Ramona Davis
Fresno
Summary
Experienced healthcare professional with 30 years in the industry, including 5 years as an Account Executive specializing in ancillary cross sales and membership retention. Secure a rewarding career transition where I can utilize my skills while contributing to a strong and successful company. Detail-oriented and empathetic, with strong communication and problem-solving abilities.
Overview
24
24
years of professional experience
1
1
Certification
Work History
ACCOUNT EXECUTIVE
Aetna, a CVS Health
06.2014 - Current
- Ensure customer/retention targets are achieved through the renewal process for groups sized 2-100
- Retain and manage growing Book of Business
- Seek out opportunities for ancillary cross sales growth
- Working closely with brokers, general agents, and plan sponsors to understand their needs
- Ensure accuracy of plan changes and final bill review
- Use and knowledge of our product line
- Works collaboratively with internal and international colleagues
Consultant
DISYS
11.2013 - 06.2014
- Review documents and submit New Business RFP
- Ensure all required information has accurate details prior to install submission
- Search claims experience and/or risk assessment
- Served as the main point of contact for clients
- Kept detailed notes of all correspondence
- Maintained confidential patient, employee and company information in compliance with company policies and regulatory requirements.
- Stayed calm under pressure to and successfully dealt with difficult situations.
- Maintained up-to-date knowledge of product and service changes which gave a better understanding of customer needs and recommended appropriate solutions.
Accounts Receivable Support
Emergency Groups Office
01.2010 - 08.2013
- Prepare and bill claim forms to healthcare providers and members
- Implement correct billing and adjustment codes
- Verified member eligibility and benefits using health plan websites and NaviNet
- Submission of appeals for underpaid/no pay accounts
- Retrieve claim numbers and medical records using Laserfiche software
- Entered claim acknowledgements and denial letters received using CPU billing software
Customer Service Representative
Lereta
08.2004 - 07.2008
- Process homeowner tax bills and high priority flood reports
- Handled heavy volume of flood disputes calls using automatic call distribution system
- Resolve complaints successfully in accordance with established guidelines
Utilization Management Coordinator
Network Medical Management
12.2001 - 06.2003
- Billed claims and collection statements to patients and heath care agencies
- Assist healthcare providers in developing and implementing authorizations
- Processing treatment authorization request forms using current ICD 9 and CPT coding
- Formatted policy and procedure letters with medical terminology format
Education
Certified Medical Office Management -
Bryman College
12.1999
Skills
- Client relationship building
- Managing client relationships
- Account management
- Sales quota achievement
- Written and verbal communication
- Product knowledge
- Closing sales
- Team collaboration
- Attention to detail
- Time management
- Task prioritization
- Cross-functional coordination
Certification
CA Accident & Health or Sickness License 0M57525
Qualifications Summary
- Proficient Use and knowledge of healthcare software such as MMACT, Rumba, MEA, CCI, and Enterprise Billing.
- Qualified use of Salesforce, MS Windows, MS Word, MS Excel, and MS Outlook.
- Typing speed 45-50 WPM accurately and Ten Key by touch 16,000+ KPM.
- Medical office skills include Accounts Receivable, Correspondence, Collections, ICD & CPT Coding, Medical Terminology.
- Knowledge of Medicare/Medicaid, Workman’s Comp, HMO, PPO, Medi-Cal, and CCS billing.
- Strong written and verbal communication skills, with problem solving capabilities.
- Understand HIPAA compliance guidelines while maintaining client confidential matters.
- Able to read and comprehend plan summaries and EOB's.
- Self-starter who can handle multiple tasks with efficiency and organization.
Timeline
ACCOUNT EXECUTIVE
Aetna, a CVS Health
06.2014 - Current
Consultant
DISYS
11.2013 - 06.2014
Accounts Receivable Support
Emergency Groups Office
01.2010 - 08.2013
Customer Service Representative
Lereta
08.2004 - 07.2008
Utilization Management Coordinator
Network Medical Management
12.2001 - 06.2003
Certified Medical Office Management -
Bryman College
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