Alexis Biggins
Jacksonville,FL
Summary
Methodical Revenue Cycle Specialist with strong attention to detail and in-depth understanding of billing procedures. Excellent planning and problem-solving abilities. Prepared to bring ten years of related experience to a dynamic position with room for career growth. Energetic leader with over seven years of customer service, lending and leadership experience; extremely flexible, with ability to work with large diverse teams. Production trained leader with a strong consumer banking, customer service, sales, medical, accounting, risk, card service and retail banking background; excellent written and verbal communication skills; along with a thorough knowledge of customer service policies, procedures, spirit, and core values. Motivated leader with ability to influence, and enhance skills, strong well-organized work habits, able to function smoothly in pressured situations to meet service levels and deadlines; excellent team building skills, ability to grow the business with excellent coaching skills. Analytical problem solver, strong decision making skills and financial management skills, Word, Excel and more. Verifying insurance Medical terminology Regulatory compliance Multi-line telephone operation Insurance coding (ICD-10 and CPT) Analyzing claims MS Office Organization Relationship development Team building Project organization, Authorized to work in the US for any employer.
Overview
13
13
years of professional experience
Work History
Claims Resolution Specialist
Baptist Medical Center
11.2022 - Current
- Gathered and reviewed rejected claim information in order to develop successful resolutions.
- Processed payments, refunds and adjustments.
- Detailed coverage, liability and reasons for denial of claims to policyholders, attorneys and third-party providers.
- Maintained knowledge of policies and procedures and insurance coverage benefit levels, eligibility systems and verification processes.
- Sent clinical request and missing information letters to obtain incomplete information.
- Enhanced claims processing efficiency by streamlining workflows and implementing time-saving procedures.
- Reduced claim resolution times with thorough investigation and effective communication among involved parties.
- Collaborated with various departments for comprehensive claim evaluations, improving overall outcomes.
- Contributed to team success by consistently meeting or exceeding individual performance metrics for claim resolution.
- Increased accuracy in claims assessment through meticulous record-keeping and organized documentation.
Registrar
HCA Memorial Health University Medical Center
10.2022 - 02.2023
- Answered questions and fulfilled requests with friendly and knowledgeable service.
- Registered patients for diagnostic appointments, surgeries and medical consultations using electronic health record system.
- Proofread documents carefully to check accuracy and completeness of all paperwork.
- Interviewed patients to complete documents, case histories and intake and insurance forms.
- Collected, evaluated and stored documents securely in permanent records.
- Processed patient medical records requests in compliance with HIPAA guidelines.
- Accessed patient charts to collect, abstract and extrapolate patient data.
- Pushed computer cart to register patients at bedside and obtain account information.
- Utilized reporting system to print patient charts, labels and future appointments report.
- Streamlined registration processes by implementing efficient online systems and reducing wait times.
Medical Administrative Assistant
Mayo Clinic
06.2022 - 11.2022
- Managed physician calendar, scheduling patient appointments and procedures.
- Making travel arrangements; answering telephones and providing related follow-through; filing; preparing reports, meeting agendas and minutes, and presentation materials; processing reimbursement for travel and other professional expenses; and maintaining records.
- Routinely serves as a resource and mentor to others as opportunities arise.
- Demonstrates initiative, proficiency, and good judgment to optimize the time of those supported.
- Strong organizational and communication skills and a commitment to quality and excellence in service are important components of the role.
Patient Financial Counselor
Cancer Specialist of North Florida
07.2021 - 06.2022
- Attending and participating in meetings, training, and presentations
- Completing financial applications
- Furnishing patients and health care providers with estimates
- Assisting patients with financial applications and arrangements
- Collecting estimated liabilities from patient
- Communicate with patients and insurance companies on the phone
- Appropriately document and report payment information
- Educate patients about payment options and financial assistance
- Negotiate and strategize patient payment arrangements
- Update patient accounts and balances
- Review and process patient and insurance company forms
- Obtain referrals for new patients.
Revenue Cycle Specialist- Team Lead
Baptist Health
12.2016 - 07.2021
- Supported company in maintaining work environment focused on quality, communication, collaboration, integration and team work
- Created, edited and updated forms and documentation used by quality assurance team
- Collaborated with management to provide training and assist with creation and maintenance of quality training
- Facilitated WebEx training for several service lines .Educated employees on specific QA standards and confirmed maintenance of standards
- Gathered data on integration issues and vulnerabilities and reported all findings, including improvement recommendations
- Developed monthly, end-of-quarter and other statistical reports, including analysis for leadership team
- Promoted adherence to quality standards by educating agents on quality assurance standards
- Create training material for education purposes.
- Conducted training sessions for junior QA analysts, enhancing their skills and knowledge of industry best practices.
Referral Coordinator
Baptist Health
12.2016 - 07.2021
- Provides referral assistance to physicians, patients, and insurance companies
- Obtains authorizations
- Knowledge of insurance verification and other related activities
- Serves as a coordinator, expert and liaison for patient and practice for referral coordination, scheduling and other office functions
- Responsible for maintaining patient flow by coordinating referral and appointments
- Responsible for accurate data collection, documentation, and data retrieval with computerized and paper systems
- Ability to perform registration processes, insurance verification, co-payments, authorizations, and referral inquiry functions
- Assists in maintaining medical records and filing systems
- Assist with clerical and secretarial support
- Interfaces with multiple departments.Maintained accurate records on in-progress and completed referrals, ensuring full data integrity throughout process.
Senior Customer Service Representative
AETNA
03.2015 - 12.2016
- Answers questions and resolves issues based on phone calls/letters from members, providers, and plan sponsors
- Documents and tracks contacts with members, providers and plan sponsors
- Explains member's rights and responsibilities in accordance with contract
- Processes claim referrals, new claim handoffs, nurse reviews, complaints (member/provider), grievance and appeals (member/provider) via target system
- Responds to requests received from Aetna's Law Document Center regarding litigation; lawsuits
- Determines medical necessity, applicable coverage provisions and verifies member plan eligibility relating to incoming correspondence and internal referrals
- Handles incoming requests for appeals and pre-authorizations not handled by Clinical Claim
- Management
- Performs review of member claim history to ensure accurate tracking of benefit maximums and/or coinsurance/deductible
- Uses applicable system tools and resources to produce quality letters and spreadsheets in response to inquiries received.
Member Service Representative
Citibank
10.2010 - 03.2015
- Responsible for assisting with customer accounting request; responsible for helping make sure team exceed quality assurance and customer delight goals and Net promoter score; accountable for leading projects and leading peers by example;maintain effective service levels, completing quarterly evaluations, compliance training, completing yearly performance reviews
- Responsible for obtaining billing and collecting payments
- Learned all internal systems and related service role duties to provide skilled team backup in handling customer demands
- Achieved and consistently exceeded revenue quota through product and service promotion during routine calls.
Education
Associate of Science -
University of Phoenix
Tempe, AZ12.2026
High School Diploma -
William M. Raines High School
Jacksonville, FL05.2006
Skills
- EPIC
- Payer portals expertise
- Allscripts/Touchworks
- Cerner
- Caseload management
- Conflict resolution
- HIPAA regulations
- Patient support
- Service referral
- Case management
- Cultural awareness
- Written communication
- Quality assurance
- Diagnostic Testing
- Communication Skills
- Staff Meetings
- Performance Improvement
- EPIC
- Policy Coverage Determinations
- Billing Procedures
- Adjustments Processing
- Benefits Coordination
- Documentation Review
- EMR Systems
- ICD-10
- Project Leadership
- Medical Records
- Medical Terminology
- Financial Management
- Policy Coverage Understanding
- Coding Expertise
Timeline
Claims Resolution Specialist
Baptist Medical Center
11.2022 - Current
Registrar
HCA Memorial Health University Medical Center
10.2022 - 02.2023
Medical Administrative Assistant
Mayo Clinic
06.2022 - 11.2022
Patient Financial Counselor
Cancer Specialist of North Florida
07.2021 - 06.2022
Revenue Cycle Specialist- Team Lead
Baptist Health
12.2016 - 07.2021
Referral Coordinator
Baptist Health
12.2016 - 07.2021
Senior Customer Service Representative
AETNA
03.2015 - 12.2016
Member Service Representative
Citibank
10.2010 - 03.2015
Associate of Science -
University of Phoenix
High School Diploma -
William M. Raines High School