Tomeka Sims
Nashville,TN
Summary
Compassionate Care Navigator recognized for delivering high productivity and ensuring efficient task completion. Expertise in patient advocacy and care coordination, coupled with strong resource management skills. Adept at communication and problem-solving to significantly enhance patient care experiences. Dedicated to optimizing healthcare processes for improved outcomes.
Overview
10
10
years of professional experience
Work History
Care Navigator
Carebridge Medical Group
05.2022 - Current
- Supports and collaborates with both patients and medical professionals to ensure organized and comprehensive care for patients with physical, developmental, and intellectual disabilities
- Conducts regular telephone and video visits with patients on a daily basis
- Assist patients in scheduling visits and facilitate care coordination with other medical providers
- Manage large amounts of inbound and outbound care inquiries and accurately document all correspondence within clinical systems targeting first call resolution
Medical Records Representative
Cigna
01.2022 - 04.2022
- Update Microsoft Excel spreadsheets with Personal Health Information (PHI)
- Hedis Project Audit team participant
- Initiate phone calls to customers around the country to update personal medical records
Medical Office Specialist
06.2016 - 06.2017
- Responsible for greeting patients as first point of contact
- Interaction with physicians daily regarding billing and referrals
- Managed patient scheduling
- Process insurance claims and collect payments
- Maintain patient records, including filing, updating and organizing
- Copy patient information and forward it to the requesting party
Patient Registrar
03.2015 - 06.2016
- Explain policies regarding services, charges, insurance billing with patient accounts
- Acknowledge file and send MOX messages via meditech
- Verify insurance benefits and determine precertification status
- Search MPI and assign correct medical codes to proper documentation
- Interview, calculate and collect patient liable amounts
- Link account numbers to patients medical records
- Answer phones, emails, and chats
Education
Online Studies
Grand Canyon University
01.2016
Nursing, Medical Informatics, Psychology, Anatomy/Physiology
Nashville State Community College
01.2015
Skills
- Administrative Skills
- Effective Communication
- Team Leadership
- Critical Thinking
- Problem-Solving
- Process Improvement
- Healthcare Software
- Documentation Accuracy
- Time Management
- Decision making
- Provider Relations
- Patient Care Coordination
- Active Listening
- Empathy and Compassion
- Patient Advocacy
- Quality Standards
- Performance Management
- Training and Coaching
- Counseling
References
Available upon request.
Timeline
Care Navigator
Carebridge Medical Group
05.2022 - Current
Medical Records Representative
Cigna
01.2022 - 04.2022
Medical Office Specialist
06.2016 - 06.2017
Patient Registrar
03.2015 - 06.2016
Online Studies
Grand Canyon University
Nursing, Medical Informatics, Psychology, Anatomy/Physiology
Nashville State Community College
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