VERONICA TURNER
McKinney,TX
Summary
Diligent Claims Processor versed in insurance processes and claims procedures. Offers great attention to detail and time management abilities to successfully handle large volume of claims. Highly accurate and thorough with focus on completing error-free work in line with processing guidelines.
Overview
1
1
Certification
2027
2027
years of professional experience
Work History
Onsite Medical Records Processor
HealthMark Group - Baylor
Frisco, TX
04.2025 - Current
- Processed and fulfilled 40+ Release of Information (ROI) requests daily in a high-volume hospital environment while maintaining strict accuracy and turnaround standards.
- Reviewed medical record requests to verify authorization validity, patient identity, and compliance with HIPAA and privacy regulations.
- Retrieved, compiled, and prepared electronic and paper medical records for release to patients, providers, attorneys, and third-party requestors.
- Entered, verified, and updated request information within electronic health record (EHR) systems and HealthMark software to ensure accurate documentation and tracking.
- Conducted quality assurance reviews to confirm record completeness, accuracy, and compliance before release.
- Maintained 99% accuracy while processing complex medical documentation and adhering to productivity expectations.
- Ensured all records were released in accordance with HIPAA guidelines, state regulations, and organizational policies governing protected health information (PHI).
- Prioritized urgent requests and managed multiple deadlines while maintaining efficiency in a fast-paced healthcare setting.
- Collaborated with hospital staff, providers, and internal departments to resolve discrepancies and obtain missing documentation.
- Protected patient confidentiality by handling sensitive health information with professionalism and strict adherence to privacy standards.
- Utilized multiple EHR/EMR systems, document imaging platforms, and Microsoft Office applications to process and track requests efficiently.
- Identified incomplete or invalid authorizations and worked with requestors to obtain the necessary documentation to prevent processing delays.
- Performed detailed data entry and verification tasks requiring a high level of accuracy, confidentiality, and adherence to established quality standards.
- Reviewed medical documentation for completeness, accuracy, and regulatory compliance, strengthening expertise in healthcare records management and documentation review.
Specialty Pharmacy Care Representative
CVS Health
Remote
2024 - 2024
- Managed 50+ inbound and outbound patient calls daily, providing support for specialty medication access, refills, benefits verification, and prescription coordination.
- Supported specialty pharmacy operations by assisting members with medication access, insurance coverage questions, and claim-related concerns.
- Reviewed member benefit information, eligibility details, and insurance requirements to assist with accurate coverage determination and issue resolution.
- Coordinated with members, healthcare providers, pharmacies, and insurance partners to obtain and communicate information needed for accurate processing.
- Researched account and coverage issues, documented interactions, and provided accurate updates while maintaining HIPAA compliance.
- Managed high-volume healthcare interactions requiring attention to detail, problem-solving skills, and knowledge of healthcare insurance processes.
Licensed Benefits Advisor
Willis Towers Watson (WTW)
Remote
06.2023 - 11.2023
- Handled 45+ inbound calls daily, assisting employees with health, dental, vision, life, and retirement benefit inquiries.
- Assisted Medicare-eligible retirees and individuals with evaluating and enrolling in health insurance and prescription drug plans through a healthcare benefits marketplace platform.
- Reviewed member profiles, eligibility information, employer-sponsored funding details, and plan options to provide accurate benefit guidance.
- Utilized proprietary enrollment and plan comparison tools to research coverage options, provider networks, prescription needs, and Medicare plan selections.
- Navigated multiple healthcare systems, insurance carrier portals, and CRM platforms to document member interactions and support accurate enrollment processing.
- Applied CMS guidelines, privacy requirements, and regulated healthcare communication standards when assisting members.
- Explained complex Medicare and insurance benefit information while resolving member questions and concerns.
- Maintained detailed documentation and accurate records to support compliance, quality review, and member service standards.
Care Team Representative - FMLA and STD
Sedgwick
Remote
11.2023 - 09.2024
- Managed a high volume of inbound calls from employees regarding Family and Medical Leave Act (FMLA), Short-Term Disability (STD), and other leave of absence programs.
- Guide callers on required documentation, expected time frames, claim status, and benefit plan provisions.
- Initiated and processed new FMLA and disability claims while ensuring accuracy and completeness of claim information.
- Reviewed claim documentation for completeness and escalated complex cases to claims examiners when appropriate.
- Educated employees on their rights, responsibilities, and available benefits under employer leave policies and federal regulations.
- Documented customer interactions and claim updates accurately in claims management systems while maintaining HIPAA and confidentiality standards.
- Collaborated with internal claims examiners, nurse case managers, and benefits teams to facilitate timely claim resolution.
- Resolved customer inquiries by researching claim status, benefit information, and required documentation.
- Maintained productivity, quality, and service level goals in a fast-paced remote call center environment.
- Demonstrated empathy and professionalism while assisting employees during medical and personal leave situations.
- Ensured compliance with company policies, HIPAA guidelines, FMLA regulations, and applicable disability program requirements.
- Managed 40+ inbound calls daily while maintaining a 97% customer satisfaction rating.
- Processed high volumes of leave and disability claim intakes with a strong focus on accuracy and timely completion.
Administrative Assistant
Turner3 LLC
Phoenix, AZ
11.2015 - 07.2021
- Coordinated document preparation and filing, promoting efficient workflow.
- Managed correspondence and communications, maintaining professionalism and clarity.
- Coordinated scheduling for meetings and appointments, ensuring efficient use of time.
- Coordinated office supply management for consistent access to necessary materials.
- Maintained confidentiality of sensitive information by adhering to strict privacy policies and implementing secure filing systems.
- Delivered excellent customer service through prompt responses to client inquiries, addressing concerns effectively, and building strong relationships.
- Improved document organization with thorough file maintenance, archiving outdated records as necessary for efficient retrieval when needed.
- Optimized calendar management for executives by scheduling appointments strategically while considering priorities and minimizing conflicts.
- Managed phone communications and addressed emails from clients and team members.
- Greeting clients and visitors while fostering a welcoming environment.
Education
GED -
International Institutes of The Americas
Mesa, AZ10.2004
Skills
- Healthcare Claims Documentation Review
- Claims Intake & Resolution Support
- Claims Research & Investigation
- Coordination of Benefits (COB) Concepts
- Insurance Eligibility & Coverage Verification
- Healthcare Documentation Processing
- Medical Records Review & Audit Requests
- Data Validation & Discrepancy Identification
- Quality Assurance & Accuracy Review
- Medicare & CMS Compliance Support
- HIPAA Compliance & PHI Protection
- Electronic Health Records (EHR/EMR) Systems
- Multiple Healthcare Systems & Databases
- Member & Client Issue Resolution
- Audit Documentation & Case Notes
- Prescription Verification & Pharmacy Support
- Data Entry & Record Maintenance
- Microsoft Office Suite (Word, Excel, Outlook)
- Customer Service
- Active Listening
- Critical Thinking
- Confidential Information Handling
- Attention to Detail
Accomplishments
Reduced processing delays by proactively identifying incomplete authorizations before release.
Certification
- Certified Electronic Health Record Specialist (CEHRS)
Timeline
Onsite Medical Records Processor
HealthMark Group - Baylor
04.2025 - Current
Care Team Representative - FMLA and STD
Sedgwick
11.2023 - 09.2024
Licensed Benefits Advisor
Willis Towers Watson (WTW)
06.2023 - 11.2023
Administrative Assistant
Turner3 LLC
11.2015 - 07.2021
Specialty Pharmacy Care Representative
CVS Health
2024 - 2024
GED -
International Institutes of The Americas
TECHNOLOGY
Epic | MedRelease | OnBase | EMR/EHR Systems | Healthcare Information Systems | Microsoft Office
ADDITIONAL QUALIFICATIONS
- Healthcare professional with experience across insurance, Medicare benefits, specialty pharmacy, claims support, medical records operations, and healthcare documentation review.
- Experienced analyzing healthcare information to identify missing documentation, inconsistencies, and processing issues.
- Strong understanding of HIPAA requirements, CMS-regulated healthcare environments, and compliance standards.
- Ability to learn proprietary audit platforms, databases, and healthcare systems quickly.