SYMANTHIA L ACY
Mansfield,TX
Summary
Professional in claims processing and management and evaluation , equipped to drive accurate and efficient claim resolutions. Proven track record in handling diverse cases and ensuring compliance with regulatory standards. Known for strong team collaboration and adaptability, bringing valuable problem-solving skills and reliability to every project. Detail oriented and strong Veteran advocacy skills.
Overview
17
17
years of professional experience
1
1
Certification
Work History
Claims Examiner
Department of Labor Office of Workers Compensation
Dallas, TX
08.2021 - Current
- Evaluated claims for accuracy and compliance with federal regulations.
- Processed benefit payments, ensuring timely resolution of claims disputes.
- Collaborated with medical professionals to clarify treatment-related inquiries.
- Analyzed claim documentation to identify discrepancies and potential fraud.
- Provide case management services including coordination of all rehabilitation services, employment services, documentation of progress and adjustment, and maintenance of case records
- Provide coordination of all rehabilitation services such as financial decisions, adjust rehabilitation plans, and coordinate employment services.
- Approve any adjustments to rehabilitation plans, if necessary, for the claimant to meet the goals of the original plan.
Contact Representative Enrollment and Case Mangmt
Doris Miller VA Medical Center
Waco, TX
02.2021 - 08.2021
- Managed patient inquiries and provided information on services and benefits.
- Assisted veterans with appointment scheduling and navigation of healthcare systems.
- Processing requests to update veterans personal, eligibility and enrollment information, entering demographic, insurance, and income information, into the Vista and Veteran Enrollment System (VES).
- Adjudicating and authorizing Veteran's eligibility applications for programs such as, but not limited to, enrollment, eligibility for Veterans Affairs (VA) healthcare benefits, and financial assessment.
Lead Medical Support Assistant
Fort Worth VA Medical Center
Fort Worth, TX
04.2015 - 10.2019
- Managed patient scheduling and appointment coordination, ensuring timely access to healthcare services.
- Trained and mentored junior staff in administrative procedures and patient interaction protocols.
- Oversaw records management, maintaining accuracy and confidentiality of sensitive patient information.
- Process claims for compensation and pension
Lead Medical Support Assistant
Michael E DeBakey Veteran's Affairs Medical Center
Houston, TX
04.2013 - 04.2015
- Support all administrative and clinical staff with matters relating to entitlement for care and act as an advocate for veterans and beneficiaries.
- Interview and enroll patients applying for medical benefits; including, and not limited to, enrollment, registration, eligibility, collection of insurance, means testing, income verification, patient file data management, and admissions.
- Entered demographics, insurance, and income information into VISTA; independently handles a wide range of difficult contacts and complex situations, including eligibility determination for all categories of patients.
- Communicates directly with senior management regarding admissions for the facility through daily reports; prepares detailed correspondence detailing veterans’ ineligibility for health care services; collaborates with the VA Police Service in the Fugitive Felon Program for ensuring veterans are properly coded within the database; supports all administrative and clinical staff with matters relating to entitlement for care, including Medical Support Assistants located in community-based outpatient clinics; receives and responds to a wide variety of correspondence relating to enrollment and eligibility;
- Advocating for veterans, conduct training class for new veterans to educate and provide resources for healthcare and explain health benefits.
Medical Support Assistant
Fort Lee Army Medical Treatment Facility
09.2009 - 11.2012
- Coordinated patient scheduling and managed appointment reminders to enhance clinic efficiency.
- Assisted in the preparation of medical records for accurate patient information retrieval.
- Supported healthcare providers by ensuring timely availability of essential medical supplies and equipment.
- Worked troop medical clinic sick call and updated soldier physical readiness ie; immunizations, physicals in MEDPROS system for all soldiers on Fort Lee base.
Education
Master of Science - Health Administration
Trident University
Cypress, CA07-2020
Bachelor of Science - Health Education
Trident University International
Cypress, CA07-2011
Skills
- Claims processing
- Verbal communication
- Data verification
- Disability claims process
- Client advocacy
- Job placement Assistant
- Progress monitoring
Certification
Family Health Certificate
Timeline
Claims Examiner
Department of Labor Office of Workers Compensation
08.2021 - Current
Contact Representative Enrollment and Case Mangmt
Doris Miller VA Medical Center
02.2021 - 08.2021
Lead Medical Support Assistant
Fort Worth VA Medical Center
04.2015 - 10.2019
Lead Medical Support Assistant
Michael E DeBakey Veteran's Affairs Medical Center
04.2013 - 04.2015
Medical Support Assistant
Fort Lee Army Medical Treatment Facility
09.2009 - 11.2012
Master of Science - Health Administration
Trident University
Bachelor of Science - Health Education
Trident University International