Yetta W.
Lead Financial Clearance Specialist/Patient Financial Services at Montefiore Nyack Hospital- Claim this Profile
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Topline Score
Bio
Credentials
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Certified Application Counselor
Marketplace Health Insurance ServicesSep, 2017- Nov, 2024 -
Certified Revenue Cycle Representative
Healthcare Financial Management Association (HFMA)Feb, 2015- Nov, 2024
Experience
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Montefiore Nyack Hospital
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United States
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Hospitals and Health Care
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200 - 300 Employee
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Lead Financial Clearance Specialist/Patient Financial Services
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Jun 2019 - Present
Under general supervision of the Operations Manager and the Financial Clearance Manager Leads small team in coordination of authorization and denial activities between PFS Patient Service Center, insurance companies, patients, PFS billing, and referring practicesEnsures all tasks related to obtaining insurance authorizations for diagnostic imaging tests and/or procedures - primarily in Paragon System- meet defined performance metrics. Direct accountability for authorization related financial outcomes, leads statistical performance tracking and measurable service improvement initiatives. Has a broad knowledge of principles, practices, and procedures relating to authorizations and a track record of success; uses this insight to identify areas where operational efficiency gains can be achieved; leads service improvement initiative PFS to staff; provide effective daily direction and communication, continually evaluates staff performance and provides timely and effective feedback. Ensures employees have appropriate training and other resources to perform their jobs; responds to and resolves/escalates employee relations issues expressed by team members. Creates and maintains a high-quality work environment so team members are inspired to perform at their highest level. Participates in staff selection, training and review process Works as a member/leader of special projects that are critical to continual process improvement
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Financial Clearance Specialist/Patient Financial Services
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Jul 2017 - Jun 2019
Collection of financial and demographic data interview, instructs and assists in the completion of Medicaid applicationMonitors all self –pay patients, inquiring about coverage, offering options and assistance to realize paymentWorks with Case Management to expedite insurance related placement issues to reduce length of stayResponds to billing inquiries and resolves problems for walk-in patients and guarantorsMaintains follow-up on pending Medicaid decisions for timely reclassification and rebillingPerforms auditing functions to ensure ongoing registration qualityContacts insurance carriers and confirms authorizations and benefits prior to elective services or with 24 hours of urgent/emergent admissionMinimizes accounts not selected for billing and their impact on revenue cycle recognizes and addresses deficienciesFormats collection notes accurately, availing users timely access to pertinent financial informationCases needing financial clearance such as diagnostic testing, surgery, pathology and lab workPayment options (Charity Care and Payment plan) to uninsured patientsDemonstrates positive communication with people of different cultures, values and beliefs
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NYU Langone Health
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United States
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Hospitals and Health Care
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700 & Above Employee
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Financial Services Associate/Outpatient Department
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Nov 2012 - Jun 2017
Ability to reconcile high volume of accounts provides analytical review of accounts and coordinates communication between departments to ensure resolution of claimsHospital claims follow-up and resolution experience with detailed knowledge of claims adjudications process for commercial managed care carriersInsure accuracy of insurance claims, verify correct ICD-9 and CPT codes for a verify of specialties Special projects that are assigned by the management teamAccess EPIC updates patient demographics, update patient insurance coveragesCheck all Verification of insurances before submission Knowledge with insurance authorization and denialsEnsures work is performed in compliance with company policies including privacy/HIPAAElectronic billing verified correct coding and charge to ensure clean billing up to over 3,000 claims dailyProven the ability to solve problems and adapt to change quicklyExperience with and ability to work with multiple hospital claims systemsUpdate and adjust the coding adjustment spreadsheet by reversing charges and billing accounts on a daily bases Charge and supply posting on patient accountsAdd procedure codes to billed claims on a daily basesWork Medicare and Medicaid commercial claims on electronic Epremis systemWork all Epremis rejections update and correct all patient guarantors and insurances
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Aptium Oncology
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United States
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Hospitals and Health Care
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1 - 100 Employee
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Patient Account Representative/Clinical Cancer Center
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Sep 2007 - Nov 2012
Resolved customer complaints via phone, email, mail, or social media.Used telephones to reach out to customers and verify account information.Greeted customers warmly and ascertain problem or reason for calling.Canceled or upgrade accounts in SMS or HTS databaseAssisted with placement of orders, refunds, or exchanges.Advised on company information.Took payment information and other pertinent information such as addresses and phone numbers Placed or cancel orders.Answered questions about the patient accountProcessed all payments and receipts including credit card transactions. Created and updates service contracts and contract purchase orders. Reconciled all financial activity (invoices, interdepartmental invoices, journal entries, cash receipts, etc.) Makes corrections and re-classifies transactions as needed to ensure consistent reporting on excel spreadsheet
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Medical Billing/Finance Department
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Feb 2007 - Jul 2007
Sent to Medicaid the billing record with in the first three business day after the pay period Kept the information up to date at the billing system batch denied declaim Reviewed and resend billing and any other required to Medicaid Made monthly reports regarding billing amount collected amount with information such as dated invoice numbers providers name check numbers .Kept backup filed up to date Entered new employees information Solved payroll procedures problems and worked issue regarding the fiscal Made all duties assigned to the finance department Sent all Medicaid claims to eMedny for processingMedical Biller/Revenue Cycle Department
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Columbia University Irving Medical Center
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United States
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Hospitals and Health Care
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700 & Above Employee
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Medical Biller/Revenue Cycle Department
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Jun 2004 - Feb 2007
Reduced accounts receivable by following up on unpaid claims with third party payers patients or other accounts responsible partiedInvestigated assigned accounts to determine what additional steps must be taken for claims to be paidMaintain a through working knowledge of all aspects of billing and collectionsIncluded billing rules and regulation collections procedure coding and applicableProcesses HFCA 1500 requirement diagnosis and procedure coding and applicable country state and federal requirementsResearched and responded to insurance request address incoming correspondence and prepared correspondence to insurance companies patient and or guarantor as necessaryAssisted with claims including accounts that are delinquent initiates appropriate action and maintains recordsContacted insurance companies and or patient guarantor through direct contact letters or other means of due diligence updated the online system with accurate and completed informationChecked status of claims using online functionality and automated system as necessaryReviewed accounts history for third party sponsorshipEstablished payment arrangements according to present guide lines document information on IDXBARPhysician billing or third party payer
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Medical Biller/Case Management
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Apr 2002 - Jun 2004
Conducted data entry for patient information admissions hospital stay ambulatory surgeries and discharges Contacted and collaborate with various Medicaid and Medicare agencies daily to managed and coordinate patient medical collection and follow up on third party reimbursements and payment posting appeals approval and denial reviewed and requested for clinical information Corresponded with IPRO regarding patient refusal in being discharged Provided assistance to the Social Work and nursing homes to ensure and coordinated proper placement for patient in need of home care services Performed general administrative support of office management Received incoming authorizations from providers Reviewed new born admission
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Education
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2012 - 2014
Ashford University
Master's Degree, Health Care Administration (MHA), -
2010 - 2012
Ashford University
Bachelor's Degree, Business Administration (BBA) Finance
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