Alicia Clea
Brandywine,MD
Summary
Well-qualified financial systems leader offering demonstrated skill and success in managing internal accounting processes, improving controls and strengthening systems for optimal performance. Gifted in building and leading solid teams to handle high-volume operations with consistency, accuracy and full compliance with regulatory requirements. Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy.
Overview
11
11
years of professional experience
Work History
Senior Billing Specialist
Maryland Department of Health- St. Mary’s County Health Dept.
11.2023 - Current
- Verify monthly account deposits and ACH, bank, and deposit transactions from insurance companies.
- Verify insurance information uploaded in patient account is accurate to ensure payments from insurance payers.
- Prepare daily deposits for bank, expense sheets, check for mathematical accuracy, proper coding, and approvals.
- Monitor aging reports for claims outstanding of 60-90 days, resubmitting claims withing insurance guidelines and adhering to timely filing per payers.
- Adjust balances to ensure proper write-offs and patient responsibility are allocated properly on accounts ledgers.
- Collaborate with consultant company on deciphering difference between software errors, payer and or credentialing errors.
- Correct claim issues such as missing/incorrect payer id information, coding modifiers, patient demographics errors
- Prepare billing statements for clients and inform clients of outstanding debts and deadlines.
- Provide training and serves as point of contact for clinical staff members on procedure and protocols of daily operations on insurance verification, billing issues and discrepancies.
- Contributed towards development of Standard Operations Procedure and process within Cure Md software.
- Handle all non-payment and denied insurance matters while ensuring all electronic and paper claims are without error.
- Review, tracking and appeal unpaid claims along with answering all patient billing questions.
- Process credit card payments through online portal while meticulously uploading documentation into software and forwarded to fiscal account.
- Develop, implement, and update automated spreadsheets, ledgers, and reports for use by other agency staff for procurement and purchasing and /or tracking.
- Adhere to state and county policies and guidelines when doing account write-offs on payer balances longer than 365 days.
- Weekly meeting to collaborate with team members on matters relating to program objectives, priorities and claim deadlines as well as streamlined insurance process to ensure accurate information is conveyed.
- Negotiated payment plans with delinquent clients, minimizing losses while maintaining positive customer relationships.
- Implementing protocol for member representatives and front office staff through insurance verification process ensuring that insured patients have active coverage as well as provide sliding fee scale for low-income patients.
- Provides technical guidance and direction concerning fiscal policies and procedures to agency staff as it relates to agency procurement and purchasing cross reference payor information to ensure correct submittal of electronic files.
- Developed customized reports for management, providing valuable insights into billing trends and areas for improvement.
- Optimized revenue generation by identifying under-billed accounts and working closely with clients to rectify the situation.
- Enhanced customer satisfaction by addressing billing inquiries professionally and providing effective solutions.
Medicaid AR Specialist
South Carolina Oncology Association
12.2022 - 08.2023
- Served as point of contact for Medicaid representatives to assist with No-pay claims, trending denials, and recoupment of payments.
- Assisted patients with questions about coverage and acceptance of specific plans
- Composed emails using Microsoft office as formal means of communication between staff about patient concerns and account activities.
- Prepared spreadsheets for supervisory meetings calculating outstanding balances and tracking AR progress.
- Participated in monthly meetings with insurance representatives to discuss claims issues such as repetitive denials, changes and effects of claims pending, along with specificity of drug coverages and write-offs
- Administered, coordinated, and assisted with any needs from specialists, nurses as well as patient coordinators and billing department.
- Thoroughly document patients account to most current information regarding appeals, refiling of corrected claims due to modifiers, along with making account adjustment such as write-offs
- Submitted claims using multiple systems to intercept any error and adjust claims before being batched and processed to insurance company.
- Updated pertinent National Drug Codes into database to ensure correct numerical attachment.
- Informed patients regarding insurance coverage and breakdown, remaining deductibles, as well as calculated payment arrangements for fiscal responsibilities.
- Verified eligibility via insurance portal as well as input information into patients account to ensure proper submission.
- Maintained highest level of attention to detail to avoid duplicate entries of documents into electronic files.
- Analyzed trends in payment patterns and customer behavior, identifying opportunities for process enhancements that would improve overall AR performance.
- Worked collaboratively with other team members to expedite resolution of outstanding claims.
- Managed high volume of customer accounts while maintaining strict attention to detail, ensuring all transactions were accurately recorded and documented.
- Weekly contractual fee adjustments are made to accounts after primary and secondary insurances payments have been received and posted to patient’s accounts within Centricity and Unlimited Financial Software.
- Performed targeted collections on past due accounts aged over 60-90 days.
- Increased customer satisfaction levels by promptly addressing inquiries regarding billing issues or adjustments needed on their accounts.
Patient Coordinator II
Smiles Pediatric Dentistry
06.2022 - 10.2022
- Presented treatment plans while ensuring all pertinent documents have been signed by parents giving all providers consent to perform services.
- Posted all rendered services accurately to patients’ accounts and ledgers to ensure accounts are balanced.
- Completeness of all patient documentation to be electronically transferred into appropriate files
- Thorough audited accounts for all outstanding claims and accounts unpaid within 60-90 days along with discrepancies of unallocated monies
- Utilized Microsoft Office suites to create, edit emails and excel spreadsheets.
- Provided excellent customer service to all patients, addressing concerns and answering questions promptly and professionally.
- Completed detailed verification of active insurance benefits, while importing benefit coverage and breakdown information, and any other relevant information into electronic patient files.
- Coordinated referrals to specialists as needed, following up with patients to confirm appointments and provide necessary information.
- Accessed insurance portals to gather electronic funds transfers, patients’ explanation of benefits and acquire status of outstanding claims
- Effectively communicated relevant patient account information pertaining to scheduled appointments with staff.
- Reviewing, printing, and emailing necessary documentation as business concludes for end of day.
- Updating excel spreadsheet to directly reflect patients accounts to be sent over to regional manager as well as accounts receivable manager.
- Creating detailed financial notes in accounts while thoroughly reviewing unpaid claims and uncollected client portions with balances for 30-60days.
- Increased efficiency of the front office operations through effective multitasking, attention to detail, and organization skills.
Administrative Assistant (Seasonal)
Allen Associates Fiscal Services
01.2022 - 05.2022
- Directed and forwarded all incoming phone calls while assisting customers with complaints and/or issues appropriately within 24 hours
- Fostered multiple calendars, scheduled meetings, to optimize productivity
- Displayed organizational skills by managing multiple assignments and projects while meeting deadlines
- Managed multiple calendars to assist in prioritizing and accomplishing tasks by deadlines
- Completed clerical tasks including filing, faxing, and completing follow up calls to customers
- Demonstrated the ability to answer customers concerns about the Internal Revenue and yearly tax return questions as well as competency in the ability to explain pertinent information while keeping customers financial confidentiality
- Assembled and compiled documents and forms to be used appropriately for accountant specialist.
- Responsible for picking up incoming mail when received as well as responsible for sorting and distributing incoming mail and packages.
- Gathered all appropriate documentation and signatures from all parties are correct according to state and federal guidelines filings.
- Collected clients’ financial portion after services rendered for tax preparations
- Distribution of weekly paychecks to bookkeeping clients for employees.
- Maintained confidentiality of sensitive information by adhering to strict privacy policies and implementing secure filing systems.
Insurance Verification Specialist
Wes Mark Family Dentistry
07.2021 - 01.2022
- Allocation of patient and insurance payments, review for necessary adjustments due from contractually agreed upon fees
- Collected patient payments and modified payment arrangement via Clover
- Verification of insurance breakdown, coverage, and eligibility
- Extreme attention to detail to provide 100% accuracy on benefits documenting any clauses within coverage
- Submission of patients' pretreatment estimates to ensure patients knowledge of their dental fiscal responsibility
- Daily submission of claims with NEA attachments to include narratives, radiographs or specialty charting while ensuring claims are without error
- Maintained patient demographics information and data collection system
- Assisted with working on 30–60-day aging reports, which included disputing, appealing, and following up on accounts that need further attention
- Creating insurance coverage books to include correct procedure codes, prices and percentages covered by the insurance company
- Informed patients of clauses in dental coverage such as waiting periods, termination of dental policy or downgrading of procedures which would result in patients having additional fees
- Answered incoming calls from patients regarding billing issues and explanation of benefits knowledge.
- Updated patient records with accurate, current insurance policy information.
- Managed high-volume insurance verifications within pressured timeframes for productive medical operations.
Patient Coordinator Specialist
Premier Endodontics
02.2018 - 07.2021
- Balancing of accounts after full payments have been received, performed account write off and account adjustments based on contractual obligations between the office and in network insurance companies
- Prepared/ process patient statements, collections letters and refunds, informed patients of estimated out of pocket portions/ balance for treatment
- Reviewed weekly review of insurance deposits in company account to ensure accurate payments
- Verified and updated patient demographics, insurance coverage and other pertinent information using specific software
- Send completions of services to the referring offices including but not limited to emails, fax, and letters
- Processed Electronic Funds Transfer (EFT) claims payments and bulk payment type
- Provided excellent customer service for patients with inquiries regarding account status
- Ensured patient records were stored securely and handled in compliance with HIPAA privacy and security regulations
- Bi-weekly audit of insurance 60-90 aging claims to be reprocessed, begin appeals process on claims that have been incorrectly denied, follow up on denial trends with state funded insurance
- Organized patient schedule to accommodate doctors' preference and create conducive patient flow
- Acted as liaison between patients and specialist to produce positive experience for customers
- Created invoices for patients with outstanding balances after collection of all insurance payments
- Organized and submitted supporting documentation including but not limited to radiographs, written narratives for insurance claims providing necessity of services rendered to decrease denials
- Ensured accuracy of insurance information for each patient visit, verifying coverage details ahead of time for smooth processing at appointment time.
- Handled End of day closing reports along with the final submission of electronic claims.
- Provided excellent customer service to all patients, addressing concerns and answering questions promptly and professionally.
Educational Manager
Columbia Academy of Cosmetology
04.2014 - 10.2016
- Evaluated and implemented curriculum, testing and teaching methodologies of hair, skin, and nails
- Pioneered mock state board testing practical and theory testing for senior level cosmetology students
- Transmitted student attendance, practical assignments, and testing scores into computer database
- Spearheaded seminars for educators about updated precautions and bylaws for state of South Carolina.
- Supervised 4 educators and 30 students on clinic floor, while delegating clinical assignments to students
- Implemented all OSHA, MSDS, and South Carolina board of cosmetology rules and regulations.
- Assisted teachers in aligning assessments with curriculum objectives, ensuring consistency across classrooms in measuring student progress.
Educator
American Beauty Academy
07.2013 - 04.2014
- Organized learning curriculum that reflects current standards within industry guidelines.
- Ensured safe and sanitary practices by both students and instructors when practicing cosmetology and related sciences.
- Managed academic records and ensure continuous evaluation is given to students on ongoing basis, for student performance in theory, practical and clinical experiences.
- Participated in extra curricular events, such as Talent/ fashion shows, Career Fairs, student recognition
- Ensure client satisfaction by effectively managing clinic floor, counseling, and guiding students, and assisting in resolving student issues.
- Perform other duties as assigned.
- Developed and implemented differentiated instruction strategies for diverse learners, ensuring individualized attention and success.
Education
High School Diploma -
Crossland High School
Temple Hills, MD06.2004
Skills
- Payment tracking
- Microsoft Office
- Invoice Processing
- Cash application
- Dispute Resolution
- Time Management
- Attention to Detail
- Accounts Receivable
- Relationship Building
- Bill Payment and Recordkeeping
- Proactive and Self-Motivated
- Financial records and reporting
- Bank Statement Reconciliation
- Precision and Accuracy
- Data Entry
Timeline
Senior Billing Specialist
Maryland Department of Health- St. Mary’s County Health Dept.
11.2023 - Current
Medicaid AR Specialist
South Carolina Oncology Association
12.2022 - 08.2023
Patient Coordinator II
Smiles Pediatric Dentistry
06.2022 - 10.2022
Administrative Assistant (Seasonal)
Allen Associates Fiscal Services
01.2022 - 05.2022
Insurance Verification Specialist
Wes Mark Family Dentistry
07.2021 - 01.2022
Patient Coordinator Specialist
Premier Endodontics
02.2018 - 07.2021
Educational Manager
Columbia Academy of Cosmetology
04.2014 - 10.2016
Educator
American Beauty Academy
07.2013 - 04.2014
High School Diploma -
Crossland High School
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