Adria Allen
Austell
Summary
Diligent professional with solid background in managing patient health records. Proven ability to maintain accurate documentation and improve record-keeping processes. Demonstrated expertise in confidentiality and compliance with regulatory standards.
Overview
24
24
years of professional experience
Work History
Medical Records Specialist
Ortho, Sport & Spine Physicians
Atlanta, GA
01.2023 - 01.2025
- Processed 250+ medical record requests weekly with 98% accuracy, ensuring HIPAA compliance.
- Generated invoices and managed electronic distribution of records for patients, attorneys, and providers.
- Supported customer service calls, resolving inquiries efficiently and professionally.
Bilingual Healthcare Representative II
Change Healthcare
Atlanta, GA
01.2016 - 01.2023
- Interview admitted patients in a hospital setting and/or home visits to assist the clients in obtaining maximum benefit coverage.
- Make decisions to take a Federal, State, or local program application based upon medical definition of disability as it relates to body systems and to functions of daily living, and information contained in medical records.
- Completion of applications for state and federal programs (including Health Exchange/Marketplace programs, SSA Disability/SSI and Medicaid), analyze medical records and taking all necessary action to expedite benefit approval.
- Achieve and maintain certification designation as “Certified Application Counselor”.
- Adherence to company and legal standards regarding Protected Health Information (PHI), Personal Identifiable Information (PII) and Personnel Transaction Identifier (PTI).
- Maintain ongoing communication with government agencies regarding the status of applications.
- Provide updates and assistance to hospital personnel and other Change Healthcare staff as needed.
- Maintain documentation of claims status and client contracts on Change Healthcare and/or hospital computer systems.
- Assist with special projects for the company as needed.
- Assist call center with inbound and outbound calls from patients and/or family members to determine possible eligibility for state/federal benefits.
- Work effectively with hospital employees and patients.
Contract Implementation Analyst
Medical Card System
San Juan, PR
01.2015 - 01.2016
- Create daily production reports, assign daily the referred cases by other departments to the corresponding implementation technicians.
- Attend to meetings posted by the manager and vice president of Contract Implementation Department.
- Participate in training for other employees.
- All duties assigned as Special Contracts Auditor.
Special Contracts Auditor
Medical Card System
San Juan, PR
01.2010 - 01.2015
- Analyze and interprets institutional, professional, and special providers contracts and coordinates with the Configuration Department the implementation in Power MHS (JWalk).
- Translate the contracted services and convert them into processable codes (Revenue and CPT) according to industry standards.
- Maintain fee schedules of the contracted facilities in Power MHS and do modifications as necessary.
- Register demographic information for new contracts in Power MHS screens for the corresponding line of business.
- Review fee schedules once completed renegotiations of facility contracts and make sure they are assigned properly.
- Interprets facility and ancillary contracts and converts them into billing guides.
- Analyzes and identifies the reasons for professional and institutional claims that are not processable and modify configuration in Power MHS if necessary.
- Refer any situation of incorrect billing to external service representative for the proper orientation.
- Verify contract configuration in Power MHS made be Configuration Department and recommend corrective actions if necessary.
- Participate in special projects related to the configuration of special/facilities contracts as may be required, such as ambulatory surgery facilities, invasive cardiology packages, interventional radiology packages, new hospital grids, etc.
- Active participation and support in meetings with Claims Department and Facility Contracting area for the resolution of any kind of situations related to facilities configuration and
- Comply fully and consistently with standards, policies, and procedures of the company in conjunction with local and federal laws applicable to the health insurance industry.
Contracting Official
Medical Card System
San Juan, PR
01.2003 - 01.2009
- Start the new provider credential and re-credentialing process for existing providers (Provider Data Record, Primary Source Verifications, DEA, licenses, etc.)
- Evaluate documents and credentials in file of prospect providers.
- Send welcome packages to new providers (copy of contract, welcome letter indicating effective date of contract, contracted fee schedules)
- Maintain demographic information.
- Configure new providers contracts, including USVI, US providers and medical groups.
- Receive and resolve calls and emails related to contracting process.
- Participate in Contracting and Credentialing Committee.
- Verify and correct configuration error reports.
Receptionist/Front Desk Clerk
Medical Card System
San Juan, PR
01.2001 - 01.2002
- Receive phone calls and public in general.
- Channel situations to the correspondent area.
- Sort and distribute the mail received.
- Maintain inventory of office supplies and order required materials.
Education
Bachelor’s Degree - Pre-Medicine General Science
Caribbean University
Bayamón, PR01-2013
Skills
- Knowledge in physician and hospital billing (HCPCS/CPT/Revenue Codes)
- Microsoft Office
- EPIC
- Cerner
- Bilingual (Spanish/English)
- Adaptability in managing multiple priorities
- Organized, good interpersonal and communication skills
- Analyzing and problem solving oriented
- Great working under pressure
- Low or no supervision required
- Commitment to quality
- Attention to details
- Medical Records Management
Languages
English
Native or Bilingual
Spanish
Native or Bilingual
Timeline
Medical Records Specialist
Ortho, Sport & Spine Physicians
01.2023 - 01.2025
Bilingual Healthcare Representative II
Change Healthcare
01.2016 - 01.2023
Contract Implementation Analyst
Medical Card System
01.2015 - 01.2016
Special Contracts Auditor
Medical Card System
01.2010 - 01.2015
Contracting Official
Medical Card System
01.2003 - 01.2009
Receptionist/Front Desk Clerk
Medical Card System
01.2001 - 01.2002
Bachelor’s Degree - Pre-Medicine General Science
Caribbean University