Romanita Mcmillian

 Romanita McMillian - Houston Texas, 77054 - SUMMARY OF QUALIFICATIONS & CERTIFICATION • Excellent customer service skills • Outstanding verbal, written, organizational and interpersonal skills • Proficient in Microsoft Word, Excel, PowerPoint • CNA CERTIFIED Education And Training nursing- cnA Certified February 2018 to March 2018(Conferred) SAad’s healthcare Mobile, AL Psychology January 2014 to May 2015 Clark atlanta university Atlanta, GA HIGH SCHOOL DIPLOMA August 2007 to July 2011 MOUNTAIN VIEW HIGH SCHOOL Lawrenceville, GA Professional Experience CVS HEALTH CLAIMS BENEFITS SPECIALIST • Review claims information to determine the nature of a member's illness or injury. • Identify claim cost management opportunities and refer claims for follow up. • Process claims accurately to enhance customer satisfaction and retention. • Analyzes and approves routine claims that cannot be auto adjudicated.  • Applies medical necessity guidelines, determine coverage, complete eligibility verification, identify discrepancies, and applies all cost containment measures to assist in the claim adjudication process.  • Proofs claim or referral submission to determine, review, or apply appropriate guidelines, coding, member identification processes, provider selection processes, claim coding, including procedure, diagnosis and pre-coding requirements.  • May facilitate training when considered topic subject matter expert.  • In accordance with prescribed operational guidelines, manages claims on desk, route/queues, and ECHS within specified turn-around-time parameters (Electronic Correspondence Handling System-system used to process correspondence that is scanned in the system by a vendor). Pilot Catastrophe Claims Processor • Investigated insurance claims by interviewing the claimant and witnesses. • consulting police and hospital records, and inspecting property damage to determine the extent of the company's liability. • Call the insured letting them when a field adjuster will be out to their home. • Assist adjusters with emails, follow up calls and claim requests • Completed Admin authorization forms • Took attendance, created out of office notes and rescheduled task • Document NG with ROR tracking and created file notes • Mail itel reports, compiled content lists from insured Getix health Patient access rep.and trainer • Records insurance information • Relays information between patients and other staff members, and provides them with updates as needed • Calculates payment information, accepts funds, and credits accounts accordingly Franklin Primary Front desk receptionist • Maintain established policies and procedures, objectives, quality assurance, and safety standards within the department. • ➢ Provide appointment scheduling for Providers, ensuring accurate appointment time is allotted, per published protocols. • ➢ Complete patient check-in: ensure all required demographic information is accurate in the NextGen Electronic Health Record. Collect patient insurance and payment information. EASTERN SHORE REHABILITATION CERTIFIED NURSING ASSISTANT • Assist in providing nursing care to residents as assigned including activities of daily living such as bathing, eating, grooming, toileting, and obtaining vital signs. • Provide and document medication assistance as directed. • Provide assistance to the residents as needed in preparing for medical testing, activities programs, and visitation. alorica customer service representative • Answered phones and respond to customers request regarding billing, technical, and general inquires • Provide customers with product and service information • Identified, and resolved customers issues using the computer systems • Follow up on customer inquiries that wasn’t immediately resolved • Complete call logs and reports