Summary
Overview
Work History
Education
Skills
Certification
Professional Qualities
Timeline
Generic

Aleshia A. Blade

Royse City,TX

Summary

To secure a challenging position in a professional environment where I can leverage my strong organizational and communication skills to contribute to a consumer- and client-focused culture, while pursuing opportunities for growth and professional development.

Overview

11
11
years of professional experience
1
1
Certification

Work History

Revenue Integrity Analyst/ Credentialing Specialist

AllerVie Health
Frisco, TX
10.2023 - Current
  • Responsibilities included: Participate in credentialing, re-credentialing, licensing, and privileging activities maintain credentialing files and database with current and accurate provider information. Management of providers CAQH, NPPES and PECOS profiles. Maintain copies of current state licenses, DEA and CSR certificates, malpractice coverage, collaborative agreements and any other required credentialing documents for all providers, clinics, and facilities. Maintain proficiency in credentialing platforms, data tracking systems, and cross-functional workflows to support contract execution, maintain active network status, and prevent service disruptions due to credentialing gaps. Maintain professional communication with all providers, external customers, coworkers and management, correspond with providers as needed to obtain information in a professional manner. Managed multiple priorities effectively, resulting in the on-time completion of credentialing tasks for numerous providers simultaneously. Conducted audits of provider files, ensuring all necessary documents were up-to-date and compliant with regulatory requirements. Conducted primary source verifications such as background checks and board certifications.
  • Reduced revenue leakage by proactively identifying trends that led to underpayments or denials.

Sr. Revenue Cycle Analyst

AllerVie Health
09.2023 - Current
  • Responsibilities included: Assist billing /AR team with EDI claim submissions, rejections, medical documentation, follow-ups on payer denials, daily appeals, clearing house rejections, collections and revenue recovery for allergy and asthma specialty physician group. Analyze revenue cycle performance metrics, verify eligibility, evaluate referral and authorization status, identify denial trends and recommend areas for improvement. Apply critical thinking skills to compare payments to client contracts, audit claims against payer policies and or medical records to identify over and under payments. Knowledge of payer/provider contracts, rules, regulations and guidelines. Maintain compliance with State, Federal and Government programs that ensures ethical and compliant standards. Provide education and training to offshore teams as needed with a focus on appropriately identifying denial reasons and appeal strategies. Identify billing and coding errors, request claim resubmission with suggested corrections. Provide support to team members as a resource to improve daily productivity, revenue increase, and manage special projects simultaneously that result in optimal reimbursement. Approve final denial adjustments and patient refunds.

Revenue Cycle Analyst Supervisor

ERISA Recovery
Dallas , TX
04.2017 - 08.2023
  • Responsibilities: Supervisor of the claim analyst team follow up on outpatient/inpatient claims, daily appeals, and revenue recovery. Provide knowledge of payer contracts, provider rules, regulations, and guidelines as well as payor medical policies. Maintain compliance with State, Federal and Government programs that ensures ethical and compliant standards. Provide education and training to staff as needed and appropriate to identify denial reasons with appeal strategies. Knowledge of self-funded/fully funded employer plans that will apply to ERISA and DOI guidelines according to employers Summary Plan Descriptions. Provide analytical support to team members as a resource to improve daily productivity and efficiency. Investigate review and provide clinical and coding expertise as a resource to provide written communication to providers and payors. Monitor workloads, set priorities, manage team system access with clients Work A/R daily denials, correspondence, and aging reports. Identify billing and coding errors, submit corrections for professional and institutional claims. Approve final denial write offs. Assist and manage special projects simultaneously that result in optimal reimbursement. Scrubbing, batching and submitting claims to the clearing house, revising rejected claims, updating procedure and diagnosis codes, posting payments and rejections. Participated in regular audits, proactively addressing any issues identified to minimize financial risks to the organization. Monitored daily reports, identifying trends or discrepancies that warranted further investigation or action from the revenue cycle team. Contributed to improved cash flow by monitoring and resolving aged account balances in a timely manner.

Collections Supervisor

Orthofix
Lewisville , TX
09.2016 - 04.2017
  • Responsibilities: Managing aged trial balance for assigned region(s) while meeting cash receipt goals based on revenue. Responsible for pursuing company and team goals, including cash collections metrics Review accounts daily to ensure billing with proper requirements and documentation. Analyze patient's medical file in conjunction with payer knowledge to effectively pursue payment. Utilize payer and product knowledge to develop and implement effective appeal requests. Recommend write-offs for approval after exhausting appropriate collection efforts. Share knowledge amongst peers and proactively suggest process improvements to management team. Exhibit and maintain strong performance in cash collections while professionally overcoming objections. Demonstrate professionalism in all internal and external communications. Handle multiple tasks and heavy volume with strong negotiation and persuasion skills. Ability to be detailed oriented with emphasis on quality while prioritizing work assignments and meeting all deadlines. Reviewed delinquent accounts daily, prioritizing efforts based on balance size and days past due status. .Duties and special projects as assigned.

Revenue Cycle Team Lead

US Renal Care
Plano, TX
09.2014 - 01.2016
  • Responsibilities: Analyze accounts, reconcile, and apply changes to patient accounts to correct charging issues. Initiate inquiries, either by telephone or in writing to resolve reimbursement and balance issues. Maintain tracking system of accounts worked and outcome of each contact. Perform account receivable follow up activities and/or audits for assigned payers (patients) using aged account work queues and accounts receivable reports. Initiate any follow up issues with appropriate parties and maintain tracking of all communications. Audit patient accounts for accuracy of insurance posting, proper secondary billing, and authentic patient balances. Respond to requests from third party payers and/or patients regarding reimbursement problems and issues. Work with clinical units to ensure billing issues are addressed in a timely, comprehensive, and proactive manner. Be responsible for identifying and documenting payer issues as they arise while communicating effectively with clinical units and staff. Prepare and submit insurance claims to carriers electronically or by hard copy billing. Assist with special projects as determined by management.
  • Promoted a positive work environment by fostering teamwork, open communication, and employee recognition initiatives.

Education

Some College (No Degree) - Healthcare Administration

School of Business And Economics
South Bend, IN

Skills

  • Medical Terminology certification, Microsoft Word, Medical Manager, PowerPoint, Excel, Next-Gen Applications, Epic, Athena Cerner Millennium, Centricity, Encoder, Meditech, Quadax, Xpeditor Claims Management, IMS Software, ICD-9 & 10, Billing/Procedure Codes, Med-Force, Internet Explorer, Microsoft Outlook, EMR/EHR applications, QMS Focus, Waystar, Change Healthcare, Oracle, Type 50 wpm
  • Claims processing
  • Denial management
  • Healthcare billing
  • Charge capture
  • Cash flow analysis
  • Auditing procedures

Certification

  • 2015 Pharmacy Technician Trainee Certification
  • 2016 Certified Revenue Cycle Representative (CRCR)
  • 2018 Certified Professional Coder – AAPC
  • 2021 All- Lines Insurance Adjustors Certification

Professional Qualities

  • I am an enthusiastic and proactive professional with strong leadership skills, capable of empowering and motivating teams to identify challenges and opportunities while achieving realistic goals. I adapt quickly to change and thrive in fast-paced, healthcare-driven environments, demonstrating flexibility and self-sufficiency.
  • I excel at prioritizing projects with attention to detail, working effectively under minimal supervision. As a quick learner with a positive attitude, I am eager to acquire new skills and take on additional responsibilities. Confidentiality, sensitivity, diplomacy, and cultural competence are core to my interactions with patients, families, healthcare professionals, and team members. I am an excellent communicator, maintaining professionalism in highly stressful situations, and effectively resolving issues across diverse ethnic and age groups.
  • With sound judgment, I review and manage complex claims in compliance with protocols, consistently recovering and collecting over $100,000 monthly in lost revenue from various sources, including Medicare, Medicare Advantage, SNF, Transplant Plans, Medicaid, and private commercial insurance plans.

Timeline

Revenue Integrity Analyst/ Credentialing Specialist

AllerVie Health
10.2023 - Current

Sr. Revenue Cycle Analyst

AllerVie Health
09.2023 - Current

Revenue Cycle Analyst Supervisor

ERISA Recovery
04.2017 - 08.2023

Collections Supervisor

Orthofix
09.2016 - 04.2017

Revenue Cycle Team Lead

US Renal Care
09.2014 - 01.2016

Some College (No Degree) - Healthcare Administration

School of Business And Economics

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