ALICIA MCINTOSH
Senior Medical Support Professional
Atlanta,GA
Summary
Fantastic senior healthcare support worker with 16 years of experience in healthcare administration. Provides a wide range of skills in healthcare support within medical offices, surgery procedures, and insurance payout resolution. Detail-oriented professional with expertise in problem-solving, escalations, and appeals. I'm a natural leader for any department and show dependable accountability without micromanagement. Vast knowledge of systems as listed below
My-Leave| CPR+| Nex-gen| E-clinical| Facets| Share-point| Athena| Med-Advance| DMS| Encoder-Pro| Epic| Xfinity| Pass-Port| Front-Runner| Microsoft Office |HIM| Teams| Skype| Leave Pro| MD Guidelines| Geneyes| Project Management| Technical Writing| Data Analysis| Business Analysis |Productivity Software | Centricity system and more.
Methodical Revenue Cycle Specialist with strong attention to detail and an in-depth understanding of billing procedures. Excellent planning and problem-solving abilities. Prepared to bring 10 years of related experience to a dynamic position with room for career growth. Well-qualified Medical Billing Specialist proficient in ICD-10 coding and CPT. Demonstrated success in analyzing existing systems and providing recommendations for improvement. Forward-thinking and hardworking with a flexible and diligent approach.
Overview
15
15
years of professional experience
Work History
Revenue Cycle Specialist/Medical Transcriptionist Subcontractor
FFAM360
07.2022 - Current
- Post payments for multi-specialty physicians within the Morehouse School of Medicine healthcare system
- Also, post inpatient/ outpatient payments for Grady Hospital System, make adjustments, audits, and make determinations on payment denials
- Posted manual patient payments and post-government and commercial insurance payments.
- Balanced and reconciled accounts.
- Identified and resolved payment issues between patients and providers.
- Created well-researched presentations on revenue cycle data to deliver to upper management and executives.
- Wrote and distributed quarterly evaluations of revenue cycle processes and recommendations to senior management.
- Monitored and analyzed financial, statistical, and operational data trends.
HR Advice & Council Subcontractor
CVS Caremark Corporate Office
01.2022 - 03.2022
- Case Management for all 50 states for CVS Corporate Office, FLMA
- COVID-19 & Religious Accommodations, Medical Claims, and Medical Accommodations
- Leveraged feedback and process improvement opportunities to create a safer and healthier environment and increase patient satisfaction.
- Conducted ongoing monitoring and evaluations of behaviors and conditions, and updated clinical supervisors with current information.
- Quickly responded to situations impacting the safety and security of the unit, actualizing crisis prevention interventions to control and de-escalate situations.
- Followed all personal and health data procedures to effectively comply with HIPAA laws and prevent information breaches.
- Approving and Denying claims, maintaining CVS partnerships
- Obtained case history and gathered triage information to determine appropriate avenues for care.
- Counseled patients via telephone according to established guidelines and protocols, advising on provider-established plans of care.
- Assisted in the management of patient utilization of the health care system and provided patient education relative to health care needs, use of community resources, and responsibilities of membership in managed care.
Disability Case Manager
Reed Group
01.2020 - 05.2021
- Case Management for all 50 states for Reed Group Corporate Office, FLMA
- COVID-19 & Religious Accommodations, Medical Claims and Medical Accommodations
- Approving and Denying claims while maintaining multiple partnerships contracts
- STD,
- LTD, Workers Compensation, COVID-19, Intermittent Leaves
- Physician Consultations, negotiations and Medical Coding
- Medical Applications, Evaluations and Determination
- Assist employees in understanding and their legal rights and responsibilities
- Maintain knowledge on legislation and national, state and local issues affecting clients with disabilities
- Train employees individually and in a group setting
- Developed and implemented a variety of innovative policies and strategies to promote client self-sufficiency.
- Coordinated individual referrals to obtain community services, advocated for client needs, and resolved roadblocks.
- Used critical thinking to break down problems, evaluate solutions and make decisions.
- Offered friendly and efficient service to customers, handled challenging situations with ease.
- Quickly learned new skills and applied them to daily tasks, improving efficiency and productivity.
- Carried out day-day-day duties accurately and efficiently.
- Demonstrated respect, friendliness, and willingness to help wherever needed.
Healthcare Consultant
Multiple Staffing Agencies
01.2018 - 01.2020
- Performed clinical and disability case management on a contract basis
- Clients included Kaiser Permanente, Cochlear Implant, Denver Healthcare, Solutions, Village Family Practice, and PharCom-USA Pharmaceutical Inc
- Admission and discharge for new clients conducted orientations and determined
- Created and implemented organizational policies and procedures.
- Developed and maintained electronic record management systems to analyze and process data.
- Developed and updated policies and procedures, maintaining compliance with statutory, regulatory and local, state and federal guidelines relating to HIPAA, benefits administration and general liability.
- Recruited, hired and trained all staff, providing direct supervision, ongoing staff development and continuing education to employees.
- Spearheaded and implemented new projects to expand scope of engagement.
- Implemented best practice standards for billing resulting in substantial reduction of accounts receivable delays.
- Conducted literature and coding reviews to adhere to state and federal standards.
- Payment posting, charges, refunds, write-offs, A/R collections,
- Full cycle medical billing and coding including self-pay
- Release of information, issue payments to providers, request refunds and appeals
- Investigated, evaluated, settled law claims, analysis, prevent fraud
- Consulted with healthcare professionals on business decisions.
- Assisted with regulatory issues such as compliance.
Medical Collections Specialist
Amerita Specialty Infusion Services Inc
12.2017 - 12.2018
- A/R medical collections support and administration, Post payment, and Project management
- Rebill claims, Coding, Reconsiderations, and Appeals,
- Insurance refunds and patient refunds, adjustments
- Corrected, completed, and processed claims for multiple payer codes.
- Processed billing calls and answered questions from patients and third-party carriers.
- Processed online and paper appeal submissions and refund requests.
- Logged charges and payments within Epic.
- Entered client details and notes into the system for interdepartmental access and review.
- Worked with customers to create debt repayment plans based on current financial conditions.
- Quickly learned new skills and applied them to daily tasks, improving efficiency and productivity.
- Carried out day-day-day duties accurately and efficiently.
- Demonstrated respect, friendliness, and willingness to help wherever needed.
- Entered client details and notes into system for interdepartmental access and review.
- Corrected, completed and processed claims for multiple payer codes.
Full Cycle Medical Billing & Coding Specialist
Orthopedic Associates
08.2017 - 12.2017
- Full Cycle Medical billing & Coding, for clinical office and hospital surgeries including DME
- Coordinating with 12 orthopedic surgeons and physicians and assist nurses
- De-escalate complex issues between patient and staff
- Open & close batches, make claim adjustments and write-offs
- Provided patients estimated financial responsibility and take payment for surgeries including DME
- Process all payments prior to procedure and scheduling
- Process refunds for patient and insurance companies.
Medical Operations Specialist
Collect Rx Inc
01.2014 - 02.2016
- Full cycle medical billing & coding, claim reconsiderations and appeals for OON claims
- Received, responded to, and resolved reimbursement claim issues, specializing in out-of-network providers and facilities
- Financial recovery and negotiated with third-party providers including multi-plan
- Processing refunds for the insurance company and for patients
- Train employees, write procedures, and help implement and design a new billing programming system.
- Tracked and analyzed reports to determine needed improvements.
- Collected, arranged, and input information into the database system.
- Motivated and trained employees to maximize team productivity.
- Developed and updated tracking spreadsheets using Excel.
- Developed medical financial negotiations with CompIQ's and companies to payout at 95%
Loan Officer/Customer Service Rep
Wells Fargo Inc
08.2012 - 01.2014
- Processed student loans, credit approvals, denials, and loan applications
- Money handling, posted payments and deposits and made payment adjustments
- Customer Service and Loan Origination Officer, Product Up-sells
- Write procedures and policies, Project Management
- Reviewed and validated details of loan applications and closing documentation.
- Collected and compiled paperwork such as title abstracts, insurance paperwork, loan files and tax histories.
- Communicated acceptance or rejection to applicants via mail, email, telephone or personal consultations.
- Filed completed loan applications with underwriting and made approval or denial recommendations.
- Quickly learned new skills and applied them to daily tasks, improving efficiency and productivity.
- Worked flexible hours; night, weekend, and holiday shifts.
- Maintained energy and enthusiasm in a fast-paced environment.
- Proved successful working within tight deadlines and a fast-paced atmosphere.
- Offered friendly and efficient service to customers, handled challenging situations with ease.
- Developed and maintained courteous and effective working relationships.
- Used critical thinking to break down problems, evaluate solutions and make decisions.
Medical Billing &Coding Specialist
Spectra-cell Laboratories
01.2011 - 08.2012
- Fully cycle medical billing and coding, coordinating with specialty physicians
- Created and closed batches
- Provided patients with estimates for specialty labs
- Medical collections, A/R support and administration, adjustments and followed up
- Project Management, Explain EOB and exercised all options to obtain claim payments
- Reviewed credit balance reports for correct recipient of refunds and reconciled refund accounts
- Identified problems on accounts and followed through to conclusion
- Audit analysis, chart review, patient registration and discharge
Home Healthcare Manager
Prevailing Faith LLC
01.2006 - 12.2010
- Medical B2B Consultation, create partnerships, hiring managers, employees and enrolling clients
- Referrals & additional support to patients with medical conditions and disabilities
- Head of Human resources
- Coordinate with all departments and Legal on escalated issues when needed
- Medical billing and coding, charts, administrative front and back-office work, refunds for patients and to the state
- Create legal documents for the business and create procedures
- Patient evaluation and oversight
- Admissions and discharge
- Manage sensitive cases such as behavioral health and chronic medical conditions
- Managed human resources and department supervisors
- Conduct job site analyses, help employees to understand their legal rights and responsibilities
- Maintain knowledge on legislation and national, state and local issues affecting clients with disabilities
- Train employees individually and in a group setting.
- Recruited, hired and trained all staff, providing direct supervision, ongoing staff development and continuing education to employees.
- Created customized care plans, working with hospital staff and families to assess and meet individual needs.
- Designed and introduced leadership development, coaching and team management model, resulting in promotion of employees into increased levels of responsibility.
- Implemented best practice standards for billing resulting in substantial reduction of accounts receivable delays.
- Developed and updated policies and procedures, maintaining compliance with statutory, regulatory and local, state and federal guidelines relating to HIPAA, benefits administration and general liability.
- Conducted routine facility inspections, identifying areas needing improvement and eliminating hazards posed to staff and residents for continued compliance with associated regulations.
- Discussed medical histories with patients in effort to provide most effective medical advice.
- Spearheaded and implemented new projects to expand scope of engagement.
- Conducted literature and coding reviews to adhere to state and federal standards.
- Successfully negotiated client contract renewals to create increased revenue.
- Organized and facilitated 2 department head meetings weekly, discussing current census, admissions and discharges and residents' Medicaid applications.
Education
Associate of Science (AS) - Healthcare Management
Ashworth University
Norcross, GADipolma - Medical Reimbursement Billing & Coding
Remington College
Houston, TXBachelor of Science - CJ Homeland Security And Emergency Management
Strayer Univeristy
Washington05.2024
Dual Certification N5Y3T7Q4 - Medical Billing&Coding
National Healthcare Association
Leawood, KSSkills
- Critical Thinking Leadership Case Management Compliance Communications Medical Appeals HR Analyst
- Case Management Problem Solving-Escalations Full Cycle Medical Biller Medical Coder Medical Negotiations
- Medical Office Management Facility Management
- Revenue Cycle Management
- Needs Assessment
- Report Preparation and Presentation
- Analyzing Claims
- CMS Guidelines
- Direct Patient Care
- Financial Problem Assessments
- Client Financial Status Assessment
- Deals Execution
- Client Advisory
- New Client Acquisition
- Safety Policies and Procedures
- HIPAA Regulations
- Insurance Benefits Understanding
- Best Practices and Standards
- Charge Capturing
- HCPCS Coding Guidelines
- Financial Records and Processing
- Client Information Database Systems
- Procedural Codes
- Past Due Balance Management
- Medical Terminology Knowledge
- Health Programs
- Strategic Initiatives
- Information Updates
- Plan Details Presentation
- Operations Advisory
- Team Training and Mentoring
- Spreadsheet Tracking
- Word Processing
Affiliations
National Association of Scholars
National Healthcare Association
National Society Collegiate Scholars
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Quote
The greater danger for most of us lies not in setting our aim too high and falling short; but in setting our aim too low, and achieving our mark
Michelangelo
Timeline
Revenue Cycle Specialist/Medical Transcriptionist Subcontractor
FFAM360
07.2022 - Current
HR Advice & Council Subcontractor
CVS Caremark Corporate Office
01.2022 - 03.2022
Disability Case Manager
Reed Group
01.2020 - 05.2021
Healthcare Consultant
Multiple Staffing Agencies
01.2018 - 01.2020
Medical Collections Specialist
Amerita Specialty Infusion Services Inc
12.2017 - 12.2018
Full Cycle Medical Billing & Coding Specialist
Orthopedic Associates
08.2017 - 12.2017
Medical Operations Specialist
Collect Rx Inc
01.2014 - 02.2016
Loan Officer/Customer Service Rep
Wells Fargo Inc
08.2012 - 01.2014
Medical Billing &Coding Specialist
Spectra-cell Laboratories
01.2011 - 08.2012
Home Healthcare Manager
Prevailing Faith LLC
01.2006 - 12.2010
Associate of Science (AS) - Healthcare Management
Ashworth University
Dipolma - Medical Reimbursement Billing & Coding
Remington College
Bachelor of Science - CJ Homeland Security And Emergency Management
Strayer Univeristy
Dual Certification N5Y3T7Q4 - Medical Billing&Coding
National Healthcare Association
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