Hi, I’m
ALICIA BELOW
Scott City,MO
Summary
Detail-oriented Quality Assurance Specialist with over ten years of experience in healthcare revenue cycle management and clinical documentation review. Conducts quality audits of medical-legal disputes, ensuring compliance with federal CMS standards. Manages high-volume workloads while maintaining attention to detail in remote settings. Specializes in policy analysis, claims processing, and regulatory compliance, fostering effective team coordination and client communication.
Overview
11
years of professional experience
Work History
Provider Resources, Inc.
Quality Assurance Analyst
02.2025 - Current
Job overview
- Conducted rigorous quality reviews of independent dispute resolution cases to ensure 100% accuracy and federal regulatory compliance.
- Executed quality audits to verify compliance with company standards and uphold operational integrity.
- Performed internal audits to measure adherence to established quality assurance standards.
- Analyzed complex clinical and billing documentation to identify error trends, utilizing advanced Excel for reporting to leadership.
- Communicated with management to identify quality trends and recommend improvement strategies.
- Trained team members on quality assurance best practices, enhancing overall team competency.
- Collaborated with team members to develop efficient workflows, resulting in increased productivity.
- Assisted QA team in pinpointing areas for process and procedural enhancements.
Provider Resources, Inc.
Health Insurance Specialist
02.2024 - 02.2025
Job overview
- Evaluated extensive documentation and offer amounts from both parties in accordance with NSA.
- Drafted letters for both parties and utilized CMS portal to finalize disputes and issue payment determinations.
- Conducted determinations and arbitrated disputes within IDRE program under NSA guidelines.
Allied Benefit Systems
Product Operations Liaison
08.2023 - 02.2024
Job overview
- Streamlined claim processing by coordinating vendors, clients, and internal teams, improving turnaround time for medical claims.
- Facilitated communication to resolve operational bottlenecks, ensuring adherence to quality assurance standards.
- Tracked claims progress using Microsoft Access, enhancing visibility and accountability.
HCA Parallon
Insurance Follow-Up Specialist
11.2019 - 08.2023
Job overview
- Facilitated timely resolution of claims by managing high volume of payer correspondence.
- Ensured compliance with industry regulations while maintaining high-quality standards for claim activities.
- Resolved denied claims through successful appeal submissions for all types of denials.
- Provided regular status updates to stakeholders regarding claim progress and resolutions.
Saint Francis Healthcare SystemCape Girardeau, USA
Revenue Cycle Team Lead
09.2017 - 11.2019
Job overview
- Oversaw revenue cycle team operations, improving accuracy in patient registration and insurance verification.
- Led staff training initiatives to optimize workflows during Epic EMR transition, ensuring documentation integrity across department.
- Coordinated daily operations to ensure efficient workflow among staff.
- Led team in delivering high-quality patient care services.
- Mentored junior team members on best practices and procedures.
Saint Francis Medical CenterCape Girardeau, USA
Admitting Clerk
06.2015 - 11.2019
Job overview
- Coordinated admissions registration and scheduling at registration center, ensuring smooth patient flow.
- Guided patients through paperwork process, ensuring compliance with HIPAA regulations.
- Confirmed insurance coverage for admitted patients, ensuring adherence to network policies.
- Played a key role in revenue cycle management by optimizing front-end operations.
- Enhanced registration process, contributing to improved efficiency and patient satisfaction.
- Worked alongside utilization review team for patient pre-certification processes.
Education
Southeast Missouri State UniversityCape Girardeau
Bachelor of Science from General Studies
05-2019
Notre Dame Regional High SchoolCape Girardeau, MO
High School Diploma
05-2012
Skills
- Quality & Compliance: QA Case Review
- CMS Regulatory Standards
- Federal Compliance (NSA/IDRE)
- HIPAA
- Clinical Reviews
- Error Trend Analysis
- Peer Review Coordination
- Claims Adjudication
- Advanced Excel skills
- Microsoft Word
- Epic
- ECW
- MyCBO
- Government Portals
- Communication: Stakeholder Collaboration
- Remote Team Leadership
- Quality assurance
- Claims processing
- Regulatory compliance
- Dispute resolution
- Workflow optimization
- Process improvement
- Team collaboration
- Problem solving
- HIPAA compliance
- Insurance regulations
- Health insurance
- Revenue cycle management
- Claims review
- Denial management
- Medical billing expertise
Work Preference
Work Type
Full TimeLocation Preference
RemoteSalary Range
$65000/yr - $200000/yrTimeline
Quality Assurance Analyst
Provider Resources, Inc.
02.2025 - Current
Health Insurance Specialist
Provider Resources, Inc.
02.2024 - 02.2025
Product Operations Liaison
Allied Benefit Systems
08.2023 - 02.2024
Insurance Follow-Up Specialist
HCA Parallon
11.2019 - 08.2023
Revenue Cycle Team Lead
Saint Francis Healthcare System
09.2017 - 11.2019
Admitting Clerk
Saint Francis Medical Center
06.2015 - 11.2019
Southeast Missouri State University
Bachelor of Science from General Studies
Notre Dame Regional High School
High School Diploma