Alicia Hughes
Lawrenceville,GA
Summary
Healthcare Revenue Cycle Professional experienced in optimizing revenue cycles and enhancing patient access across diverse healthcare settings. Delivered improved reimbursement and compliance through effective analysis of operational challenges and collaboration with cross-functional teams. Focused on implementing strategic solutions that elevate productivity and financial outcomes.
Overview
3
3
years of post-secondary education
25
25
years of professional experience
Work History
Revenue Cycle Specialist
EMORY HEALTHCARE
Atlanta, GA
02.2025 - Current
- Verify active insurance coverage and eligibility.
- Determine whether the ordered imaging exam requires prior authorization.
- Review payer-specific guidelines and authorization requirements.
- Submit authorization requests through payer portals or by phone.
- Obtain authorization numbers before the patient’s date of service.
- Review physician orders and clinical documentation to ensure it supports medical necessity.
- Confirm CPT and ICD-10 codes accurately support the requested procedure.
- Requested peer-to-peer reviews to assess medical necessity when required.
- Facilitated appeals process for denied authorizations to secure approvals and minimize patient impact.
Financial Counselor
PIEDMONT ATHENS REGIONAL HOSPITAL
Athens, GA
08.2023 - 02.2025
- Educated patients and families on healthcare financing options, insurance coverage, Medicaid eligibility, and payment arrangements.
- Verified patient insurance and ensured compliance with all requirements to support financial accuracy.
- Facilitated revenue optimization through thorough account reviews and timely reimbursement follow-ups.
- Prioritized tasks to maximize reimbursement and mitigate financial risk for patients and hospital.
- Assisted in the coordination, prioritization and completion of front-end patient registration activities ranging from pre-registration through discharge in the Patient Access Department.
- Accurately completed patient registrations based on departmental protocols and standards, policies and procedures, and compliance with regulatory agencies.
- Prioritized tasks to maximize reimbursement and mitigate financial risk for patients and the hospital.
Financial Coordinator
NORTHSIDE HOSPITAL ATLANTA / GMC
Atlanta, GA
02.2019 - 06.2023
- Coordinated insurance authorizations, referrals, and pre-certifications to reduce claim denials.
- Trained new employees on department procedures and financial processes to enhance team competency and service delivery.
- Coordinated insurance authorizations, referrals, and pre-certifications, significantly minimizing claim denials.
- Ensured compliance with all insurance requirements before or on date of service, informing patients of financial liability and collecting due amounts.
- Assisted patients, guarantors and families with insurance questions in a professional manner.
- Facilitated employee orientation to improve understanding of department procedures and financial processes.
- Completed registration by verification of information and insurance for established patient or entered information for new patient prior to discharge of patient.
Collections Analyst Supervisor
CHILDREN'S HOSPITAL OF PHILADELPHIA
Philadelphia, PA
07.2014 - 01.2018
- Supervised and mentored a team of 13 employees within the revenue cycle and collections department.
- Managed accounts receivable aging reports and implemented strategies that reduced reimbursement timelines.
- Led denial management and appeals processes involving Medicaid, Medicare, and commercial insurance carriers.
- Generated operational reports and analyzed financial performance metrics to uncover improvement opportunities.
- Identified trends impacting revenue performance and collaborated with leadership to recommend process improvements.
- Identified trends affecting revenue performance and collaborated with leadership to recommend actionable process improvements.
- Demonstrated leadership through accountability, collaboration, and proactive resolution of operational challenges.
- Served as a resource for complex revenue cycle questions, assisting staff with workflow clarification, problem resolution, and best practices.
Revenue Cycle Representative
CIGNA
Philadelphia, PA
10.2013 - 07.2014
- Reviewed and resolved denied or incorrectly paid claims, facilitating timely reimbursement for services rendered.
- Managed high-volume patient account inquiries, ensuring accurate resolution of claims, billing, reimbursements, and payment processing.
- Performed payment auditing and reconciliation, ensuring accuracy in batch balancing to support financial integrity.
Eligibility / Billing Representative
PRUDENTIAL FINANCIAL
Philadelphia, PA
01.2007 - 09.2013
- Managed billing adjustments, resolved premium discrepancies, coordinated collections, and tracked payments to ensure accuracy.
- Managed payment collections and coordinated billing cycles effectively.
- Reviewed billing data and financial reports to identify and address trends and discrepancies.
- Processed billing inquiries and resolved customer account issues.
- Generated accurate invoices using proprietary billing software systems.
Eligibility Specialist
INDEPENDENCE BLUE CROSS
Philadelphia, PA
01.2002 - 12.2006
- Verified insurance eligibility and benefits, ensuring compliance with healthcare regulations and facilitating timely access to services.
- Reviewed insurance applications for eligibility compliance and accuracy.
- Analyzed member data to determine eligibility for various health plans.
- Coordinated communication between members and healthcare providers for benefit clarification.
- Managed high-volume inbound member inquiries and enrollment records, improving member satisfaction through effective communication and support.
Education
Bachelor of Science - Business Administration with Healthcare Management
Gwynedd Mercy University
Gwynedd, PA 08.2012 - 01.2016
Skills
Patient Registration
Financial Counseling
Epic Electronic Medical Record System
Revenue Cycle Applications
Insurance Verification Platforms
Claims Processing Systems
Microsoft Office Suite
Healthcare Billing Systems
Reporting & Data Analysis Tools
Timeline
Revenue Cycle Specialist
EMORY HEALTHCARE
02.2025 - Current
Financial Counselor
PIEDMONT ATHENS REGIONAL HOSPITAL
08.2023 - 02.2025
Financial Coordinator
NORTHSIDE HOSPITAL ATLANTA / GMC
02.2019 - 06.2023
Collections Analyst Supervisor
CHILDREN'S HOSPITAL OF PHILADELPHIA
07.2014 - 01.2018
Revenue Cycle Representative
CIGNA
10.2013 - 07.2014
Bachelor of Science - Business Administration with Healthcare Management
Gwynedd Mercy University
08.2012 - 01.2016
Eligibility / Billing Representative
PRUDENTIAL FINANCIAL
01.2007 - 09.2013
Eligibility Specialist
INDEPENDENCE BLUE CROSS
01.2002 - 12.2006