Patient Access Representative I/HealthCare Delivery - SSM Health St. Anthony's Emergency Room - OKC, OK
(2023-12)
- Responsible for leading patients through the admissions process by screening patients for eligibility, preparing patient medical record information for clinical staff, and answering patient questions.
- Performs a variety of clerical and administrative duties related to the delivery of effective patient care, including but not limited to greeting, and checking in patients, answering phones, collecting patient co-pays and insurance payments, processing paperwork, and performing other office duties as required in a fast-paced, customer-oriented clinical environment. Communicates directly with patients and / or families either in person or on the phone to complete the registration process by colle
- Utilizes computer to input / verify patient data in real-time ensuring accuracy and completeness of information. Proficient with MS Office for preparing various medical documents and maintaining records.
- Collects patient co-pays as appropriate and conducts conversations with patients on their out-of-pocket financial obligations. Identifies outstanding balances from patient's previous visits and attempts to collect any amount due.
- Responsible for collecting data directly from patients and referring provider offices to confirm and create scheduled appointments for patient services prior to hospital discharge.
- Responds to patient and caregivers' inquiries related to routine and sensitive topics always in a compassionate and respectful manner. Maintains up-to-date knowledge of specific registration requirements for all areas, including but not limited to: Main Admitting, OP Registration, ED Registration, Maternity, and Rehabilitation unit.
Patient Access Representative I/HealthCare Delivery - United Health Group/Optum - OKC, OK
(2022-11 - 2023-12)
- Responsible for leading patients through the admissions process by screening patients for eligibility, preparing patient medical record information for clinical staff, and answering patient questions.
- Performs a variety of clerical and administrative duties related to the delivery of effective patient care, including but not limited to greeting, and checking in patients, answering phones, collecting patient co-pays and insurance payments, processing paperwork, and performing other office duties as required in a fast-paced, customer-oriented clinical environment. Communicates directly with patients and / or families either in person or on the phone to complete the registration process by colle
- Utilizes computer to input / verify patient data in real-time ensuring accuracy and completeness of information. Proficient with MS Office for preparing various medical documents and maintaining records.
- Collects patient co-pays as appropriate and conducts conversations with patients on their out-of-pocket financial obligations. Identifies outstanding balances from patient's previous visits and attempts to collect any amount due.
- Responsible for collecting data directly from patients and referring provider offices to confirm and create scheduled appointments for patient services prior to hospital discharge.
- Responds to patient and caregivers' inquiries related to routine and sensitive topics always in a compassionate and respectful manner. Maintains up-to-date knowledge of specific registration requirements for all areas, including but not limited to: Main Admitting, OP Registration, ED Registration, Maternity, and Rehabilitation unit.
Auditor III/Payment Accuracy & Federal Audit Coordination - Oklahoma Health Care Authority - OKC, OK
(2020-09)
- Serves as primary point of contact and supervises the design, implementation, contract monitoring and administration strategies of all applicable federal Program Integrity initiatives. Directs, coordinates, and oversees the work of the Recovery Audit Contractor (RAC). Researched policy and procedures to ensure providers and vendors are following all established federal and state regulations.
- Lead team meetings, providing information regarding records and reports, discussing the process and procedures regarding the follow of record information and their retrieval. Responsible for training new vendors on the proper procedures on delivering audit records and reports.
- Utilizes knowledge of concepts, principles, and practices for specific policies and programs. Plans and executes quality improvement with providers and vendor.
- Performs data mining; complex data analysis; and interprets and transforms data into accurate, consistent, and timely information in support of the business and operational needs of the organization.
- Develops recommendations and solutions for program improvement and implements innovative solutions to correct technical, complex problems. Present findings and recommendations to the department leadership.
- Analyzes data on knowledge, skills, and requirements of work processes to match up with the needs of the organization. Identifies errors in data and compiles management or program analysis data into desired formats.
- Constructs comprehensive monthly, quarterly reports, continually reviewing, and modifying status reports. Designs, prepares, and interprets financial reports for the Finance Department to recoup revenue.
- Ensures new patient files are created and information is completed and filed correctly into database according to standard procedures or per physician's preference.
- Manages and resolves conflicts in a constructive, efficient manner. Skillfully gathers and analyzes information, develops alternative solutions, and uses effective reasoning strategies.
- Responsible for annual performance reviews and evaluation of departmental activities to identify areas of quality improvement and training.
- Implements efforts to improve systems and processes affecting the integration of multiple healthcare disciplines, e.g., process improvement, risk management, patient safety, utilization review, credentialing, and privileging.
- Develops and maintains cooperative working relationships with various departments, coworkers, and other services such as working with the legal department to appeal cases, ensuring all medical records and files are present for the case.
- Provides education, training, and consultation of current pricing and billing errors to medical professionals, health service managers, and third-party billers to foster and build consensus to accomplish goals and objectives.
- Proficient in handling matters related to administration, personnel, and Health Information Management System (HIMS), Health Insurance Portability and Accountability Act (HIPPA) and Privacy Act guidelines and securing all data.
Audit Project Coordinator/ Payment Accuracy & Federal Audit Coordination - Oklahoma Health Care Authority - OKC, OK
(2015-04 - 2020-09)
- Responsible for the management and maintenance of the audit process and created an audit plan which includes the purpose of the audit, the main focus areas, and the schedule.
- Examined and evaluated assigned case records and provided summary findings on case audits and reviewed any feedback received from caseworkers and supervisors.
- Developed recommendations and solutions for program improvement and implements innovative solutions to correct technical, complex problems. Present findings and recommendations to the department leadership.
- Responsible for training new vendors on the proper procedures delivering audit records. Also, trained medical records file clerks, finance clerks, and birth certificate clerks.
- Worked with personal and provider information daily, verifying information from outside sources to ensure appropriate billing. Ensure specific encryption is used with sending information out via the web.
Auditor I/Provider Audits - Oklahoma Health Care Authority - OKC, OK
(2012-12 - 2015-03)
- Used a variety of computerized tools and applications to query data, and other source data systems to complete audits. Perform data mining; complex data analysis; and interpret and transform data into accurate, consistent, and timely information in support of the business and operational needs for the organization.
- Knowledge of MS Office and ability to use databases, spreadsheet, word-processing, and communication software packages to analyze, and disseminate information.
- Obtained, analyzed, and appraised evidentiary data as a basis for an informed, objective opinion on state and Federal compliance issues of both external providers as well as internal divisions and units of the agency.
- Analyzed and investigated operations to recommend improvements; identified viable options and solutions. Determined potential problems and disseminated information to upper-level management.
- Supported activities related to year-end Financial Audit on providers including preparation of audit work papers, analysis, and determination of adjusting entries required, preparation of financial records for examination.
- Supervised in making written presentations to management during and at the conclusion of the examination, discussing deficiencies, detecting fraud, developing controls for fraud prevention, recommending corrective action, and suggesting improvements in operations.
Finance Analyst II/Claims Resolutions - Oklahoma Health Care Authority - OKC, OK
(2008-12 - 2012-12)
- Provided operational support for making data-driven decisions utilizing information related to MMIS for the Medicaid Program, patient care patterns, outcomes, and associated resource costs.
- Provided alternative surveying functions and activities to determine the nature of operations and the adequacy of the system. Planned and organized work required in coordinating facility penalties and internal appeals process.
- Effectively communicated, both orally and in writing. Edited, updated, revised, and reformatted documents, reports, and correspondence. Assisted in preparing formal and informal briefings to co-workers or managers on business operations and related issues.
- Maintained accurate records for inspection and accountability purposes. Maintained control and ultimate visibility of transactions initiated within the fiscal agent's computer system.
- Monitored accuracy of processing and ensures transactions are completed in accordance with agency policy, state, and federal guidelines.
Finance Analyst II/Adjustments - Oklahoma Health Care Authority - OKC, OK
(2004-12 - 2008-12)
- Completed detailed analysis and audits of all monthly processing for completeness and accuracy to ensure data integrity. Performed annual data reconciliation ensured that all facility cost, and workload has been properly accounted for in the system.
- Responded to refund correspondence received from providers, analyzed, and researched all account data which was populated daily. Calculated and identified refunds, and ability to read and interpret explanation of benefit's (EOB's) with the purpose to streamline accounts, processed returned personal and commercial refund checks, and researched returned refund checks for updated address information. Maintained and processed monthly expenditures and revenue reports of operations.
- Trained and provided overall direction to providers on procedural technicalities. Ensured individuals fully understood the remittance advice statements, processing claim submissions, and the recoupment process. Analyzed, evaluated, advised on and/or coordinated health care delivery systems and operations.
- Provided high-quality service, assisting customers with locating products and answering questions with knowledgeable responses. Known for building reputation of integrity, knowledge, and accountability. Assessed routine problems and assured a resolve to support the organization, medical providers, and Health Maintance Organization (HMOs).
Records Conversion Specialist/Contracts - Oklahoma Health Care Authority - OKC, OK
(2001-01 - 2004-12)
- Responsible for the quality of the documentation of the care provided as recorded by the clinicians in the patient records. Complete chart audits, trending/tracking provider documentation compliance.
- Evaluates health records and independently determines the nature and extent of problem areas. Reviews clinician documentation outlines areas that require more specificity and trains clinicians in improving the quality of their documentation.
- Maintained accurate microfilm and microfiche data log's, operated computer assisted retrieval system; created and maintained indexes, retrieved information; checked information for accuracy, and completed all required corrections.
- Assisted Contract Specialist Personnel with processing of contracts, verification of contracts, and frequent use of the database logging contracts out to the record conversion specialist. Helped develop the provider information record form that is used to process contracts.
- Use a variety of computerized tools and applications to query conversion data and source data systems to complete audits. Operated imaging equipment such as a scanner, CD recorder, viewer, and printer. Cleaned and made minor adjustments or repairs to scanning equipment.
Birth Certificate Administrator/Health Information Management - OU Health - OKC, OK
(2011-04)
- Manages and maintains administrative records and reports. Obtains birth information from parent(s) using appropriate questionnaires and state, or federal reports.
- Reviews patient medical records and other resources, as needed, to obtain required birth information. Reviews birth certificate for completeness and accuracy.
- Maintains all health information input into the local Oklahoma State Rover database and assures timely transmission of all information into the centralized database.
- Reports and transmits birth certificate information in a timely manner as required by state law. Trains and directs parents in completing birth certificate forms. Completes and reviews paternity papers with parents as needed.
- Responsible for training new PRNs on the proper procedures in working the night shift on the unit. Also, trained medical records file clerks, and birth certificate clerks. Performs administrative duties utilizing the computer software Centricity Prenatal (CPN) and MEDITECH while abiding by all PHI and HIPAA regulations. Ensuring compliance with record keeping requirements for Oklahoma State Vital Records Division.
- Develops recommendations and solutions for program improvement and implements innovative solutions to correct technical, complex problems.
- Assists with other duties in the department by providing support to the HIM Department by Retrieve discharged medical records from various nursing units and ancillary departments through the hospital and reconciles them using MEDITECH compiled reports and/or automated reconciliation to ensure that all records are accounted for and ready by the deadline for document imaging daily pickup.
- Places reconciled records in the designated area for Document Imaging. Batches, labels and routes loose reports, late charts and/or late documentation to Document Imaging. Scans and indexes loose reports/documents that are identified as critical to coding and prioritize them accounting to policy.
- Performs routine data entry to assist in updating applicable unbilled reason codes (URCs) into appropriate systems (HPF/MPF, MEDITECH, Reconciliation Tool) if chart is not received/reconciled within established timeframes.
- Processes facility specific HIM mail as applicable. Assists physicians and other health professionals in obtaining health record information. Assisted with Physician question related to HPF and the physician portal or other issue that may arise.
- Conducts daily quality controls by running, reviewing, and monitoring unsigned documents in the electronic health records system for compliance purposes and notifying the appropriate providers of their unsigned documents in the electronic health records.
- Coordinates the retrieval and printing of medical records from storage, as well as the storage, archival and record retention of documents and/or other Alternate Media that cannot be scanned into HPF to include monitor strips (e.g. fetal monitor strips, EKGs, etc.)
- Meets with the HSC courier to receive and account for all totes/containers delivered. Unpacks all totes/containers, sorts, and screens medical records according to established procedures.
- Conducts daily, quality control checks by running, reviewing, and monitoring unsigned documents in the electronic health records system for compliance purposes and notifying the providers of their unsigned documents in the electronic health records. Excellent communication skills to serve as this vital link between the physicians, nursing staff, patients, and visitors. Provides support to the clinical staff by tracking consults, stat orders, supplies, patient movement throughout the system, etc.
Night Auditor/Hotel Operations - Renaissance Hotel - OKC, OK
(2016-09 - 2017-01)
- Managed and prepared daily restaurant revenue report data by auditing micros tapes/journals to breakdown revenue, covers and servers' fees, tips paid out and settlements by tape and cashier. Ran audit reports/journals from the front office mainframe, the micros computer, and credit card system. Input into database the revenue, expenses, and allowances to generate daily reports and restaurant summary. Balanced all revenue and settlement accounts nightly, maintained files and reset the system for
- Performed cash accounting duties such as preparing bank deposits, counting cash and ensuring that cash drawers are balanced. Worked as a desk clerk to check in late arrivals. Made reservations for consumers who call into the hotel. Acted as manager on duty (MOD) when night manager was not present. Performed other duties and responsibilities asked by the Night Manager based upon department needs.
