ALEXANDRA NICHOL EZENWEKWE
Cusseta,GA
Summary
Healthcare administrative and claims specialist with 10+ years of experience spanning claims auditing, front office leadership, behavioral health coordination, and clinical support. Skilled in high-volume patient flow management, revenue cycle operations, and policy compliance. Adept at analyzing complex medical claims, ensuring accurate eligibility/enrollment processing, and supporting both providers and patients. Certified in Basic Life Support (BLS) & AED with extensive experience in CareLogic and other EHR systems, HIPAA compliance, and process improvement.
Overview
11
11
years of professional experience
1
1
Certification
Work History
Senior Medical Claims & Credentialing Specialist
MedRenewal Credentialing & Claims Review Services
02.2021 - 09.2025
- Provided advanced auditing and credentialing support for stop-loss and commercial health plans. Independently analyzed high-dollar and complex medical claims for eligibility, pre-authorization, medical necessity, and coding accuracy to ensure correct payment. Documented audit methodology, identified system errors and monetary discrepancies, and collaborated with payers and providers to recover overpayments and prevent future losses. Reviewed and updated program policies and operational procedures tied to eligibility and enrollment. Analyzed customer and provider issues to uncover root causes, created process improvements, and documented new workflows. Processed and maintained provider credentialing applications in full compliance with payer and regulatory requirements.
Front Office Team Lead & Clinical Support
Hughston Clinic / Jack Hughston Memorial Hospital
01.2024 - 05.2025
- Managed and mentored a high-volume front office team in an orthopedic and rehabilitation setting serving 350+ patients daily. Oversaw all administrative and revenue cycle operations including insurance verification, patient intake, and scheduling to ensure efficient clinical flow. Collected and recorded vital signs, fingerstick blood sugars, and intake data, while supporting admissions, discharges, EKG placement, daily living assistance, and safe patient transport. Directed cash flow and financial front-end functions: reconciled daily patient payments, copays, and deductibles; prepared bank deposits; processed checks and handled secure cash drop-offs; and monitored daily batches to maintain accurate financial reporting. Managed provider claims and superbill accuracy, reviewed ICD-10/CPT coding for front-end claim readiness, and coordinated with billing to resolve discrepancies before submission. Analyzed monthly enrollment and insurance discrepancy reports and partnered with carriers to reconcile records and ensure accurate patient accounts. Resolved escalated eligibility and coverage questions from patients, agents, and providers, upheld HIPAA compliance, and implemented workflow improvements that boosted overall front office efficiency.
EEMR Assistant II (Medical Records)
Emory University Hospital
05.2021 - 04.2022
- Ensured accuracy and compliance in medical record management by processing requests, verifying patient data, and maintaining strict HIPAA standards. Collaborated with clinical and administrative staff to resolve documentation issues and improve record-keeping efficiency. Played a key role in ensuring timely access to accurate medical information to support patient care and regulatory audits.
Medical Claims Auditor & Eligibility Specialist
Premier Health Solutions
01.2018 - 01.2021
- Specialized in reviewing inpatient and outpatient claims to detect coding and coverage errors. Recommended recoveries and process enhancements that reduced overpayment trends and improved claim accuracy. Monitored ticketing trends for assigned health and dental carriers, worked closely with carriers to resolve escalated eligibility and enrollment issues, and updated consumer eligibility, verification, and appeals policies to stay compliant with program standards. Submitted system enhancement requests and provided feedback and training guidance to claims processing teams to strengthen accuracy and efficiency.
Clinical Care Coordinator & Patient Access Representative
Pathways Center
03.2019 - 01.2020
- Coordinated care and access to behavioral health services for individuals with complex psychiatric needs. Conducted comprehensive insurance verification, determined benefits eligibility, and managed referrals to appropriate services while maintaining confidentiality and HIPAA compliance. Engaged and supported families during the admission and orientation process, explaining care plans, available resources, and expectations to help them navigate behavioral health systems. Trained and mentored new staff on CareLogic EHR workflows, billing procedures, and patient intake best practices to improve departmental efficiency. Assisted with crisis intervention by supporting safe restraint techniques and de-escalation strategies during psychiatric emergencies. Collaborated with interdisciplinary treatment teams to develop care plans, monitor patient progress, and update records with accurate clinical documentation. Facilitated therapeutic and skills-based group sessions to encourage patient engagement, socialization, and emotional regulation. Provided one-on-one support to help patients and families connect with community resources and follow-up care. Participated in safety and quality improvement rounds to maintain a secure, therapeutic environment. Actively contributed to audit preparation and compliance tracking for behavioral health programs.
Forensic Service Technician
West Central Georgia Regional Hospital (DBHDD)
05.2017 - 01.2018
- Delivered direct care and behavioral health support to forensic patients in a secure hospital setting. Provided personalized training and daily living assistance, documented care plans and progress, and monitored patient safety and whereabouts. Transported and accompanied patients to on- and off-campus appointments and activities. Assisted with admissions and orientation, conducted recreational and socialization activities, and supported lab draws and specimen collection. Participated in interdisciplinary treatment planning, crisis de-escalation, and hospital committees. Helped maintain a clean, safe, and therapeutic environment and facilitated group sessions to promote skill-building and rehabilitation.
Customer Service & Claims Support Representative
Blue Cross Blue Shield
01.2015 - 04.2017
- Handled a high volume of 100–150 calls daily to assist members with claims, benefits, and eligibility issues. Worked directly with providers to ensure claims were accurate and processed promptly. Investigated complex claim disputes, explained coverage and policy details, and resolved escalated concerns to improve member satisfaction. Consistently exceeded quality and customer service performance goals while maintaining compliance with company and regulatory standards.
Education
Bachelor of Science - Public Health
Georgia State University
Atlanta, GA01.2027
High School Diploma - undefined
Chattahoochee County High School
Cusseta, GA01.2012
Skills
- Claims Auditing & Payment Accuracy
- Eligibility & Enrollment Policy Management
- Medical Coding (ICD-10/CPT) & Pre-Authorization
- Behavioral Health Coordination & Crisis Intervention
- Revenue Cycle / Cash Flow Oversight & Banking
- HIPAA & Regulatory Compliance
- EHR Systems (CareLogic, EPIC, EMR)
- Team Training, Process Improvement & Workflow Design
Accomplishments
NHSCS (National Honor Society of Collegiate Sscholars)
NSLS (National Society of Leadership and Success)
Global Scholar
Certification
- Basic Life Support (BLS) & AED Certified
- HIPAA Compliance Training (2024)
Timeline
Front Office Team Lead & Clinical Support
Hughston Clinic / Jack Hughston Memorial Hospital
01.2024 - 05.2025
EEMR Assistant II (Medical Records)
Emory University Hospital
05.2021 - 04.2022
Senior Medical Claims & Credentialing Specialist
MedRenewal Credentialing & Claims Review Services
02.2021 - 09.2025
Clinical Care Coordinator & Patient Access Representative
Pathways Center
03.2019 - 01.2020
Medical Claims Auditor & Eligibility Specialist
Premier Health Solutions
01.2018 - 01.2021
Forensic Service Technician
West Central Georgia Regional Hospital (DBHDD)
05.2017 - 01.2018
Customer Service & Claims Support Representative
Blue Cross Blue Shield
01.2015 - 04.2017
High School Diploma - undefined
Chattahoochee County High School
Bachelor of Science - Public Health
Georgia State University
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