing procedures.
- Implemented solutions to streamline communication between departments during high-volume periods.
- Developed comprehensive reports on escalated cases to inform management decisions and strategy adjustments.
- Proficiency in : Outstanding Claims, identifying trends and met/exceeded strict deadlines .
- Proficiency in:
- Experity
- Waystar
- Inovalon
- Encoder
- Avality
- Payton
- Finthrive (ARO)
- One Note
- Webex
- Teams
- UMR
- AARP
- Kentucky Medicade
- Alabama Medicade
- Ambetter TN
- LA Healthcare Connection
- IN Btt
- Kymis
- BCBS Al, MS
- Ilink Blue- LA
- Cigna Health
- Excel/Word
- Mississippi Medicade Portal
- Magnolia Health
- Palmetto AL, NC, TN
- Medicare
- NPDES
- CGS
- KY Medicare
- Farm Bureau
- WPS
- IN Medicare
- Echo
- Novitas
- AR, LA, MS Medicare
- Arkansas Medicaid Portal
- VACCN
- Tricare East, West, and for life
- Alabama Medicaid
- Global Protect
- Outlook
- United Healthcare
Dental Assistant
Webbs Dental Clinic
Huntingdon, TN
04.2015 - 08.2022
- Assisted in patient preparations for dental procedures, ensuring comfort and understanding of processes.
- Sterilized and maintained dental instruments, adhering to strict safety protocols.
- Managed appointment scheduling and patient records using electronic health record systems.
- Supported dentists during examinations and treatments, enhancing workflow efficiency.
- Educated patients on oral hygiene practices and post-treatment care instructions.
- Monitored inventory levels, ordering supplies as needed to ensure seamless operations.
- Collaborated with team members to improve clinic processes and patient experience.
- Implemented new patient intake procedures, streamlining data collection and processing times.
- Cleaned and sanitized dental tools and equipment, straightened treatment rooms, and restocked supplies to prep for next patient and maintain health and safety practices.
- Maintained a clean and sterile work environment to prevent cross-contamination and infection.
- Sanitized trays, instruments, and surfaces for clean dental office setting and patient safety.
- Provided chairside assistance during examinations, improving dentist efficiency and patient satisfaction.
- Performed x-rays safely while adhering to radiation safety guidelines, ensuring high-quality diagnostic images for dentists'' evaluations.
- Prepared and arranged instruments, medications, and required materials for dental procedures.
- Successfully assisted dentist by performing four-handed dentistry and other chair-side duties.
- Sterilized rooms and prepped equipment and instruments for Number procedures daily.
- Performed general chair-side duties for general dentistry, endo procedures, and oral surgery.
- Assisted dentists with complex procedures, ensuring optimal patient care and treatment outcomes.
- Documented patient dental health information, medical history, and vital signs for future reference.
- Assisted dentists, hygienists, and other personnel by handing appropriate tools and supplies needed for procedures.
- Prepared instruments and equipment for use in dental procedures, ensuring their availability when needed.
- Explained treatment procedures and instructed patients on home care guidelines.
- Created dental impressions used for diagnostics, opposing models and study casts to make crowns, bridges, and other dental prosthetics.
- Managed inventory of dental supplies, reducing waste and optimizing resource allocation.
- Maintained dental supply inventory by checking stock to determine inventory levels and placing and expediting orders for supplies.
- Prepared patient x-rays and images for dentist review.
- Took dental images following strict patient protection rules, applying lead aprons.
- Recorded patients' health histories, documented current symptoms, and pulled up records from prior visits for dentists to view and evaluate.
- Supported dentists during oral surgeries by preparing surgical rooms with necessary tools and sterilized instruments.
- Educated patients on proper oral hygiene techniques, promoting long-term dental health.
- Increased patient retention by building rapport through excellent communication skills and a friendly demeanor.
- Contributed to office organization by maintaining accurate patient records and updating files regularly.
- Reduced appointment cancellations by implementing reminder calls and text messaging services, resulting in improved scheduling efficiency.
- Handled administrative tasks such as billing, insurance claims processing, and appointment confirmation calls to support office operations efficiently.
- Collaborated with the dental team to develop customized treatment plans for individual patients.
- Conducted preliminary assessments of new patients, gathering crucial information for accurate diagnoses.
- Streamlined appointment scheduling, reducing wait times and enhancing patient satisfaction.
- Improved patient care with meticulous attention to instrument sterilization and preparation.
- Increased office efficiency by maintaining patient records with up-to-date information.
- Facilitated patient education on oral hygiene practices, contributing to improved dental health.
- Maintained cleanliness and organization of dental office, creating welcoming atmosphere for patients.
- Streamlined digital x-ray processing, reducing wait time for diagnosis and treatment planning.
- Enhanced patient rapport by consistently delivering compassionate and professional care.
- Enhanced patient comfort by carefully explaining procedures and addressing concerns prior to treatments.
- Prepared treatment areas for patient care, ensuring sterile and organized environment.
- Improved dental procedure outcomes with accurate preparation of filling and crown materials.
- Conducted inventory management to maintain essential supplies, avoiding procedural delays.
- Supported dental procedures, ensuring efficient operation and patient satisfaction.
- Assisted in emergency dental procedures, providing critical support in high-pressure situations.
- Contributed to clinic's reputation for excellence by consistently receiving positive patient feedback.
- Implemented waste reduction initiatives in clinic, promoting environmental sustainability.
- Collaborated with dental team to develop treatment plans, ensuring patient needs were met comprehensively.
- Participated in community outreach programs, educating public on importance of dental health.
- Prepared and sterilized instruments and materials for use by dentists.
- Monitored patient comfort and safety during dental procedures.
Education
Medical Coding
Jackson State Community College
Jackson, TN05.2024
High School Diploma -
Clarksburg High School
Clarksburg, TN05.2013
Skills
- Complaint handling
- De-escalation techniques
- Assertiveness
- Goal setting and achievement
- Client retention strategies
- Spreadsheet tracking
- Collections management
- Complaint investigation
- Reporting and documentation
- Teamwork
- Customer service
- Problem-solving
- Multitasking Abilities
- Computer skills
- Team collaboration
- Verbal and written communication
- Decision-making
- Problem resolution
- Microsoft office
- Team building
- Data entry
- Self motivation
- Medical terminology
- Analytical thinking
- Work prioritization
- Professionalism
- Issue and complaint resolution
- Administrative and office support
- Resourcefulness
- MS office
- Record keeping
- Time management abilities
- Written communication
- Professional telephone demeanor
- Billing procedures
- Customer data confidentiality
- Policies and procedures adherence
- Document and records management
- Data management
- Process improvement
Certification
Nitrous Oxide Certification
CPR
Radiation
Coronal Polishing
CPC License
Accomplishments
CPC License
Medical Coding
Timeline
Claims Escalation Specialist/CPC-A
Fast Pace Urgent Care
09.2016 - Current
Dental Assistant
Webbs Dental Clinic
04.2015 - 08.2022
Medical Coding
Jackson State Community College
High School Diploma -
Clarksburg High School