Experience

Laureate Medical Group

• Medical Practices
• 1 - 100 Employee

• Quality Assurance Manager

  • Feb 2023 - Present

  •Understands protocols of triage nurse calls and refill department. •Perform audit on Refill Department calls regarding refill requests and prior authorizations (PAs). •Review documentation refill requests and prior authorizations for accuracy. •Determine correct work flow for PAs through E-Auth system and CoverMyMeds.com. •Coach refill agents on their audited calls and documentation. •Train new hires for refill department as needed. •Collaborate with Refill Supervisor to… Show more •Understands protocols of triage nurse calls and refill department. •Perform audit on Refill Department calls regarding refill requests and prior authorizations (PAs). •Review documentation refill requests and prior authorizations for accuracy. •Determine correct work flow for PAs through E-Auth system and CoverMyMeds.com. •Coach refill agents on their audited calls and documentation. •Train new hires for refill department as needed. •Collaborate with Refill Supervisor to create incentive program for individual/team goals that were met. •Participates in activities designed to continue professional self-improvement. •Per requests of management and leadership, pull calls of any employees; refill agents, scheduling agents, nurses, triage nurses, TAs, MAs, leadership, and etc. •Provide QA updates to the Refill during Refill Team huddles weekly. •Communicate with management/leadership and front office staff of inaccuracies of Blue Cross Blue Shield insurance during pre-visits/check-ins, to have the front office staff to update corrections to errors at all locations. •Update the Patient Satisfaction Survey report to management monthly. •Managing time effectively to complete assignments. •Collaborates with director, medical staff and office staff regarding operational issues and systems improvement. •Utilizes leadership principles to initiate, prescribe, influence, and facilitate changes in clinical practice when appropriate. •Presents findings and recommendations to managers, directors, CEO, board, and physicians. •Assists Senior Leadership to interpret reports, identify trends, analyze variances, and recommend changes in treatment practices or departmental workflow. •Work remotely but travel to all locations when needed. Show less



Emory Healthcare

• United States
• Hospitals and Health Care
• 1 - 100 Employee

• Denials Management Specialist (Promoted)

  • May 2018 - Nov 2023

  Atlanta, Georgia, United States •Challenge government and commercial payers (including TPAs) for payment discrepancy from expected payment minus payer allowed amount per contractual fee schedule. •Per fee schedule, submit reconsideration and/or appeals for difference in payment discrepancy. •Follow denials worklist prioritization of invoices established by department policies and procedures with resolution. •Researches, responds, and documents insurer and patient correspondence/inquiry notes regarding coverage… Show more •Challenge government and commercial payers (including TPAs) for payment discrepancy from expected payment minus payer allowed amount per contractual fee schedule. •Per fee schedule, submit reconsideration and/or appeals for difference in payment discrepancy. •Follow denials worklist prioritization of invoices established by department policies and procedures with resolution. •Researches, responds, and documents insurer and patient correspondence/inquiry notes regarding coverage, benefits, and reimbursement on patient invoices. •Review EOBs and payer portals to identify and verify frequent root causes of denials and route to correct department or responsible party. •Review EOBs and payer portals to identify and verify frequent trends causing underpayments and create reports to escalate to management/ manage care representative for resolution. •Managing time effectively to complete assignments within established time frames, optimize collections, and meet performance metrics. •Timely and appropriate response to phone calls, internal questions, and correspondence from various departments, outside agencies, and payers regarding information pertaining to the resolution of denied claims. •Works collaboratively with physician offices, Patient Access, Utilization Review, HIM, and facility clinicians to correct deficiencies in a timely manner. • Main systems used to resolve underpayments; EPIC, Excel, Microsoft Outlook, and payer portals for government & commercial payers, and various third-party administrators.

• Accounts Receivable Specialist III (Promoted)

  • 2018 - Nov 2023

  Atlanta, Georgia, United States • Work with team and independently to resolve patient account issues; currently working remotely. • Meeting metric expectation 8 invoices per hour by resolving invoices, choose outcomes to escalate for further assistance, or forwarding to correct departments for resolution. Main systems used to resolve invoices; Centricity (GE), Power Chart, SA Viewer (Anesthesiology Access), Excel, Microsoft Outlook, and payor portals. • Mainly follow up on patient accounts by completing accurate… Show more • Work with team and independently to resolve patient account issues; currently working remotely. • Meeting metric expectation 8 invoices per hour by resolving invoices, choose outcomes to escalate for further assistance, or forwarding to correct departments for resolution. Main systems used to resolve invoices; Centricity (GE), Power Chart, SA Viewer (Anesthesiology Access), Excel, Microsoft Outlook, and payor portals. • Mainly follow up on patient accounts by completing accurate resolution of credit balance invoices through inquiring about status of payments from insurance carriers by telephone, Emory's systems, email, payor portals, websites, and research efforts. Making sure of accurate posting of insurance company, patient payments, reimbursements, contractual adjustments, and denials. When appropriate, submit explanation of benefits, medical records, and other required documents to Insurance and TPAs by hard copy or electronic submission. Communicate with collections staff to ensure timely and accurate rebill of accounts. Ensure that payments are received within appropriate timeframe; immediately bill secondary insurance or patient and apply the appropriate allowance and adjustments. • Maintain knowledge of current government/hospital contracts with insurances and familiarize with UB92 and HCFA billing manuals. Maintain knowledge of insurance rules, referral requirements through the insurance websites & portals and verifying through Emory’s systems. • Obtain/verify 75 patient demographics and insurance information for registration in the GPR System weekly. • Assist in the new hire training and development of new staff members through the quality assurance process. • Provide support to leadership by communicating trends, updates, and valuable information to resolve patient account billing; provide improvement by reporting problems, concerns, and opportunities to increased revenue and decreased denials.

• Patient Access Specialist (Promoted)

  • May 2018 - 2018

  Decatur, GA •Obtain/verify 75 patient demographics and insurance information for registration in the GPR System weekly. •Use Centricity, GPR, and PowerChart to schedule up to 30 appointments and procedures; provide location, time, and special instructions. •Use Microsoft Outlook to obtain referrals, orders, and required patient documentation. •Escalate clinical/administrative concerns using EMR Messaging through PowerChart/email/phone. •Train new hires in specific departments and serve as a… Show more •Obtain/verify 75 patient demographics and insurance information for registration in the GPR System weekly. •Use Centricity, GPR, and PowerChart to schedule up to 30 appointments and procedures; provide location, time, and special instructions. •Use Microsoft Outlook to obtain referrals, orders, and required patient documentation. •Escalate clinical/administrative concerns using EMR Messaging through PowerChart/email/phone. •Train new hires in specific departments and serve as a mentor to new Access Associates. •Improved new patient and follow-up scheduling process by 30 percent compared to last quarter by implementing scheduling details in the EMR Messaging system.

• Patient Access Specialist

  • May 2018 - 2018


Target

• Mexico
• Appliances, Electrical, and Electronics Manufacturing
• 1 - 100 Employee

• Human Resources Specialist (Promoted)

  • Sep 2013 - Dec 2015

  East Point •Created employee scheduling, managed payroll, and monitored attendance/meal compliance through Workday/HRIS. •Processed applicant screening and managed position openings through Taleo. •Conducted new hire orientation and managed I-9 and new hire information. •Organized Fast-Fun-Friendly events for employees for morale. •Assist and validate employee training through Target’s systems. •Implemented performance recognition and promotions for employees. •Made outbound/inbound… Show more •Created employee scheduling, managed payroll, and monitored attendance/meal compliance through Workday/HRIS. •Processed applicant screening and managed position openings through Taleo. •Conducted new hire orientation and managed I-9 and new hire information. •Organized Fast-Fun-Friendly events for employees for morale. •Assist and validate employee training through Target’s systems. •Implemented performance recognition and promotions for employees. •Made outbound/inbound calls to communicate for Management team and be liaison for Target’s Benefit Center. •Improved completed annual training for 2014 for all employee at 97 percent compared to 88 percent in 2013. Show less