Energetic customer service representative dedicated to efficient and effective collaboration between care teams, patients and families. Outgoing professional with collaborative and flexible approach to reaching mutually beneficial resolutions. Enthusiastic and motivated to work with patients, families and care teams efficiently. Friendly, adaptable and collaborative professional successful devising satisfying solutions to complex problems. Capable Patient Representative dedicated to providing superior support for patients in need of reliable information regarding insurance coverage, finance options and documentation requirements. Well-versed in scheduling and database management functions for streamlined communication and reduced correspondence backlogs. Excels at identifying client needs and concerns to improve engagement strategies and overall service.
Hi, I’m
Sheretta Winston
Bedford,Texas
Summary
Overview
11
years of professional experience
Work History
AmerisourceBergen
Patient Care Coordinator
12.2018 - 12.2022
Job overview
- Acted as main point of contact for patients, doctors and hospital staff by closely reviewing medical charts and maintaining high levels of communication.
- Worked closely with patients to deliver excellent and direct individualized patient care.
- Delivered excellent patient experiences and direct care.
- Maintained confidentiality of patient data and condition to safeguard health information.
Professional Medical Services
Claims Representative
09.2017 - 09.2018
Job overview
- Examined reports, accounts and evidence to determine integrity and accuracy of information.
- Worked productively in fast-moving work environment to process large volumes of claims.
- Proposed settlements for uncomplicated issues to resolve claims.
- Checked level and type of coverage and evaluated contracts.
- Processed and recorded new policies and claims.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology and procedures and HIPAA regulations.
- Managed large volume of medical claims on daily basis.
- Paid or denied medical claims based upon established claims processing criteria.
- Responded to correspondence from insurance companies.
- Used administrative guidelines as resource or to answer questions when processing medical claims.
- Reviewed provider coding information to report services and verify correctness.
- Checked documentation for accuracy and validity on updated systems.
- Generated, posted and attached information to claim files.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Modified, updated and processed existing policies.
- Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
- Prepared insurance claim forms or related documents and reviewed for completeness.
- Communicated effectively with staff members of operations, finance and clinical departments.
- Communicated verification and authorization status updates with claims department to facilitate decision-making for patient admissions and insurance coverage.
- Reviewed 84 patient cases per week and verified insurance coverage information.
National Patient Account Services
Insurance Follow-Up Specialist
11.2011 - 08.2017
Job overview
- Maintained accuracy, completeness and security for medical records and health information.
- Input data into computer programs and filing systems.
- Reviewed medical records for completeness and filed records in alphabetic and numeric order.
- Utilized scriptmed to manage and confirm patient data, such as insurance, demographic and medical history information.
- Displayed consistent, positive attitude towards customers, peers and other personnel, even during high-stress situations.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology and procedures and HIPAA regulations.
- Managed large volume of medical claims on daily basis.
- Responded to correspondence from insurance companies.
- Used administrative guidelines as resource or to answer questions when processing medical claims.
- Reviewed provider coding information to report services and verify correctness.
- Checked documentation for accuracy and validity on updated systems.
- Generated, posted and attached information to claim files.
- Assured timely verification of insurance benefits prior to patient procedures or appointments.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
Education
Trimble Technical High SchoolFort Worth, TX
GED
05.1995
University Overview
Skills
- Reliability and Dedication
- Multitasking Abilities
- Attention to Detail
- Health Information Access Management
- Patient Rapport
- Outbound Calling
- Multi-Line Telephone Systems
- Payment Arrangements and Negotiation
- Professional Relationships
- Organizational Skills
- 50 WPM Typing Speed
- Claim Processing
- Patient Care and Monitoring
- Appointment Confirmation
- Time Management
- Medical Histories and Vital Statistics
- Customer Service
- Medication Side Effect Knowledge
- Claims Handling and Coverage Verification
- Insurance Practices
Timeline
Patient Care Coordinator
AmerisourceBergen
12.2018 - 12.2022
Claims Representative
Professional Medical Services
09.2017 - 09.2018
Insurance Follow-Up Specialist
National Patient Account Services
11.2011 - 08.2017
Trimble Technical High School
GED
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