SHARONDA FORD
Ocala
Summary
Customer-focused professional with extensive experience in customer service, healthcare, and administrative support. Proven ability to resolve issues efficiently and enhance patient and client experiences. Skilled in communication and problem-solving, with a strong track record of managing escalated support issues. Demonstrated success in prioritizing tasks and collaborating within teams to achieve organizational goals.
Overview
22
22
years of professional experience
Work History
FRONT OFFICE ASSISTANT
Village Dermatology
The Villages
08.2023 - Current
- Coordinate prior authorizations and referrals to streamline patient care
- Provide clear explanations of benefits, deductibles and out-of-pocket expenses
- Regularly use Microsoft Word and Excel for documentation and reporting.
- Verify insurance eligibility and patient financial responsibility
- Maintain accurate electronic records and uphold HIPAA standards
- Schedule appointments and surgeries across multiple calendars using MS Outlook
- Received and screened high volume of internal and external communications.
- Performed data entry of patient information into computer systems.
ELIGIBILITY SENIOR REPRESENTATIVE
Accredo Health Group Inc
Orlando
12.2018 - 04.2023
- Investigated claims by gathering supporting information from claimants, third parties, and internal systems.
- Utilized the Facets system for claim entry and processing, and maintained detailed records for audits.
- Documented claim actions, decisions, and communications in internal systems for audit and compliance.
- Communicated claim decisions clearly to policyholders, providers, or third-party representatives.
- Ensured claims processing complied with applicable laws, regulations (e.g., HIPAA, state insurance laws), and company guidelines.
- Met performance targets related to claim accuracy, timeliness, and customer satisfaction.
- Monitored and followed up on pending claims to support timely resolution and met performance targets.
- Verified accuracy of data entered into system, contacted applicants when necessary.
MEDICAL OFFICE SECRETARY
Jowairia Qadri, MD FACOG PA
Altamonte Springs
06.2003 - 12.2018
- Verified coverage details and assessed claim validity based on policy terms.
- Entered and validated new claim information, ensuring data accuracy and completeness.
- Maintained up-to-date knowledge of policy changes and industry updates impacting claims processes.
- Documented claim actions, decisions, and communications for audit and compliance purposes.
- Supported patients by explaining coverage and addressing billing or authorization issues.
- Approved or denied claims within authority limits; escalated complex cases to supervisors.
- Identified potential fraudulent claims, contributing to significant year-to-date savings.
- Reviewed patient bills for accuracy before submission for payment.
Education
Associate's Degree - Science
Florida Metropolitan University
Orlando, FL04.2023
Skills
- Verbal and written communication
- Medical billing
- Time management and prioritization
- Claims processing and review
- Multitasking in fast-paced environments
- HIPAA compliance and data confidentiality
- Problem-solving and conflict resolution
- Data entry and documentation
- Microsoft Office Suite
- Insurance verification
- Insurance claims processing
- Salesforce
- Facets
Timeline
FRONT OFFICE ASSISTANT
Village Dermatology
08.2023 - Current
ELIGIBILITY SENIOR REPRESENTATIVE
Accredo Health Group Inc
12.2018 - 04.2023
MEDICAL OFFICE SECRETARY
Jowairia Qadri, MD FACOG PA
06.2003 - 12.2018
Associate's Degree - Science
Florida Metropolitan University
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