Experience

Diversicare Healthcare Services Inc.

• United States
• Hospitals and Health Care
• 400 - 500 Employee

• AR Support

  • Aug 2021 - Present

  Very hardworking and independently very willing to learn and research any project that is needing to be done. Very hardworking and independently very willing to learn and research any project that is needing to be done.



Actively seeking full time position

• Design Services
• 300 - 400 Employee

• Actively Searching

  • Jun 2021 - Present



ClarisHealth

• United States
• Software Development
• 100 - 200 Employee

• Claims Specialist

  • Mar 2020 - Jun 2021

  • Reviewed, identified, and validated claim overpayments included but not limited to Duplicate Payment, Contract Compliance, Authorizations, Eligibility, Coordination of Benefits, Medical Review, Medicare, and Medicaid reimbursement policies• Worked with team members to ensure project goals are met efficiently and effectively• Achievement of individual productivity and quality goals• Communicated to management any issue(s) that would impede the accurate and timely review of claims • Worked with management to ensure that these issues were resolved• Gave feedback to management regarding query effectiveness and new query ideas• Acquired knowledge of the client's claims adjudication system, provider contracts, and basic client claim payment policies and procedures • Communicated with management issues that may have affected the review of claims• Communicated any discrepancies of the client's data as loaded in the data mining internal system• Validated claims to ensure the accuracy of query results and that no refund had previously been posted to clients' systems• Worked with management on clarification of matters as they rose through the course of the review• Informed manager of trends discovered in the review and validation process• Contacted appropriate parties to confirm that a valid claim has been identified - this could include but not limited to Providers, Members, and/or Other Health Insurance Carriers• Worked Accounts Receivable staff to research and/or answer questions from providers regarding overpayments



Community Health Systems

• United States
• Hospitals and Health Care
• 700 & Above Employee

• Pre Bad Debt Team Lead

  • Sep 2019 - Mar 2020

  • Coordinated daily workflow among team members• Monitored employee time on account reports to ensure that time spent on account review was purposeful and that appropriate action was taken• Directed MDI (Managing Daily Improvement) huddles with staff each day to improve team KPIs as well as company KPIs• Reported employee production and quality scores to Director and senior leadership• Composed job aides and performed job training for new hires and current staff• High dollar account review of self-pay accounts that could possibly qualify for charity or special programs• Contacted Facility CFOs weekly for high dollar account review and possible charity adjustment write offs when patient did not qualify for special programs• MVA and Auto Liability Claim review, follow-up, and management with Professional Account Services, filing and closing MVA Liens

• Overpayment Anaylst Trainer

  • May 2017 - Sep 2019

  • Processed refunds to patient and insurance accounts, maintained appropriate knowledge and understanding of all Managed Care Contracts, Federal payers, and CHS policies• Trained Past and Present Employee's on procedures for reviewing, identifying, and submitted refunds and adjustments as needed on credit and non-credit balance accounts• Worked insurance overpayments request letters received via BARRT, faxes and telephone requests• Prepared daily Credit Balance reports• Analyzed issues causing credit balances• Ensured compliance procedures were followed for prompt recording of all refunds• Coordinated any refund issues with Reimbursement Manager/Supervisor and Reimbursement Specialists as needed• Assisted with month end reporting to ensure that all credit balances and high account variances were resolved to ensure clean A/R was reported appropriately by facility CFOs

• Discovered Insurance Rep

  • May 2014 - May 2017

  • Followed up with Commercial and Government Payers for Claim status and payment information• Billed Medical Claims via Mail and Fax• Verified claim integrity prior to Billing• Reviewed payment postings for correct Patient Responsibility and Contractual Adjustments• Reviewed EOB'S and Correspondence from Carrier• Sent Correct Letters to Patient to update COB or Balance Owed• Filed Appeals for No Authorization, Timely filing, and Non-Medical Necessity Claims• Submitted Request for Coding, Billing Errors via internal software



PathGroup

• Hospitals and Health Care
• 500 - 600 Employee

• Cash Poster/Labtech

  • Jun 2006 - Apr 2014

  • Posted Insurance Payments• Posted cash for all payers• Posted electronic files• Posted client payments• Posted patient payments• Balanced and log all cash• Balanced month end reports• Posted all payments according to fee schedule and EOB's or EOP'S• Identified duplicate payments• Requested refunds to insurance companies• Analyzed and corrects unbalanced cash amounts• Entered missing contractual adjustments• Entered denial codes into system to set up for Insurance billing• Entered telephone and credit payments in an accurate and timely manner