Sherika Jones
Sandys,MA
Summary
Highly-motivated employee with desire to take on new challenges. Strong work ethic, adaptability, and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.
Overview
27
27
years of professional experience
Work History
Admitting Registration Specialist
Bermuda Hospitals Board
Paget, Bermuda
09.2018 - Current
- Verified insurance coverage for incoming patients and ensured that all documents were accurate and up-to-date.
- Followed established procedures while registering new patients into the system.
- Maintained confidentiality of all protected health information as required by HIPAA regulations.
- Resolved any discrepancies between insurance companies, physicians, hospitals, and and or other healthcare providers regarding payments or services rendered.
- Utilized multiple computer systems to access patient information, update records, verify insurance eligibility.
- Responded promptly to inquiries from staff members concerning patient accounts or payment issues.
- Provided excellent customer service to patients and their families regarding registration process.
- Communicated with various departments to ensure timely processing of patient registrations.
- Assisted in the management of patient information, including data entry and maintenance of medical records.
- Processed payments from patients or third party payers accurately and in a timely manner.
- Cross-trained other staff members on registration processes when needed.
- Registered patients for outpatient procedures and emergency services.
- Processed cash, debit and credit card payments for services rendered and printed receipts detailing services.
- Asked various questions from clients to obtain the information necessary for paperwork.
- Responded to incoming department phone calls and directed callers to appropriate team members based on need.
- Worked with nurses and other clinic staff to process patients and direct to appropriate departments.
Local Claims Coordinator
Bermuda HealthCare Services
01.2012 - 01.2013
- Manage day to day inventory of respective claims queues to ensure stated turnaround times of claims reimbursement are consistently met
- Weekly EOB Posting
- Discuss outstanding balances with insurance companies and patients
- Preparation and mailing of patient statements
- Cross training of staff in administrative areas
- Process all route slips so that clean claims can be electronically and manually generated as required
- Monthly generation of AR reports to ascertain outstanding balances and potential write-offs or adjustments
- Respond to insurance company and patient queries
- Scheduling patient appointments
- Establishing patient payment plans for those patients who cannot pay.
Local Claims Analyst
The Argus Group
01.2007 - 01.2012
- Analyze routine and complex local medical claims based on thorough knowledge of the Bermuda Hospital's Act
- Provide claim support to Local Claims Examiners, assist management in training and development Claims adjustments
- Assist Customer Service with all queries relating to the Local Health Claims Dept
- Cosmetic Claims Examiner - identify and assess each individual case
- Follow up on suspended/pending KEMH claims; respond to customers and providers within established customer service guidelines
- Prepare complex medical claims for submission to Manager/Special Investigation Unit
- Investigate each query on the daily query spreadsheet
- Schedule patient appointments
- Home healthcare - Assess each case for pending approval/declination.
Local Claims Examiner
The Argus Group
01.2000 - 01.2007
- Review all medical/surgical billings for reasonable and necessary charges
- Examine coding of operative reports, procedures, and multiple and complicated surgeries
- Examine, control and process all claims, assist with client queries, investigate claims queries from Customer Service, process suspended/pending hospital claims; provides second review of bills on which providers question the appropriateness of payments authorized
- Evaluate claims referred for medical management and makes recommendations for follow-up, further investigation or documentation as necessary
- Assist and advises claims examiners concerning the monitoring of claimants' medical treatments.
Office Junior
The Argus Group
01.1997 - 01.2000
- File all Hospital, Group, outpatient and inpatient claims
- Mail drafts and checks, insurance I.D
- Cards
- Sort and file incoming claims
- Verify microfilm tapes reporting problems to supervisor when identified
- Keep enrollment cards current and file new insurance cards
- Pull terminated insurance cards
- Pull and copy for third party claims
- Mail monthly group and individual policies.
Education
Skills
- Patient Registration
- Confidentiality
- Patient Scheduling
- Medical Terminology
- Client Rapport
- Patient Discharging
- Payment Processing
- Office Organization
- Patient Transfer Coordination
- Problem-Solving
- Insurance Verification
- Accuracy and Precision
Certification
- Bermuda Employers Council 2006 Quality Customer Service
- Bermuda Employers Council 2004 Conflict Resolution - Handling Difficult People
- Bermuda Employers Council 2000 Assertiveness - The Key to Effectiveness
References
References available upon request.
Timeline
Admitting Registration Specialist
Bermuda Hospitals Board
09.2018 - Current
Local Claims Coordinator
Bermuda HealthCare Services
01.2012 - 01.2013
Local Claims Analyst
The Argus Group
01.2007 - 01.2012
Local Claims Examiner
The Argus Group
01.2000 - 01.2007
Office Junior
The Argus Group
01.1997 - 01.2000
Similar Profiles
Trichelle BollersTrichelle Bollers
Medical laboratory technologist at Bermuda Hospitals BoardMedical laboratory technologist at Bermuda Hospitals Board
Lashuna Smith BSc RNLashuna Smith BSc RN
Registered Nurse, Medical-Surgical Unit at Bermuda Hospitals BoardRegistered Nurse, Medical-Surgical Unit at Bermuda Hospitals Board
Denelle SaundersDenelle Saunders
Supply Chain Systems Analyst at Bermuda Hospitals BoardSupply Chain Systems Analyst at Bermuda Hospitals Board
EUTHALYN MCFARLANEEUTHALYN MCFARLANE
Certified in IV Insertion and Phlebotomy at Bermuda Hospitals BoardCertified in IV Insertion and Phlebotomy at Bermuda Hospitals Board
Madinath AssaniMadinath Assani
E-Business Managing Director at FasdinaE-Business Managing Director at Fasdina