Amanda Payton
Smyrna,TN.
Summary
Healthcare professional with 17 years of experience in EHR configuration, EDI transactions, and claims processing. Demonstrated proficiency in Agile methodologies, contributing to improved system configuration and operational efficiency. Managed software updates and patches, facilitating seamless production deployment and addressing compatibility challenges.
Overview
17
17
years of professional experience
Work History
Technical Configuration Analyst
Qualifacts
09.2021 - 07.2025
- Provided support on tickets using Salesforce related to system configuration issues, research State fiscal year updates and update the SPEC according to State Reporting guidelines
- Collaborated with development teams to deploy software updates into QAREG, CERT, PROD environments efficiently and effectively
- Installed software updates and patches in a timely manner according to established guidelines
- Design, develop, maintain web forms using the Orbeon forms platform, specializing in XForms and related technologies, and ensuring forms are functional, user friendly, and meet specific business requirements
- Investigated reported incidents quickly and accurately using problem-solving skills
- Worked closely with Product Owners, QA Team, and Customers during product testing phases in order to resolve any compatibility issues
- Agile, SCRUM methodologies, complete code review's, git, JIRA, visual studio, confluence
- Remote
Healthcare Claims Specialist
HBCS
10.2019 - 09.2021
- Provides plan and claim information, assists with submission of claims, and makes outbound calls to gather missing information on incomplete claims for 3rd party hospitals
- Examine insurance claims, collect and analyze patient data to ensure the filing procedures have been completed correctly
- Verify insurance is accurate, Assist with coordination of benefits updates in Millennium, Epic billing system
- Responsible for resolving claim issues, monitoring A/R denials, underpayments, over payments and follow up on discrepancies, Review and appeal unpaid and denied claims
- Review billing and coding procedures according to the medical policy guidelines for specific payers for UB, 1500 claims
- Assist with aging A/R, denials and timely filing guidelines
- Remote
Data Maintenance Rep
US Renal Care
04.2017 - 10.2019
- Add Doctors, New Facilities, Insurance Plans and Contracts to Billing System
- Research Payer set up to determine root cause of any issues, Update EDI mapping, setup, configuration, testing setup and maintenance
- Assist in the research of any new CMS Regulations every year
- Research websites and contracts for accurate rate groups
- Payer enrollments and ongoing maintenance
- Prepare and maintain accurate data files and reports
- Update, mapping, setup and testing process for healthcare transaction sets X12, 837, 835, 999, UB
- Ensure and update 837I, 837P claim forms with payer specific information for claim processing
Senior Insurance & Pricing Coordinator
American Home Patient
05.2016 - 04.2017
- Maintain the insurance payer pricing file for the organization
- Review, process, and load new contracts or pricing and changes to current contracts/pricing
- Evaluate payment trends to determine if reimbursement and/or pricing files are accurate
- Work collectively with Billing Centers & Sleep Support Center Management to determine root cause on denials related to insurance master attributes and update as necessary
- Work with Accounts Receivable Manager and patient service centers to complete pricing and master file clean up
- Develop IT requirements and AHOM business rules to implement or improve processes, increase productivity through automation, and provide front end user support and/or testing of new applications as needed
Medical Biller
Xtend Healthcare
01.2014 - 05.2016
- Daily re-billing of primary, secondary claims and correction billing for Inpatient, Outpatient, Labs, and Labor/Delivery claims
- Corrected claim edits before billing 3rd party hospital claims such as added/or removed modifiers from codes, enter occurrence codes, corrected coding edits within the billing system, add appropriate condition codes and enter value codes/amounts on claim
- Verified insurance information was correct on claims before sending out via electronically or sending UB04 and worked rejection reports
- Insurance's worked with include: Commercial, Medicaid, Medi-cal, VA and some Medicare
Medical Biller
DSI
04.2008 - 01.2014
- Daily follow-up, re-billing, secondary billing, correction billing and keying Medicaid claims online for Dialysis charges
- Checked flow-sheets, completed adjustments, medical records, denial report, cash posting, patient statements, closed clinics, and cleanup of old AR accounts
- Communicate daily with 120 clinics on the exception reports to make sure billing is accurate
- Assist Billing Director with closing Month end within 3 business days
Education
GED -
Cohn Adult
Nashville, TNCertified - Billing Specialist
New Horizons Learning Center
Skills
- Agile methodologies and SCRUM practices
- Accounts receivable management
- Code review processes
- CI/CD practices
- Customer support services
- EDI setup and configuration
- EHR system configuration
- Front-end technologies: XML, SQL, Orbeon Forms
- Project management tools: JIRA, Confluence
- Visual Studio expertise
- Problem-solving skills
- Software setup and deployment strategies
- Application development processes
- Version control systems: Git, GitHub
- Testing systems: TestRail
- Technical analysis skills
- User interface design
Timeline
Technical Configuration Analyst
Qualifacts
09.2021 - 07.2025
Healthcare Claims Specialist
HBCS
10.2019 - 09.2021
Data Maintenance Rep
US Renal Care
04.2017 - 10.2019
Senior Insurance & Pricing Coordinator
American Home Patient
05.2016 - 04.2017
Medical Biller
Xtend Healthcare
01.2014 - 05.2016
Medical Biller
DSI
04.2008 - 01.2014
Certified - Billing Specialist
New Horizons Learning Center
GED -
Cohn Adult
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