RODERICA JAMERSON
Memphis,TN
Summary
Customer service oriented professional with healthcare industry and data entry experience, capable of providing timely and accurate data to ensure reimbursement for patient services. Follows policies, procedures, and guidelines to ensure consistent quality. Maintains and safeguards patient privacy and confidentiality.
Overview
5
5
years of professional experience
Work History
Customer Service Agent
iQor
08.2024 - Current
- Enroll/Assist members into insurance plan for open enrollment
- Answer inbound calls
- Enter Data in the system using sales force
- High call volume
- Transfer members to correct department
- Collect personal information using HIPPA guidelines
Prior Authorization Specialist
Amerisource Bergen
10.2023 - 03.2024
- Complete data entry from the enrollment form into the CRM
- Complete electronic eligibility checks for payer and coverage details
- Conduct a benefit investigation to determine plan coverage, payer restrictions, and cost share information from insurance plans
- Identify if coverage restrictions exist, the process in which they are handled
- Collect PA requirements, follow up with the insurance for prior authorization status, and communicate the results to the healthcare provider
- Conduct follow up outreach to healthcare providers to collect information needed to evaluate for services
- Evaluate patient records against eligibility criteria to determine if they can continue free drug assistance
- Talking to patients doctors office to verify patient records and eligibility
- Contact patient health care provider to check for insurance coverage and updates
- Answer high call volume calls and outbound calls
Data Entry Clerk
Cencora
02.2023 - 04.2023
- Link charts for patients into labeled folders
- Work from home
- File charts into the correct folder using centauri data base
- Check for accuracy from patient records sent over by the doctor office
- Informed doctor office of any missing information needed to provide services for the patient
- Temporary position
Customer Service Rep.
Sykes
09.2021 - 02.2023
- Answer inbound calls
- Assist customers with refilling and check status of medications
- Assist doctors, pharmacies, insurance providers, etc
- With patient medication issues
- Help customers make billing payments on their accounts and check balances
- Transfer calls to the correct department
- Billing issues with account
- Answer high call volume calls
- Transfer for prior authorization
Home Health Aide
Senior Care Management Solution
11.2019 - 08.2022
- Provide in-home personal care services to elderly and disabled residents based on established care plans
- Assist with activities of daily living – mobility, personal hygiene, and feeding
- Take vital signs, monitor intake and output, run errands, and prepare/serve meals
- Document services provided for insurance purposes, respect patient’s privacy, and maintain confidentiality
Home Health Aide
Angels at My Door
08.2019 - 11.2019
- Provide in-home personal care services to elderly and disabled residents based on established care plans
- Assist with activities of daily living – mobility, personal hygiene, and feeding
- Take vital signs, monitor intake and output, run errands, and prepare/serve meals
- Document services provided for insurance purposes, respect patient’s privacy, and maintain confidentiality
Education
ASSOCIATES DEGREE - Medical Billing and Coding
ULTIMATE MEDICAL ACADEMY
08.2021
ASSOCIATE OF APPLIED SCIENCE - Pharmacy Technician
CONCORDE CAREER COLLEGE
05.2011
Skills
- Medical Billing
- Accounts Receivable
- Collections
- Co-Pay
- Co-Insurance
- Deductibles
- Managed Care (HMO, PPO, and POS)
- EOBs
- Revenue Cycle Management
- Posting Payments
- Government (Medicare & Medicaid)
- Third Party Payers
- Electronic Health Records (EHR)
- Electronic Medical Records (EMR)
- Workers Compensation
- Medical Office Procedures
- Scheduling
- Insurance Verification
- Insurance Claim Processing
- CMS 1500
- CMS 1450 (UB-04)
- Front Office Operations
- Medical Terminology
- Anatomy & Physiology
- HIPAA Compliance
- Medical Coding (ICD-10-CM, HCPCS, CPT)
Key Qualifications
- Medical Billing
- Accounts Receivable
- Collections
- Co-Pay
- Co-Insurance
- Deductibles
- Managed Care (HMO, PPO, and POS)
- EOBs
- Revenue Cycle Management
- Posting Payments
- Government (Medicare & Medicaid)
- Third Party Payers
- Electronic Health Records (EHR)
- Electronic Medical Records (EMR)
- Workers Compensation
- Medical Office Procedures
- Scheduling
- Insurance Verification
- Insurance Claim Processing
- CMS 1500
- CMS 1450 (UB-04)
- Front Office Operations
- Medical Terminology
- Anatomy & Physiology
- HIPAA Compliance
- Medical Coding (ICD-10-CM, HCPCS, CPT)
Activities
- Heartsavers CTC | CPR Certification – Basic Life Support Provider
- Flexible: Adapts to new challenges and ideas and able to develop rapport with diverse populations.
- Team-Oriented: Motivates to create a collaborative and respectful environment.
- Customer Service: Regarded as a natural people person with strong interpersonal communication skills.
- Microsoft Office Applications / MS Excel | MS Word | MS PowerPoint
Timeline
Customer Service Agent
iQor
08.2024 - Current
Prior Authorization Specialist
Amerisource Bergen
10.2023 - 03.2024
Data Entry Clerk
Cencora
02.2023 - 04.2023
Customer Service Rep.
Sykes
09.2021 - 02.2023
Home Health Aide
Senior Care Management Solution
11.2019 - 08.2022
Home Health Aide
Angels at My Door
08.2019 - 11.2019
ASSOCIATES DEGREE - Medical Billing and Coding
ULTIMATE MEDICAL ACADEMY
ASSOCIATE OF APPLIED SCIENCE - Pharmacy Technician
CONCORDE CAREER COLLEGE