Winifred Oliver
San Antonio,TX
Summary
Meticulous Medical Records Clerk with history processing medical records requests while delivering highest quality customer service. Builds rapport with staff and patients to foster smooth and effective department operations. Strong knowledge of Release of Information policies and procedures and HIPAA regulations.
Overview
14
14
years of professional experience
Work History
Medical Claims Processor
BC Forward LLC
07.2022 - 09.2023
- Pay, deny, and adjudicated medical/dental, paper and electric claims in accordance with state and federal claim processing guidelines reaching 95% client goals
- Deciphered UB-04/CMS-1500 claims needing rejections and escalated to higher authority for review or returned to provider for required details to resubmit if applicable
- Multi tasked EHR, Microsoft Office, and Microsoft Excel. Accessed policyholder’s profiles to coordinate/verify benefits for Medicare/Medicaid and other third party insurance coverage
- Analyzed physician's reports, hospital records, laboratory results, operative reports, diagnostic tests to assess medical necessity of services rendered.
- Maintained HIPPA and privacy data laws to protect confidentiality of customer information
- Prepped for provider coding, reviewed information to report services and verify correctness.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures. Integrated training and researched coding/procedures for processing accuracy
- Processed insurance payments and maintained accurate documentation of payments.
Records Management Specialist II
EmployBridge
04.2021 - 04.2022
- Analyzed order requests using data entry technique and workflow queues in Electronic Health Records (EHR), serviced 100K veteran medical and/or dental records
- Abstracted and reviewed 50-65 medical disability claims daily for missing or incomplete documentation required from physicians
- Relayed and identified discrepancies in processing claims to close gap on time sensitive orders; detail oriented, transmitted documents, organized revisions and tracked changes
- Utilized phone queue, Microsoft Outlook, and teleconference communications to send out reminders/notice letters for claim suspense
- Managed migration and abstraction of paper documents into digital databases; communicate status of account
- Collaborated with stakeholders from multiple departments in order to improve overall efficiency in managing organizational records.
- Upheld HIPAA regulations and standards for protecting patient information.
- Knowledge of computer equipment; strengthened system efficiency by identifying lagging operational processes and implementing optimal solutions
- Engaged in daily communications with internal partners and identified document-related issues that required interdepartmental cooperation.
- Logged Freedom of Information Act (FOIA) requests and verified eligibility of documents for release to requestors.
Administrative Assistant
U.S. Air Force Active Duty
07.2018 - 12.2020
- Multi-tasked; utilized Microsoft Office, transcribed vital material into multiple data sheets across dual screens for Department of Defense services
- Sorted documents from DoD headquarters to appropriate channels, performed quality checks on automated reports 2 days before suspense dates
- Answered incoming telephone calls from internal and external customers promptly and professionally; transferred calls appropriately; responded to inquiries in timely manner
- Prepared agendas for meetings; took minutes during meetings; channeled info to 285 personnel for follow-up
- Developed filing systems to maintain confidential records of personnel information and business activities in accordance with company policies.
- Produced accurate office files, updated spreadsheets, and crafted presentations to support executives and boost team productivity by 15%
- Coordinated complex annual meeting involving multiple presenters, high number of global attendees and robust budget encompassing livestream production, remote location arrangements and senior executive accommodations
- Handled confidential and sensitive information with discretion and tact
Clinical Supervisor
U.S. Air Force Active Duty
07.2009 - 07.2018
- Led and directed Physical and Occupational Therapy departments servicing 240K patients annually
- Triaged, reviewed 60 medical referrals daily
- Provided consultation services to other departments or organizations regarding clinical matters
- Coordinated with patient's case managers for patient transfers and future scheduling. Delivered patient-centered customer service; earned 92% performance rating
- Created and modified 12 provider templates weekly meeting 6-week access to care standards
- Provided direct supervision of clinical staff, including orientation, training and development of employees.
- Maintained accurate documentation of client progress within Electronic Health Record system; updated enrollee data using EMR.
- Assessed patients, determined needs and managed care.
- Trained all staff, providing direct supervision, ongoing staff development and continuing education to employees
- Developed and updated policies and procedures, maintaining compliance with guidelines relating to HIPAA, benefits administration and general liability
Education
Certificate - Medical Billing And Coding
The University of Texas At San Antonio
San Antonio, TX05.2025
Bachelor of Arts - Health Care Administration
University of Arizona Global Campus
Alameda, CA01.2012
Associate of Applied Science - Physical Therapy Assistant
Community College of The Air Force
Montgomery, AL02.2006
Skills
- Claims Adjudicator/Processor
- Teamwork and Collaboration
- Medical Terminology
- Customer service skills
- Data Entry skills
- Front/Back Office Admin
- Electronic Medical Records
- Medical transcription
- Communication skills
- Problem Resolution
- Prepping/Scanning Documents
Additional Information
- WEBSITES https://linkedin.com/in/winifred-oliver-, 24572b44
- ACCOMPLISHMENTS 2017 Noncommissioned Officer in Charge for career field’s area region.
Timeline
Medical Claims Processor
BC Forward LLC
07.2022 - 09.2023
Records Management Specialist II
EmployBridge
04.2021 - 04.2022
Administrative Assistant
U.S. Air Force Active Duty
07.2018 - 12.2020
Clinical Supervisor
U.S. Air Force Active Duty
07.2009 - 07.2018
Certificate - Medical Billing And Coding
The University of Texas At San Antonio
Bachelor of Arts - Health Care Administration
University of Arizona Global Campus
Associate of Applied Science - Physical Therapy Assistant
Community College of The Air Force
Similar Profiles
LaKeisha BrownLaKeisha Brown
Utilization Review Nurse at BC Forward StaffingUtilization Review Nurse at BC Forward Staffing
Manuel BenjaminManuel Benjamin
Customer Service Representative at BC FORWARD For ACCENTURECustomer Service Representative at BC FORWARD For ACCENTURE
Theresa WerkingTheresa Werking
Healthy Purpose Administrator for Elanco at BC ForwardHealthy Purpose Administrator for Elanco at BC Forward
Collin DoanCollin Doan
Sales Associate at Sams Club DistributionSales Associate at Sams Club Distribution
Karen VasquezKaren Vasquez
Registrar at Urban Champions AcademyRegistrar at Urban Champions Academy