Aisha Campbell
Houston,TX
Summary
Dedicated Reimbursement Specialist with exemplary analyzation and negotiation abilities. Highly skilled in customer service and coverage evaluation. Specializing government,commerical ,charity insurance claims with a well-established knowledge of the general industry.
Overview
17
17
years of professional experience
Work History
Reimbursement Specialist
St Luke's Healthcare System
06.2022 - Current
- Delivered timely information to insurance representatives to resolve common and complex issues.
- Receives, sends and documents payer requests for clinical documentation.
- Receives and documents payer authorization and communications including but not limited to concurrent denials.
- Coordination of peer to peer conversations, as applicable.
- Reviews surgery schedule to verify correct authorization is documented, if applicable.
- Identifies accounts lacking authorization and follows up with payers, as needed.
- Communicates with interdepartmental staff regarding payer documentation requests.
- Under RN direction submits requests for and follows up on administrative days authorization, where indicated.
- Identifies and reports trends to department Leadership.
- Utilizes payer related reports from Care Management software, where applicable.
- Collaborates with and supports the UM team including but not limited to UR and Denials RN.
- Contributes to the identification of opportunities for process improvement.
- Supports administrative departmental functions, as assigned.
- Other job duties as assigned.
Reimbursement/ Appeals Coordinator -Lead
Pyramids Pharmacy
01.2019 - 07.2022
- Submit appeals and Iro for biologics and infusions medication to commercial, medicare and medicaid plans
- Obtained Prior Authorization and Redeterminations from medical and pharmacy benefits
- Received and replied to all doctor inquiries about patient accounts and deliveries
- Obtain patient assistance for patient with no insurance
- Received and sent updated status though EMR systems
- Maintain and update patients accounts with accurate information
- Handle escalation calls from doctors, patients, insurance and marketers
- Billed correct and accurate J-Codes and CPT Codes
- Weekly training on medications and process for pharmacy.
- Developed appeals functions, policies and procedures and documentation.
- Acted as a departmental resource on appeals matters.
Reimbursement Specialist
Southside Pharmacy
02.2018 - 03.2020
- Complete benefit and prior authorization request accurately to ensure payer reimbursement
- Contact MD office, patient, or appropriate sales representative if additional information is needed or required
- Enter complete and accurate notes all systems and send updates to appropriate person
- Assisting in finical assistance or enrolling patient in programs
- Answering incoming calls and outbound call to patient, insurance plans, and patient for updates
- Submitted authorizations for biologics, PSK9, osteoarthritis drugs to pharmacy or medical benefits
- Trained new employees on process.
- Coordinated with insurance providers to verify customer's policy benefits in relation to claims.
- Employed clinical and billing codes expertise to correct billing inconsistencies.
- Delivered timely information to insurance representatives to resolve common and complex issues.
Authorizations / Billing Specialist
Nova Medical Center
01.2017 - 10.2017
- Maintain and track pre-authorizations with strong attention to detail
- Billed codes to insurance companies
- Maintain appropriate logs for workers comp for state requirements
- Obtain insurance referrals and authorization from insurance carriers
- Verified commercials, private and state insurance
- Obtain authorization for clinic for workers comp patients.
- Worked with multiple departments to check proper billing information.
- Assisted with billing inquiries and provided timely responses to enhance customer satisfaction.
Patient Account Specialist / Self Pay
Ascent Revenue Management
05.2016 - 01.2017
- Collected on accounts by sending invoice reminders and communication with customers via phone, email, fax or mail
- Verified insurance coverage, deductible, copays and coinsurance
- Worked insurance denials by sending appeals on Out-of-Network Claims
- Arranged payment plans with patients.
- Worked with outside entities to resolve issues with billing, claims and payments.
- Posted payments and processed refunds.
- Contacted patients after insurance was calculated to obtain payments.
- Electronically submitted bills according to compliance guidelines.
- Reconciled statements with patient records.
Patient Account Specialist
Sutherland Global
05.2015 - 12.2015
- Created Authorization and referrals for Veterans to be outsourced to different providers
- Verified insurance coverage for commercial and government
- Scheduled appointments for Veterans
- Received incoming calls for benefits and scheduling.
Account Recovery Specialist
Acs / Xerox
04.2012 - 08.2012
- Answer incoming calls from providers, patients and insurance companies for workers comp
- Billed and collected on old aging accounts for commercial and government claims
- Arranged payment plans with patient to settle the accounts
- Verified insurance coverage through website and over the phone.
Secondary Biller
Medco
06.2011 - 03.2012
- Billed primary and secondary insurance claims
- Insurance verification on medicare, medicaid and government insurance
- Collected on DME accounts and send patient statements out
- Posted correct payments to accounts for DME
- Follow up on aging accounts.
- Identified, researched, and resolved billing variances to maintain system accuracy and currency.
- Executed billing tasks and recorded information in company databases.
- Followed up with appropriate parties to obtain prompt payments.
- Checked insurance eligibility by making appropriate phone calls and conducting research on services rendered.
Account Recovery and Billing Specialist 1
Benefit Recovery
03.2008 - 04.2011
- Billed and collected on Veterans hospital claims
- Verified insurance coverage phone and internet
- Trained new employees
- Posted insurance and patient payments to account
- Audited and evaluated accounts for approval.
- Assisted with billing inquiries and provided timely responses to enhance customer satisfaction.
- Monitored customer accounts to identify and rectify billing issues.
- Worked with multiple departments to check proper billing information.
Education
Associate of Science -
Houston Commumity College
Houston, TX05.2024
Health Technology -
Lone Star College
Houston, TX12.2023
CNA -
Houston Community College
03.2020
Medical Assistant -
Sanford Brown
Houston, TX01.2008
Skills
- Data Recording
- Bookkeeping
- Claims Processing
- Client Service
- Clerical Writing
- Policy Evaluation
- Eligibility Verification
- Customer Service
- Multitasking Abilities
- Medical Coding
- Ethical Conduct
- Electronic Health Records
- Interpersonal Skills
- Medicare and Medicaid Knowledge
- Team Collaboration
- Adaptability
- Account Reconciliation
- Conflict Resolution
- Medical Billing
- Insurance Verification
- Patient Communication
- Payment Posting
- Critical Thinking
- Revenue Cycle Management
- Denial Management
- Analytical Skills
Timeline
Reimbursement Specialist
St Luke's Healthcare System
06.2022 - Current
Reimbursement/ Appeals Coordinator -Lead
Pyramids Pharmacy
01.2019 - 07.2022
Reimbursement Specialist
Southside Pharmacy
02.2018 - 03.2020
Authorizations / Billing Specialist
Nova Medical Center
01.2017 - 10.2017
Patient Account Specialist / Self Pay
Ascent Revenue Management
05.2016 - 01.2017
Patient Account Specialist
Sutherland Global
05.2015 - 12.2015
Account Recovery Specialist
Acs / Xerox
04.2012 - 08.2012
Secondary Biller
Medco
06.2011 - 03.2012
Account Recovery and Billing Specialist 1
Benefit Recovery
03.2008 - 04.2011
Associate of Science -
Houston Commumity College
Health Technology -
Lone Star College
CNA -
Houston Community College
Medical Assistant -
Sanford Brown
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