Adrianna Wesley
Arlington,TX
Summary
My name is Adrianna Wesley Im 29 yrs old and most of my career field has been in the healthcare industry for almost 10 years. I'm hoping to start a fresh new career in a new industry while still serving my community.
Overview
8
8
years of professional experience
1
1
Certification
Work History
Senior Revenue Cycle Specialist
Inform Diagnostics Inc.
Coppell, Texas
09.2024 - Current
- Handles correspondence related to insurance or patient account, contacting insurance carriers as needed to get maximum payment on accounts and identify issues and corrective action to be taken.
- Collaborate with leadership and other key stakeholders to make solution recommendations.
- Utilizes expert problem-solving skills to resolve complex billing issues, unpaid claims, and customer complaints, taking all steps and coordinating corrective action of a multi-functional nature to ensure full resolution of prompt payment.
- Examines all documents and analyze data to ensure bills are compliant. Determines appropriate steps and communicates critical information to insurance companies, patients, and leadership both verbally and in writing, to ensure concerns are resolved in a timely manner and accounts are settled in full.
- Communicates with carriers, patients, and management of all levels as needed to get maximum -payment/resolution on accounts and identifies/resolves issues or changes to achieve profitability.
- Demonstrates in-depth understanding of Medicare, Medicaid and private payors, policies and guidelines.
- Works aging reports/cases of unpaid claims to resolve claims.
- Assists as needed to perform other related duties and special projects as required.
- Communicated effectively with patients regarding their financial responsibilities and payment options.
- Processed appeals related to denied or rejected claims in a timely manner.
Surest Member services & Benefit specialist
UnitedHealth Group
Arlington, Texas
08.2022 - 09.2024
- Maintained accurate records of all member interactions using CRM software, enabling better data analysis for improved decision-making processes within the department.
- Answer incoming calls from (i.e physicians offices, clinics, members) and identify the types of assistance the provider or member needs. (EG. benefits, eligibility, billing and payments, authorizations for treatment, and explanation of benefits.
- Responded to customer calls and emails to answer questions about products and services.
- Verified customer identification and documentation for compliant transactions.
- Verify insurance carriers are listed in the company's database system, if not request the new carrier is entered.
- Deliver information and answer questions in a positive manner to facilitate strong relationships with providers and their staff.
- Communicate with Customer Service and Management on an ongoing basis regarding any noticed trends with insurance companies.
- Responsible for contacting patient when documentation received does not meet payer guidelines.
- Collaborated with team members to identify areas of improvement in customer service processes.
- Meet quality assurance requirements and other key performance metrics.
- Navigate multiple computer systems and applications and utilized search tools to find information for customer inquiries such as Icue, outlook, Dmev's, GPS, Acet, CSR, Genesis, sharpoint, Rally, Opendoor, Onenote, UHSS Portal, Knowledge Library KC, and more.
- Administered employee benefits programs, ensuring compliance with company policies.
- Worked closely with management to implement process improvements that directly impacted overall team performance metrics.
- Supported data analysis for benefits utilization trends and employee feedback.
Intake Specialist
Adapt Health
Saint Paul, Minnesota
07.2021 - 08.2022
- Develop and maintain working knowledge of current products and services offered by the company.
- Answer all calls and emails in a timely manner, in adherence to their goals.
- Document all call information and Answer questions about products and services.
- Process orders, route calls to appropriate resource, and follow up on customer calls where necessary.
- Review all required documentation to ensure accuracy.
- Accurately process, verify, and/or submit documentation and orders.
- Complete insurance verification to determine patient's eligibility, coverage, co-insurances, and deductibles.
- Obtain pre-authorization if required by an insurance carrier and process physician orders to insurance carriers for approval and authorization when required.
- Must be able to navigate through multiple online EMR systems to obtain applicable documentation.
- Enter and review all pertinent information in EMR system including authorizations and expiration dates.
- Facilitate resolution on customer complaints and problem solving while actively listening to patients and handling stressful situations with compassion and empathy.
Customer Care Coordinator
Reed Group
Minneapolis, Minnesota
08.2020 - 07.2021
- Be responsible for communication between the administrative team and the clinical team, for all parties in Family and Medical Leave Act (FMLA)
- Provide leadership to your Customer Care Professionals.
- Verifying documents.
- Ensure legal compliance and confidentiality, provide timely notifications to employees and client company, review documentation for approvals and denials, and respond to periodic audits.
- Assist your Customer Care team in identifying potentially fraudulent cases.
- Act as a liaison between your Customer Care Professionals and Case Managers.
- Escalate cases to the Clinical Case Manager as applicable.
- Serve as Subject Matter Expert on Leave of Absence programs at Reed Group and support your team with expert knowledge of client specific details.
- Build strong client relationships and provide quality service in an effort to retain client base knowledge.
- Demonstrate experience leading, mentoring, and inspiring staff to achieve superior results.
- Respond timely and accurately to client and internal inquiries, according to established standards with attention to style, tone, and manner of communication.
- Communicate important information on new/updated processes and procedures to staff.
- Provide ongoing client support with the use of diagnostic skills to identify root cause of client issues, develop solutions and recommend appropriate action to prevent recurrence of problem.
Administrative Assistant-
Park Nicollet Health System
Minneapolis, Minnesota
01.2019 - 03.2020
- Answer and Document all call information including responding to incoming calls through scheduling and phone messaging.
- Follow processes and procedures that support standard work including defined specific scripts that assure all calls and requests are handled in a timely, accurate and professional manner.
- In addition, employees will support areas within a medical setting with strong interpersonal skills and flexibility.
- Employees will maintain patient confidentiality to protect patient rights and excellent customer service.
- Relay messages to providers and nurse from patient in regard's to medical needs, such as symptoms, prescription, medication, pharmacy request, etc.
Repossession Specialist
Van Wagenen Financial Services
Eden Prairie, Minnesota
01.2018 - 01.2019
- File claims on damaged vehicles with insurance providers on behalf of the lien holder.
- Review and interpret terms and conditions on an insurance policy.
- Review photos and notes to determine if a vehicle is a total loss or salvable.
- Determined insurance coverage statuses.
- Request necessary paperwork from the client(s).
- Review and evaluate damage to determine compensation outcome.
- Identify vehicle frames and body parts.
- Create, fax and attach documents.
- Follow client's specific preferences and guidelines.
- Collect payments.
Education
ASSOCIATE IN ARTS (A.A.) -
MINNEAPOLIS COMMUNITY AND TECHNICAL
Minneapolis, MN08.2018
HIGH SCHOOL DIPLOMA -
WASHBURN HIGH SCHOOL
Minneapolis, MN06.2015
Skills
- Proficient in using standard office equipment
- WPM 30
- Knowledgeable in MS Office (Word, Excel, Outlook, PowerPoint)
- Empathetic
- Excellent interpersonal skills
- Customer Calling
- Customer Service
- Admin duties
- Office duties
- File organization
- Office supply stock levels
- Excellent mail processing support
- Fax distribution
- Routine filing
- Insurance verification
- Medical billing
- Data analysis
- Claims processing
Personal Information
Age: 28
Certification
Data analytics- Google Certificate
Timeline
Senior Revenue Cycle Specialist
Inform Diagnostics Inc.
09.2024 - Current
Surest Member services & Benefit specialist
UnitedHealth Group
08.2022 - 09.2024
Intake Specialist
Adapt Health
07.2021 - 08.2022
Customer Care Coordinator
Reed Group
08.2020 - 07.2021
Administrative Assistant-
Park Nicollet Health System
01.2019 - 03.2020
Repossession Specialist
Van Wagenen Financial Services
01.2018 - 01.2019
ASSOCIATE IN ARTS (A.A.) -
MINNEAPOLIS COMMUNITY AND TECHNICAL
HIGH SCHOOL DIPLOMA -
WASHBURN HIGH SCHOOL