Take- charge nonclinical professional, delivering executive support and team leadership to business operations. Dependable with strong analytical skills with the ability to manage multiple tasks and priorities. Broad experience includes vendor management, accounts receivable, accounts payable, invoicing, and collections. Recognized for exemplary customer service and team collaboration.
Skills
Vendor Management
Accounts Receivable
Bad Debt Collections
Accounts Payable
Customer Service
Microsoft Word, Office & Excel
Insurance/Claims Follow Up
Account Reconciliation
Customer Service
Project Management
Reporting
Data entry
Experience
03/2021 to Current
Provider Support Representative (Remote)Res-Care, Inc. – Hillsborough, NC,
Handle a high volume of complex calls and other communications with Doctor offices, pharmacies, drug manufacturers and other PBMs (pharmacy benefit managers).
Resolve and maintain 100% follow-through on provider questions, requests and open items relating to members and the VIVIO Health program.
Delivered fast, friendly and knowledgeable service for routine questions and service complaints.
Assessed customer account information to determine current issues and potential solutions.
Entered and processed patient prescriptions in company system.
Made outbound calls to insurance companies, specialty pharmacies and physicians to perform eligibility checks for patients.
Scheduled peer to peer reviews for physicians to discuss medical necessity with medical providers.
Maintained high level of professionalism when speaking to doctors and insurance companies.
Followed all Medicare, Medicaid, HIPAA, and private insurance regulations and requirements.
Contacted physician's office to obtain and follow-up on authorizations, notifications and pre-certifications for patients/member's.
Used MMS to input drug- medications, prior authorization and other important medical data into system.
Identified reasons behind denied claims and worked closely with insurance carriers and specialty pharmacies to promote resolutions.
10/2017 to 08/2020
Revenue Cycle CoordinatorPlanet Fitness – Bay City, MI,
Handled high-volume of accounts receivable including bad debt accounts for errors; monitored and adjudicated self-pay, insured and aged accounts to support month-end collections are being maintained.
Accessed patient information through variety of office software applications, maintaining strict confidentiality to remain compliant with HIPAA regulations.
Issued daily adjustments and credits-issuing corrected entries when necessary to ensure account flow within the revenue cycle.
Support internal and facility management, customer service and other related departments in reporting, reconciliation and patient disputes.
Trained and developed dynamic administrative team, supporting all corporate growth and productivity objectives.
Liaised with customers, addressed inquiries, handled meeting requests and answer billing questions to provide outstanding customer care.
Defined and documented office procedures, using updated SOPs to provide thorough and comprehensive training for all administrative support staff.
Analyzed vendor/agency client's monthly invoice(s), identified variances and researched issues to correct problems and maintain financial compliance.
Problem-solved accounts payable questions on behalf of internal team members, management and vendors.
Assisted with month-end and year-end closings to support accounting system accuracy.
Verified vendor accounts by reviewing documentation, rectifying issues and contacting account holders/insurance payers.
Assessed data and information to check entries, calculations and billing CPT/HCPCS and diagnosis codes for accuracy.
Performed day-to-day financial transactions, including verifying, classifying, posting and recording accounts payable data and reconciled daily totals to confirm proper accounting.
Negotiated payment plan arrangements for patients including non-participating Insurance payers.
05/2015 to 10/2017
Team LeadTenet Healthcare Corporation – Annapolis, MD,
Trained less experienced departmental staff, new employees and onsite vendors, supporting all corporate growth and productivity objectives.
Delegated daily tasks to team members to optimize group productivity.
Problem-solved accounts payable questions on behalf of internal team members, management and vendors.
Updated accounts with recent information and processed patient payments
Investigated and resolved account discrepancies in alignment with correct business processes.
Corrected inaccuracies through root cause analysis and performance report review.
05/2012 to 05/2015
Patient Access Representative IIMemorial Hermann System Services-Vendor Management – City, STATE,
Daily analysis of accounts receivable including bad debt accounts for errors; monitored and adjudicated self-pay, insured and aged accounts to support month-end collections are being maintained.
Issued daily adjustments and credits-issuing corrected entries when necessary to ensure account flow within the revenue cycle
01/2004 to 05/2012
Onsite Liaison (Houston, TX)Receivable Management Inc. – City, STATE,
Verified patient demographics and insurance information in electronic system.
Assisted in-house insurance collectors with insurance claims follow up and claims review.
Provided necessary documents (i.e medical records, UB04 and HCFA 1500) for claims reimbursement and appeals.
Investigate and ensure expected payments and contractual agreements are met by payers.
Reviewed flagged items daily and resolved issues in accurate and efficient manner.
Collaborated with all relevant parties to resolve billing issues, insurance claims and patient payments. (i.e coding/HIM )
Disseminated information to correct department, individual or outside location.
Entered patient insurance, demographic and health information into software and confirmed records.
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