Thelma L. Merrell
Lawrenceville
Summary
Dedicated and detail-oriented professional with diverse expertise in client service, credentialing, insurance claims, provider enrollment, auditing support, and insurance billing. Successfully managed complex administrative processes within the healthcare industry. Facilitated seamless interactions between providers, clients, and insurance companies to ensure optimal service delivery and timely issue resolution. Analyzed and interpreted insurance policies and regulations to ensure compliance and accuracy. Excellent communication and problem-solving abilities with a strong commitment to delivering exceptional client satisfaction. Passionate about delivering high-quality support and contributing to the success of healthcare organizations. Proficient in using Microsoft Office and Google Suite.
Overview
17
17
years of professional experience
1
1
Certification
Work History
Referrals Specialist
NGPG, Braselton Family Medicine
03.2024 - Current
- Ensured timely communication through rapid response to referrals.
- Coordinates specialist appointments according to patient symptoms.
- Managed routine patient inquiries to ensure smooth communication.
- Builds collaborative partnerships with medical professionals to optimize referral accuracy.
- Secured a high success rate of 90% for scheduling urgent referrals within the 24-48 hour timeframe.
- Delivered prompt scheduling for referrals with an 85% success rate in under ten days.
Ophthalmic Technician | Office Assistant
North Georgia Eye Center
08.2019 - 03.2024
- Executed testing procedures to diagnose conditions.
- Facilitated acquisition of product samples by engaging with product representatives.
- Organized accurate datasets related to patients for compliance with audit requirements, insurance processes, and financial transactions.
- Trained incoming staff members effectively.
- Enhanced patient experience through proactive resolution of critical issues.
- Ensure meticulous inventory management and completion of work orders, while troubleshooting and resolving issues promptly
- Acted as the primary contact for various front- and back-office duties.
- Arranged patient appointments while updating their insurance details for approval.
- Completed prior authorizations swiftly to improve patient care.
- Coordinated order and insurance claim processes to support timely payment collections for rendered services.
Ophthalmic Technician
Milan Eye Center
02.2017 - 07.2019
- Conducted tests to ensure detailed examinations.
- Oversaw scheduling for patients.
- Directed training sessions to guide newly hired employees.
- Contribute to accurate assessment and treatment plans by aiding ophthalmologists with patient care.
- Enhanced efficiency in obtaining medical treatment approvals.
- Collaborated with product representatives to obtain valuable samples.
Customer Service Representative Lead
Milan Eye Center
06.2016 - 02.2017
- Delivered timely resolutions to inquiries during high-volume periods.
- Liaised with patients, doctors, referring providers, and healthcare organizations.
- Conducted training sessions for new staff to streamline onboarding.
- Managed collection processes with focus on precision and professionalism.
- Managed appointment scheduling while providing clear policy explanations to patients.
- Reduced the likelihood of claims denial by streamlining communication with medical professionals.
- Communicated with insurers to ascertain compatibility of providers within patients' insurance networks.
Claims Representative (temporary Position)
Great Expressions Dental Centers
12.2015 - 04.2016
- Resolved claim discrepancies by investigating denials and initiating corrective actions.
- Enhanced efficiency in the claims process by thoroughly analyzing stacks of 50 daily.
Customer Service Lead
Verizon Wireless
12.2007 - 03.2015
- Provided outstanding customer service to achieve total satisfaction.
- Optimized work environment by inspiring collaborative approaches within customer support teams.
- Oversaw resolution of escalated concerns with efficiency.
- Consistently maintained high performance standards in customer service metrics.
- Secured highest sales rank consistently across four months through exceptional upselling skills.
Education
Bachelor of Science - Exercise Science, Health & Wellness Education
Georgia Southwestern State University
Americus, GASkills
- Insurance Claims Processing
- Client Services & Support
- Cross-functional Collaboration
- Provider Network Management
- HIPAA Regulations & Compliance
- Record Management & Documentation
Certification
Medical Billing and Coding Certificate, AACP, Ongoing
Timeline
Referrals Specialist
NGPG, Braselton Family Medicine
03.2024 - Current
Ophthalmic Technician | Office Assistant
North Georgia Eye Center
08.2019 - 03.2024
Ophthalmic Technician
Milan Eye Center
02.2017 - 07.2019
Customer Service Representative Lead
Milan Eye Center
06.2016 - 02.2017
Claims Representative (temporary Position)
Great Expressions Dental Centers
12.2015 - 04.2016
Customer Service Lead
Verizon Wireless
12.2007 - 03.2015
Bachelor of Science - Exercise Science, Health & Wellness Education
Georgia Southwestern State University
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