MARY DUMENA
Kernersville
Summary
Experienced, resourceful, and highly dependable Medical Administrator having over 3 years of collective experience in customer service delivery, medical billing processing, front office representation, pharmaceuticals, and determining policy coverages. While effectively processing many claims, she maintains excellent communication with patients and providers. Currently looking for an adaptable desk job where I can help bring ideas and elevate them to new positions in order to achieve long-term stability and growth within a company. Proactive and versatile professional with a dedication to quickly adapting to new challenges. Strong problem-solving abilities and a proven track record of fostering strong relationships with clients and team members. Focused on supporting team success and achieving positive results.
Overview
6
6
years of professional experience
Work History
Member Service Insurance Agent
Blue Cross & Blue Shield MA
Kernersville
03.2024 - 08.2025
- Accurately processed large volumes of medical claims every shift.
- Surpassed phone quality metrics at 95% or higher success rate.
- Help to advise members on which medical plan was best for them based on their medical needs.
- Stayed current on HIPAA regulations, benefits claim processing, medical terminology and other procedures.
- Documented file notes clearly and concisely in computer systems such as: ASD and Quickbase.
Patient Access Advocate II
Cone Health
Greensboro
02.2023 - 03.2024
- Gather patient records for the provider.
- Collected information, verified insurance, and collected co-payments for patients as part of the check-in process.
- Scheduled appointments by telephone or in person.
- Answered phone calls to provide assistance, information, and medical personnel access.
- Maintained consistent patient confidentiality in alignment with HIPAA protocols by using encryption software.
- Travel between clinics to maintain office operations.
- Maintain timeshare clinics for specialty providers with: Foot & Ankle, Urology, Vein & Vascular, Plastics, Optometry, Heartcare, Surgical, Infectious Disease, and Neurology.
Patient Advocate
Aetna/ CVS
High Point
01.2022 - 02.2023
- Accurately processed large volumes of medical claims every shift.
- Tracked differences between plans to correctly determine eligibility and access claims against benefits and data entry requirements.
- Documented file notes clearly and concisely in computer systems such as: ASD and Quickbase.
- Surpassed phone quality metrics at 95% or higher success rate.
- Stayed current on HIPAA regulations, benefits claim processing, medical terminology and other procedures.
- Help to advise members on which medical plan was best for them based on their medical needs.
- Explain benefits program and entitlement criteria.
- Analyzes claim materials and identifies issues.
- Gather relevant evidence for patient records.
- Conducts interviews to adjudicate claims and inputs data necessary to resolve issues.
- Prepared and released correspondence.
- Interpreting laws, regulations, and/or procedures to analyze evidence.
Pharmacy Technician
Walgreens
Greensboro
09.2021 - 01.2022
- Assisted pharmacists with clearing high volumes of prescriptions and responded to customer questions.
- Refilled medications, offering insight into over-the-counter products and verified insurance benefits.
- Prepared prescription transfers to other pharmacies.
- Verified patients identities and pickup to prevent sale of wrong medications.
- Perform immunizations for Covid and Flu shots as well perform covid testing.
Inventory Associate
Amazon
Colfax
10.2020 - 01.2021
- Helped solve with sorting packages wrongly placed into correct bins to be shipped to the correct location.
- Stowed packages into the correct bag, racks, and/or end aisles by taking packages off the conveyor belt.
- Picked orders by zip code for delivery drivers to ensure a fast delivery to customers.
Marketing Associate
Walmart
Kernersville
04.2019 - 10.2020
- Maintained inventory accuracy for successful product flow.
- Used Zebra's inventory management system to track incoming shipments.
- Verified proper packaging and labeling for each shipment to promote accuracy and safety of merchandise in transit.
- Observed all company safety policies and OSHA guidelines.
Education
Graduate Certificate - Pharmacy Technician
GTCC
High Point, NC08-2022
High School Diploma -
Middle College at Guilford Technical Community College
High Point, NC05.2018
Certificate - Sterile Processing
Herzing University
Dearborn, MISkills
- Anatomy
- oral and written skills
- Physiology
- Medical terminology
- Microsoft Office
- Multi-tasking
- Excel
- PowerPoint
- Outlook
- Epic
- Medical claims handling
- Analytical skills
- CPT/ICD codes
References
References available upon request.
Timeline
Member Service Insurance Agent
Blue Cross & Blue Shield MA
03.2024 - 08.2025
Patient Access Advocate II
Cone Health
02.2023 - 03.2024
Patient Advocate
Aetna/ CVS
01.2022 - 02.2023
Pharmacy Technician
Walgreens
09.2021 - 01.2022
Inventory Associate
Amazon
10.2020 - 01.2021
Marketing Associate
Walmart
04.2019 - 10.2020
Graduate Certificate - Pharmacy Technician
GTCC
High School Diploma -
Middle College at Guilford Technical Community College
Certificate - Sterile Processing
Herzing University
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