KIANA C. MIMS
924 Determination Way, Kissimmee Fl 34741 /  [Send email to request phone number] 94-5005 primary / (407)
888-9792 alternate / chelese6262@gmail.com

Objective: To secure a position within your company bringing dedication,
responsibility, and good work ethic, combined with a desire to utilize the skills
I possess.

PROFESSIONAL EXPERIENCE:  REIMBURSEMENT TEAM LEAD – BETAPLUS formerly MS
PATHWAYS
DECEMBER 2007 – SEPT 2008    ADVANCED CARE SCRIPTS, ORLANDO FL

Oversee collection of patient data for Bayer research studies. Organize
shipments. Keep current reports of clinical research study data for Bayer
Pharmaceuticals (betaseron patients). Transition patients from study programs on
to commercial insurance.Manage daily reports. Assign case referrals. Ensure daily
goals are being reached and exceeded. Quality Monitoring / Coaching. Co-pay
Assistance Evaluations, T -PAP Evaluations. Manage incoming and outgoing
correspondence with our business partners. Assist team members with problem
solving. Train new staff as well as on-going training with co-workers. Maintain
professionalism and leadership qualities at all times. Oversee a team of
Reimbursement Specialist’s whose duties include: verify insurance benefits for
medication, identify the network pharmacy, determine if a patient is eligible for
PAP or co-pay assistance, obtain any missing information on the enrollment form
to ensure we triage a clean referral and transmit data as appropriate. 

SALES SUPERVISOR / 215 LICENSED LIFE, HEALTH & VARIABLE ANNUITIES
NOVEMBER 2005 – June 2007    CONNEXTIONS, ORLANDO FL

Manage the daily activities of a team of Licensed Agents, who place and receive
telephone calls with the intent of selling or promoting health policies, and
develop sales skills. Quality Monitoring, One on one coaching and developing,
identify strengths, as well as areas of improvement. Weekly Callibrations
sessions. Performance Improvement plans (PIP). Adhere to call center policies and
procedures which included call center operational standards, maintaining employee
sales and service levels, improving quality service, preparing reports,
operational upkeep, maintaining professional and technical knowledge. Course
training on the follow: Effective Sales Techniques, Effective Team Leadership,
How to Effective Deal with Others and Time Management, How to develop you Sales
Team, How to Motivate Your Sales Team. Administrative duties such as:  scheduling
and time off requests etc. Constant monitoring of activities throughout the day
to ensure we meet client expectation. Daily / Weekly review of past activity
reports. Follow up reports or documentation as needed. Assist clients with
questions and/or concerns regarding the different Medicare Prescription Part D
programs offered by PacifiCare. Make suggestions as to which program would best
suit the individual based on need and budget. Complete the telephonic enrollment
process. Report sales performance. 

INDEPENDENT LICENSED INSURANCE AGENT (FIELD) – 215 LICENSED LIFE, HEALTH &
VARIABLE ANNUITIES
JUNE 2005 - OCTOBER 2005    CORNERSTONE AMERICA - ORLANDO, FL

Organize health/life insurance plans based on individual needs and budget.
Prepare and present a health package to the client, addressing any concerns in
the process. Process enrollment forms.Submit daily and weekly reports to team
leader. Follow up with clients as needed.

SPECIAL PROJECTS COORDINATOR
JUNE 2002 – MAY 2005    MEDICAL CENTER RADIOLOGY GROUP – ORLANDO, FL

Work Accounts Receivable reports (payers) with large volume of accounts over 120
days to identify trends and or claims issues. Communicate findings to management
in writing, along with a proposed plan of action to address these issues.
Monitored inbound calls, produced reports to appropriate team leader. Responsible
for having correct benefit knowledge, and keeping up with various updates and/or
changes, including research of rules and regulations for health insurance on a
national and individual state level. Meet with provider liaisons to address payer
issues and electronic billing processes. Contract re-negotiations based on
current contract procedures in place vs. health care provider claim resolution
trends. Back-up for patient account representatives (out for more than 2 days).
Maintained crosswalk for insurance companies mode HOSPT in VITAL WORKS (medical
billing software). Maintained insurance company support files mode EIC in VITAL
WORKS (medical billing software).  Ran closing report assigned as needed. Group
billing collections and follow-up, Handle any systems/collection duties as
requested by management. Participate in education activities. Verify insurance
information for filing purposes. ICD-9 & CPT coding billing. Update patient
accounts per patient’s EOB, and/or respond to insurance regarding EOB. File
appeals and grievances. Answer high volume of incoming calls. Collections.Train
new employees. 

FEBRUARY 2002 - MAY 2002    SEA WORLD (FREEZE FRAME) - ORLANDO, FL
SALES DOLPHIN ENCOUNTER PHOTOGRAPHER

Take photographs of guest during their experience with the dolphins. Cash
register, Course in counterfeit money, Direct Customer Service

JUNE 1999– JULY 2001    TRICARE - ACTIVE DUTY / BENEFICIARY HEALTH CARE- DAYTON,
OH
CLINICAL INTAKE SPECIALIST

Worked out of the Main headquarters location for Region 2/5 for TRICARE
(formerly Champus). Initiate case management documentation via telephonic or
written information given by providers and/or hospitals for discharge planner
regarding pre-authorized procedures and/or inpatient stays. Processed referral
requests for specialty providers. Monitored inbound calls, produced reports to
appropriate team leader. Responsible for correct policy benefit knowledge, and
keeping up with various updates and/or changes. Created a case management intake
procedure which enabled me, as well as my co-workers, to work faster yet
accurately, detailed and more efficiently. 

SKILLS:  Microsoft Windows, Microsoft Office, Medical Billing, Internet, Data
Entry, Medical Terminology, Customer Service, Currently learning Spanish

References:
Roberta Williams – Professional Reference   [Send email to request phone number] 21 - 2042 / Brenda DuBois
-Personal Reference (937) 371 - 3829 / Cheryl Chappell-Personal Reference (407)
595 - 6577

    Thank you in advance for considering me for a position within your company.
I look forward to meeting with you.