KIERRA JAMES
Atlanta
Summary
Customer Success & Healthcare Operations Specialist with a focus on enhancing Medicaid renewals, claims accuracy, and client retention. Demonstrates success in streamlining processes and resolving complex eligibility issues while ensuring high customer satisfaction. Proficient in cross-functional collaboration and data-driven decision making.
Overview
8
8
years of professional experience
Work History
Medicaid Specialist
Visiting Nurse Health System
Atlanta
03.2023 - Current
- Evaluated Medicaid applications to ensure eligibility and compliance with regulations, enhancing program integrity.
- Collaborated with healthcare providers to collect required documentation for claims processing, streamlining submission process.
- Educated clients about Medicaid benefits and application procedures during consultations.
- Liaised between clients and state agencies to clarify eligibility determinations, improving client understanding and access to benefits.
Claims Specialist
Northside Hospital
Atlanta
10.2020 - 02.2023
- Resolved claims by approving or denying documentation, calculating benefits due and determining compensation settlement.
- Facilitated communication with patients and providers about claim status and required documentation, enhancing transparency and trust.
- Coordinated with billing department to address and resolve insurance payment issues, ensuring timely reimbursement.
- Utilized electronic health record systems to manage patient information and claims data.
Benefits Enrollment Specialist
Ideal Gynecology
Atlanta
10.2019 - 10.2020
- Educated clients on healthcare plans, facilitating informed decision-making.
- Resolved patient inquiries regarding coverage and claims, enhancing customer satisfaction.
- Processed benefit applications, ensuring accuracy in records for efficient enrollment.
- Reviewed documentation for compliance with regulations and policies.
Administrative Assistant
Emory University Hospital
Atlanta
05.2018 - 10.2019
- Coordinated patient scheduling and appointment management across multiple departments to enhance service delivery.
- Streamlined communication between healthcare providers and patients to ensure timely information exchange.
- Assisted in maintaining accurate medical records and patient information systems.
- Organized departmental meetings and maintained calendars for team members.
Education
Associate Degree - Business Administration
Georgia State University
12-2017
Skills
- Medicaid/Medicare
- Eligibility Verification
- Claims Processing
- Healthcare Compliance
- Healthcare Operations
- EMR/EHR
- Documentation Review
- Application Documentation
- Patient Support
- Customer Experience
- Client Retention
- Relationship Management
- Onboarding
- De-escalation
- Application Documentation
- CCSP
Timeline
Medicaid Specialist
Visiting Nurse Health System
03.2023 - Current
Claims Specialist
Northside Hospital
10.2020 - 02.2023
Benefits Enrollment Specialist
Ideal Gynecology
10.2019 - 10.2020
Administrative Assistant
Emory University Hospital
05.2018 - 10.2019
Associate Degree - Business Administration
Georgia State University