Revenue Cycle Representative
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Over 20+ years of experience in medical industry, Sound knowledge of medical terminology. Supervised 15+ employees. Exceptional data entry skills, Interaction/ communication with doctors, patients and clients.
Demonstrated leadership and effective communication abilities. Seeking to apply my various skills and vast knowledge in a challenging role that will utilize my expertise in communication, organizing and attention detail. I have a strong desire to succeed in a position offering an opportunity for personal contribution and professional growth.
Revenue Cycle Representative - UNC Health - Chapel Hill, NC
(2022-05)
Responsible for all aspects of authorizations / reauthorizations for appointments/ services required including insurance verification and authorization submission for the medical procedures. Contact insurance carriers to obtain authorizations and referral approvals for services and procedures. Research medical records to gather information and substantiate medical justification for procedures as required by insurance carriers.
Submit requested medical information to insurance carrier. Proficient with various insurance websites. Responsible for maintaining work queues. Access, review and respond to third party correspondence via email or phone.
Contact patients, physicians, and insurance companies to obtain information necessary for procedure authorizations. Process and complete referrals and new orders. Maintain basic understanding and knowledge of health insurance plans, policies, and procedures.
Educate others as needed on payer rules, utilize online services from the insurance companies. Accurately and thoroughly document the pertinent collection activity performed. Participate and attend meetings, training seminars and in-services to develop job knowledge.
Meet/ Exceed Producti
Site Payment Associate III - PPD, Pharmaceutical at ThermoFisher - Wilmington, NC
(2019-10 - 2022-05)
Provides administrative, reporting, contractual and financial support to the department related to the processing of payments to investigative sites.
Responsibilities include data compilation, issue/ risk resolution, and ensuring adherence to contractual guidelines and country regulations. Perform study reconciliations on contractual and site payment discrepancies. Manage payment responsibilities and workflow to meet contracted timelines and project deliverables.
Respond to study-related escalations and resolve payment issues. Build and enter budgets and SVTs. Manage and maintain investigator funds tracker for studies transitioned to site payments. Build and manage relationships with study sites.
Generate payments to sites in accordance with procedural documents and site contracts. Work closely and communicate with study sites managers and doctors to monitor patients' office visits.
Supervisor of Patient Financial Services - New Hanover Regional Medical Center - Wilmington, NC
(2011-07 - 2019-09)
Participate in staff recruitment, hiring and orientation. Conducts performance evaluations and employee discipline. Greet and register patients, verify insurance and demographic information. Manage the billing cycle.
Ensure that all billing-related issues are reviewed, researched, and resolved. Performs routine audits and prepares reports. Manage team projects and serve on recurring task force teams, project Check patient in and out, schedule appointments, collect copays and patient payments and collect outstanding balances, Answer patient billing questions.
Monitor and resolve registration errors. Assist with financial counseling duties as needed. Charge entry, payment posting, coordinate, and prepare financial estimates for patients. Obtain authorizations and direct patients to provider in their insurance plan, review benefits and educate patient on insurance coverage.
Follow up on referrals to ensure no care gaps. Provides customer service to patients and their families in need of intervention and assistance. Works with patients to identify payment resources for uninsured or under-insured patients.
Participate in meeting for the department's monthly collection target. Performs o
Senior Billing Associate - Atlantic Financial Consulting - Wilmington, NC
(2009-06 - 2011-12)
Serve as liaison for seven doctor offices (medical and behavior health) to ensure proper medical coding. Credentialing for the physicians. Verify patients' insurance coverage, benefits, and eligibility.
Review patient charts to ensure consistency, logic, and completeness. Enter patient demographics, verify, and obtain authorizations if needed. File correct insurance using HCFA forms and electronic submission.
Enter daily charges along with checking and correcting any coding errors. Post patient's payments, copays, and insurance payments to correct accounts manually/electronically. Take accurate write-offs per EOB to ensure all postings balance at the end of each business day.
Responsible for workers comp claims. Monitor and verify authorization for appointments and enter authorizations into patient's account. Communicate updates to patients and doctor offices regarding status of authorization.
Generate and print reports by email to the office manager upon request. Submit claims to secondary insurance. Refile any denied or rejected claims/ authorization to maximize reimbursement and continuous AR follow-up.
Answer patient phone calls to assist with their account statements. Communic
Billing Supervisor/ Coordinator - Carolina Sports Medicine Orthopedic - Wilmington, NC
(1999-01 - 2011-06)
Participate in staff recruitment, hiring and orientation. Conducts performance evaluations and employee discipline. Manage the billing cycle. Ensure that all billing-related issues are reviewed, researched, and resolved.
Greet patients, check in- check out patients. Schedule appointments. Prepare/review patient charts to ensure consistency, logic, and completeness. Entered patient demographics, verify patient insurance, benefits and obtain authorizations/ reauthorizations for appointments/ services required.
Collect prepayments before surgery procedures. Process and complete referrals and new orders. Entered daily charges along with checking and correcting any coding errors. File correct insurance using HCFA forms and electronic submission.
Post patient and insurance payments to correct accounts manually/electronically. Took accurate write-offs to ensure all postings balance at the end of each business day. Prepare daily bank deposits. Answered patient phone calls to assist with their account statements.
Create payment arrangements when needed. Performed extensive Medical Coding (CPT & ICD-9). Responsible for AR follow up and denials for Medicare, Medicaid, Blue Cross Blue Shield,
