Alison Hetrick
Sykesville,MD
Summary
Highly-trained individual and skilled communicator effectively interacts with patients, healthcare professionals and co-workers. Remarkable background in scheduling appointments, scrubbing claims, and getting denials overturned. Strong knowledge of HIPAA and ICD10 medical terminology.
Overview
14
14
years of professional experience
Work History
Representative III, AR & Denial Management
NextGen
Remote
01.2021 - Current
- SME Team member (Subject matter in expert) selected by management to work with them to analyze trends to maximize reimbursement and reduce claim denials
- Analyzed complex Explanation of Benefits forms to verify correct payment and postings of payments as well as denials.
- Participated in audit related team meetings with the off shore billing reps.
- Worked facility and physician claims for an OB/Gyn practice with locations in MD, VA, and DC.
- Utilized NextGen, EFR, Availity, Excel spreadsheets and insurance payer portals daily.
- Primary focus to have insurance A/R over 90 days get paid.
- Verified insurance of patients to determine eligibility.
- Liaised between patients, insurance companies, and billing office. Assisted with customer service phone calls as needed.
- Post adjustments per client request.
- Reviewed medical records for recommendation of supporting diagnosis's to be added for a corrected claim.
- Notified client of missing or inappropriate use of modifiers with suggestion for correction.
- Personal monthly audit average of 98%
Claims Resolution Specialist
TSI Healthcare
Remote
01.2017 - 01.2020
- Maintaining AR for multiple physician's offices
- Correct rejected and denied claims or appeal when appropriate
- Maintain contact with insurance payers via phone and websites, and by mail.
- Report trends for claim denials specific to each physician's office
- Next Gen EPM software, Availity RCM and payer portals utilized daily
- Physician specialties include: internal medicine, optical, and rheumatology.
- Verified insurance of patients to determine eligibility.
Patient Account Representative
Sentara Healthcare
Chesapeake, VA
01.2016 - 01.2017
- Billing claims up to $100,000, approximately 575 claims weekly
- Scrubbing of Medicare and Medicare HMO outpatient claims prior to submission
- Correct rejected and denied claims for resubmission with utmost efficiency
- Utilized Cirius prebill claim manager and Epic medical health records, & ECC software daily
- Utilize critical thinking skills, efficiency, independent working, and great attention to detail.
Medical Billing Specialist
Pulmonary and Critical Care Associates of Baltimore
Owings Mills, MD
01.2014 - 01.2015
- Work directly with insurance companies to get denied medical claims paid, via appeals
- Correct claims and resubmit to insurance companies with proper documentation
- Post insurance payments, adjustments, and write offs using medical billing software for lockbox.
- Assist callers with questions regarding their statements from three medical practices
- Work with patients to set up payment plans and process their credit card payments by phone
- Verify patients insurance eligibility for dates of service in both hospital and office settings
- Strong focus on Medicare, State Medical Assistance plans, and Managed Care Organization plans.
Medical Secretary
Carroll Arthritis - Westminster, MD
01.2013 - 01.2014
- Performed most duties using Centricity, an electronic medical records program
- Registered all new patients, in person and by phone,after determining if their condition warranted seeing a Rheumatologist
- Contacted insurance providers and verified benefits for infusion therapies and prescriptions
- Transferred necessary and authorized records to other physician offices per doctor or patient request
- Oversaw company's email, replying to or redistributing emails to appropriate staff by priority
- Added data daily to a spreadsheet, tracking infusion therapy services, expenses, and amounts payable.
- Kept information confidential and followed HIPAA guidelines to maintain patient trust.
- Answered telephone calls to offer office information, answer questions, and direct calls to staff.
Coordination of Benefits Specialist
United Health Group - Frederick, MD
Frederick, MD
01.2010 - 01.2013
- Data entry that utilized Citrix, multiple emulators, and Microsoft Office programs
- Initiated calls to members and other insurance companies to discover additional health coverage
- Reviewed and gathered information from existing medical claims, seeking out other medical insurances used
- Underwent extensive training regarding insurance primacy guidelines for private insurances and Medicare
- Began the process of retrieving money for the company by documenting other primary insurance on paid claims
- Awarded a multitude of recognition certificates for 100% quality by month.
Education
Associates of Arts in Communications - Communications, Early Childhood Education
Carroll Community College
Westminster12.2016
Skills
- Excel in rapidly changing workplaces
- Advanced skills in customer and co-worker relations, both oral and written communications
- 10 years' experience in medical office settings and duties
- EMR Systems
- HIPPA Compliant
- Excel with great focus when working from home in a designated work space
- Goal-oriented mindset
- Continuous Learning Attitude
- Attention to detail
- ICD-10 Knowledge
- Teamwork and Collaboration
Timeline
Representative III, AR & Denial Management
NextGen
01.2021 - Current
Claims Resolution Specialist
TSI Healthcare
01.2017 - 01.2020
Patient Account Representative
Sentara Healthcare
01.2016 - 01.2017
Medical Billing Specialist
Pulmonary and Critical Care Associates of Baltimore
01.2014 - 01.2015
Medical Secretary
Carroll Arthritis - Westminster, MD
01.2013 - 01.2014
Coordination of Benefits Specialist
United Health Group - Frederick, MD
01.2010 - 01.2013
Associates of Arts in Communications - Communications, Early Childhood Education
Carroll Community College