Alicia Hughes
Lawrenceville,GA
Summary
Healthcare Revenue Cycle Professional experienced in optimizing revenue cycle processes across hospital systems, physician practices, and insurance organizations. Achieved improved reimbursement and compliance through effective collaboration and strategic problem-solving. Focused on enhancing patient financial outcomes and operational efficiency in complex healthcare environments.
Overview
25
25
years of professional experience
Work History
Revenue Cycle Specialist
EMORY HEALTHCARE
Atlanta, GA
02.2025 - Current
- Manage complex patient accounts across the full revenue cycle, ensuring timely resolution of claims and reimbursement issues.
- Analyze payments, identify reimbursement variances, and resolve denied or underpaid claims while maintaining compliance with payer requirements.
- Serve as a patient advocate by assisting patients with billing concerns, financial assistance resources, payment arrangements, and insurance-related questions.
- Interpret managed care contracts and apply payer guidelines to billing, reimbursement, and authorization processes.
- Collaborated with leadership and operational teams to streamline workflows and support departmental revenue goals.
- Supported quality improvement initiatives by analyzing denial trends and proposing process enhancements.
- Identified trends impacting revenue performance and recommended process improvements in collaboration with leadership.
- Demonstrate leadership through accountability, collaboration, and proactive resolution of operational challenges
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.
- Recognized patients needing early financial counseling intervention to facilitate timely support.
- Resolved patient billing concerns promptly while maintaining exceptional customer service standards.
- Ensured all insurance requirements were met prior to or on the date of service and informed patients of their financial liability and collected liability due.
- Supported revenue optimization efforts through accurate account review and reimbursement follow-up.
- Prioritized tasks to ensure timely reimbursement and mitigate financial risk for patients and hospital.
- Collaborated with cross-functional teams to enhance Medicaid provider support processes and streamline operations.
- 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.
Financial Coordinator
NORTHSIDE HOSPITAL ATLANTA / GMC
Atlanta, GA
02.2019 - 06.2023
- Consistently exceeded production and collection targets impacting organizational revenue goals.
- Coordinated insurance authorizations, referrals, and pre-certifications, leading to minimized claim denials.
- Maintained thorough understanding of insurance, registration, scheduling, referrals, authorizations, and account follow-up.
- Performed comprehensive financial counseling for patients prior to treatment.
- Mentored employees on department procedures and financial processes to enhance team competency.
- Collaborated with colleagues to develop solutions for enhancing workflow efficiency.
- Completed registration by verification of information and insurance for established patient or entered information for new patient prior to discharge of patient.
- Obtained appropriate signature(s) and scanned all appropriate documents (Admission/Registration Agreement, Notice of Privacy Practice, and Important Message from Medicare, etc.).
- Communicated hospitals'' financial policies to all patients.
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.
- Led denial management and appeals processes involving Medicaid, Medicare, and commercial insurance carriers.
- Managed accounts receivable aging reports, implementing strategies that streamlined reimbursement timelines.
- Generated operational reports and analyzed financial performance metrics to pinpoint and recommend improvement opportunities.
Revenue Cycle Representative
CIGNA
Philadelphia, PA
10.2013 - 07.2014
- Managed high-volume patient account inquiries related to claims, billing, reimbursements, and payment processing.
- Reviewed claims and resolved denied or incorrectly paid claims.
- Performed payment auditing, reconciliation, and batch balancing activities.
Eligibility / Billing Representative
PRUDENTIAL FINANCIAL
Philadelphia, PA
01.2007 - 09.2013
- Managed billing adjustments, resolved premium discrepancies, coordinated collections, and tracked payments to ensure accurate financial records.
- Reviewed billing data and financial reports to pinpoint trends and discrepancies, facilitating timely corrections.
- Processed billing inquiries from clients and resolved discrepancies efficiently.
- Managed account updates and maintained accurate client records consistently.
- Coordinated with internal teams to ensure timely billing cycles and accuracy.
Eligibility Specialist
INDEPENDENCE BLUE CROSS
Philadelphia, PA
01.2002 - 12.2006
- Evaluated applications for eligibility in health insurance programs.
- Verified insurance eligibility and benefits, ensuring compliance with healthcare regulations to facilitate access to necessary services.
- Managed high-volume inbound member inquiries and enrollment records, enhancing member experience and ensuring accurate data processing.
- Reviewed documentation to ensure compliance with company policies.
- Assisted customers in understanding their benefits and coverage options.
Education
Bachelor of Science - Business Administration with Healthcare Management
Gwynedd Mercy University
Gwynedd, PA01-2016
Skills
- Patient registration
- Financial Counseling
- Epic EMR system
- Revenue cycle tools
- Insurance verification tools
- Denial management
- Claims processing tools
- Microsoft Office Suite
- Healthcare billing tools
- 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
Eligibility / Billing Representative
PRUDENTIAL FINANCIAL
01.2007 - 09.2013
Eligibility Specialist
INDEPENDENCE BLUE CROSS
01.2002 - 12.2006
Bachelor of Science - Business Administration with Healthcare Management
Gwynedd Mercy University