Alishia Morgan
Granite City,IL
Summary
Healthcare administration professional with over 17 years of experience in insurance verification and claims resolution. Recognized for effectively managing patient inquiries and ensuring timely billing processes, contributing to improved patient satisfaction and operational efficiency. Proven ability to work collaboratively with healthcare providers to resolve discrepancies and enhance overall service delivery.
Overview
19
19
years of professional experience
Work History
Patient Financial Services Representative
Essentia Health
Duluth, Minnesota
12.2024 - Current
- Processed patient accounts and verified insurance eligibility.
- Handled patient inquiries regarding billing and insurance coverage.
- Assisted patients with financial assistance applications and payment plans.
- Processed payments accurately and efficiently in a timely manner.
- Maintained accurate records of all financial transactions.
- Reviewed daily reports to identify any discrepancies or errors in patient account balances.
- Generated invoices for services rendered and sent them out according to established timelines.
- Collaborated with healthcare providers to clarify billing information.
- Answered incoming calls from patients regarding billing inquiries and resolved customer service issues.
Insurance Billing Collections Specialist LI
Washington University in St. Louis
St. Louis, MO
10.2022 - 12.2024
- Followed up on post-processing activities, managing rejected billings, adjustments, and denied claims for Medicare to ensure timely resolution.
- Employ EPIC system to verify patient information, confirm insurance coverage, and facilitate accurate billing and timely submission of claims.
- Investigated and resolved denials and rejected claims, coordinating with clients to expedite payment processes and enhance cash flow.
- Processed adjustments and write-offs, maintained up-to-date patient invoices, and submitted medical records to payers to facilitate claim resolution.
Dedicated Care Coordinator
United Health Group
Maryland Heights, MO
06.2015 - 10.2022
- Coordinated healthcare services for members, ensuring timely appointment scheduling and continuity of care.
- Guided members on copayment requirements and costs for prescriptions and medical services, promoting financial planning and transparency.
- Facilitated communication with medical vendors for delivery of durable medical equipment, improving patient quality of life.
- Processed coverage determinations and authorizations, while also leveraging local resources to address needs beyond healthcare scope.
Claims Analyst
Centene
St. Louis, MO
11.2018 - 12.2019
- Analyzed and applied insurance policy and contractual guidelines to adjudicate a variety of claims, including those for physician and hospital services, ensuring accurate determination for payment, information requests, or denials.
- Processed appeals and reviewed patient records for medical necessity, ensuring integrity and accuracy of claims resolution.
- Developed and implemented workflow improvements for claims processing, maintaining comprehensive records and documentation in compliance with departmental standards.
Patient/Client Advocate
Express Scripts
Berkeley, MO
01.2011 - 06.2015
- Managed prescription order processing and conducted patient screenings to determine eligibility for assistance programs, ensuring compliance with HIPAA regulations.
- Identified and resolved order-related issues through thorough problem-solving and research, escalating complex cases to appropriate channels.
- Maintained accurate data entry for patient and physician records, enhancing tracking and management of prescription orders.
Authorization/Pre-Certification Rep
Magellan Health Services
Maryland Heights, MO
06.2007 - 10.2011
- Coordinated with healthcare professionals to secure authorizations for patient radiology procedures, ensuring compliance with medical protocols.
- Addressed inquiries and maintained up-to-date patient information in collaboration with insurance companies to facilitate timely authorizations.
- Processed and documented patient cases using medical terminology and coding systems, including CPT and ICD-9, to ensure accuracy and compliance.
Education
Diploma - Medical Assistant
Everest College
Maryland Heights, MO02-2009
Diploma -
Hazelwood East High School
05-2003
Skills
- Customer Service 10 Years
- Written and Verbal Communication
- Insurance Verification
- Medical Scheduling
- Medical Billing
- Medical Records
- Icd-10
- EMR Systems
- Medical Terminology
- Benefit Verifications
- Authorization
- Medicare Knowledge
- Managed Care Reimbursement
- Claims processing
- EPIC system utilization
- Insurance verification
- Billing reconciliation
- Revenue cycle management
- Effective communication
- Attention to detail
- Customer service
- HIPAA compliance
- Medical terminology
Timeline
Patient Financial Services Representative
Essentia Health
12.2024 - Current
Insurance Billing Collections Specialist LI
Washington University in St. Louis
10.2022 - 12.2024
Claims Analyst
Centene
11.2018 - 12.2019
Dedicated Care Coordinator
United Health Group
06.2015 - 10.2022
Patient/Client Advocate
Express Scripts
01.2011 - 06.2015
Authorization/Pre-Certification Rep
Magellan Health Services
06.2007 - 10.2011
Diploma - Medical Assistant
Everest College
Diploma -
Hazelwood East High School