Zalinka Peoples
Jacksonville,Florida
Summary
Dedicated and experienced Healthcare Insurance professional with a proven track record of effectively managing policies, claims, and client relationships. Skilled in analyzing healthcare data, assessing risks, and developing innovative solutions to optimize coverage and reduce costs. Adept at navigating complex regulations and compliance requirements to ensure coverage aligns with industry standards and best practices. Strong communication and interpersonal skills, with a commitment to providing exceptional customer service and building long-lasting partnerships.
Overview
18
18
years of professional experience
Work History
Provider Care Representative
United Healthcare
Remote
05.2024 - Current
- Answer incoming phone calls from health care providers (i.e. physician offices, clinics) and identify the type of assistance the provider needs
- Focus on resolving issues on the first call, navigating through complex computer systems to identify the status of the issue and provide appropriate response to caller
- Deliver information and answer questions in a positive manner to facilitate strong relationships with providers and their staff
- Complete the documentation necessary to track provider issues and facilitate the reporting of overall trends
Customer Service Representative
United Healthcare
Jacksonville, FL
07.2023 - 05.2024
- Answer incoming phone calls from customers and identify the type of assistance the customer needs (i.e., benefit and eligibility, billing and payments, authorizations for treatment and explanation of benefits / EOBs)
- Ask appropriate questions and listen actively to identify specific questions or issues while documenting required information in computer systems
- Review and research incoming healthcare claims from members and providers (doctors, clinics, etc.) by navigating multiple computer systems and platforms and verifies the data / information necessary for processing (e.g., pricing, prior authorizations, applicable benefits)
- Ensure that the proper benefits are applied to each claim by using the appropriate processes and procedures (e.g., claims processing policies and procedures, grievance procedures, state mandates, CMS / Medicare guidelines, benefit plan, documents / certificates)
- Meet the performance goals established for the position in the areas of: efficiency, accuracy, quality, member satisfaction, and attendance
Credit Adminstrator/Trainer
Baker Distributing(Insight Global Staffing)
Jacksonville, Florida
05.2021 - 07.2023
- Work with customers as necessary to collect accounts receivable and to confirm payment status to ensure their accounts are not outstanding but current
- Help set up and monitor payment schedules for seriously delinquent customers to get their account current
- Work to resolve customer deductions, including but not limited to short payments, tax issues, warranty disputes with zero negative infractions
- Identify and resolve payment discrepancies, referring problems to the appropriate service center
- Able to identify and process NSF checks upon receipt, sending demand letters and following up with the check writer and bank as necessary as per policy thus notifying the appropriate service center to facilitate collections
- Conducted training sessions for new credit administrators on company policies, procedures, and systems to ensure consistency and accuracy in credit processing
- Developed training materials, manuals, and job aids to support the learning and development of credit administrators, resulting in improved efficiency and reduced errors.
Claims Benefits Specialist
Aetna
Jacksonville, Florida
09.2017 - 04.2021
- Reviews and adjudicates Medicare medical claims in accordance with Centers for Medicare & Medicaid Services (CMS) claim processing guidelines
- Help determine and understand the coverage provided under a member's health plan so the member can better understand what he or she is signing
- Efficiently use multiple systems and duo screens to obtain and record claim information
- Make claim payment decisions and processed claims that meet production and quality standards
- Accurately reviewed and processed medical claims to determine benefits eligibility for policyholders.
Medicare Appeals Supervisor
C2C Innovative Solutions
Jacksonville, Florida
06.2014 - 08.2017
- Ensure and maintained compliance with all applicable federal state and/or county laws and regulations related to our documented guidelines and processes
- Identify and correct all duplicate or corrected claims received to ensure no audits are triggered
- Investigated, evaluated, interpreted and made the determination of Medicare claims with sound and impartial claim judgments
- Facilitates work process and staffing of everyday exercises as well as allots and screens work of staff to stick to efficiency and quality principles.
Registration Associate
St. Vincent's Medical Center
Jacksonville, Florida
06.2006 - 12.2011
- Providing excellent customer service to patients during pre-registration appointments
- Trained in the medical billing and insurance coverage verification process
- Cross trained in multiple departments, such as, labor & delivery, heart & vascular, imaging center, and admittance, and emergency room
- Provide exceptional customer service by greeting patients, answering inquiries, and directing them to the appropriate departments or medical staff
- Verify insurance coverage and obtain necessary authorizations prior to scheduled services to ensure timely and accurate billing
- Maintain confidentiality of patient information in compliance with HIPAA regulations and adhere to industry best practices for data security
- Collaborate with healthcare providers, nurses, and other staff members to coordinate patient schedules and appointments for optimal patient flow.
Education
Bachelors in Science Management -
University of Phoenix
11.2024
High School Diploma -
William M. Raines High School
Jacksonville, FL05.2002
Skills
- Microsoft Outlook
- Microsoft Excel
- Microsoft Spreadsheet
- Microsoft Office 365
- OneNote
- IDX
- AthenaHealth
- Mincron
- EMR
- Jacada
- OnBase
Timeline
Provider Care Representative
United Healthcare
05.2024 - Current
Customer Service Representative
United Healthcare
07.2023 - 05.2024
Credit Adminstrator/Trainer
Baker Distributing(Insight Global Staffing)
05.2021 - 07.2023
Claims Benefits Specialist
Aetna
09.2017 - 04.2021
Medicare Appeals Supervisor
C2C Innovative Solutions
06.2014 - 08.2017
Registration Associate
St. Vincent's Medical Center
06.2006 - 12.2011
Bachelors in Science Management -
University of Phoenix
High School Diploma -
William M. Raines High School