Amber Watts-Thompson
Summary
Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy.
Overview
9
9
years of professional experience
1
1
Certification
Work History
Supervisor
Trinity Health
06.2023 - Current
- Trained new employees on company policies, procedures and work ethics
- Ensuring quality and production are being met by each staff member apart of my team
- Coordinated individual duties after careful evaluation of each employee's skill level and knowledge.
- Completed bi-weekly payroll for 15 or more employees.
- Familiar with state laws and regulations regarding Medicaid and employee payroll regulations
- Take part in interviews/hiring/terminations
- Monitors the billing metrics with open denials
- Evaluate medical coverage policies, maintain patient financial records and develop strategies to optimize reimbursement through denial follow-up and claim appeals
- Resolved issues through active listening and open-ended questioning, escalating major problems to manager.
- Supervised a team of 15 or more billing specialists, providing guidance and support for their professional growth.
- Collaborated with cross-functional teams within Trinity Health to resolve accounting/claim issues promptly, fostering a positive working environment that supported overall business objectives.
- Evaluated employee performance periodically using established evaluation criteria, providing constructive feedback and developing action plans for improvement.
- Maintained a strong working relationship with vendors and suppliers by addressing payment inquiries professionally, negotiating favorable payment terms, and resolving disputes amicably.
- Assisted in timely completion of audits by compiling relevant documentation and effectively communicating with auditors throughout the process.
- Conducted detailed variance analysis between actual results versus forecasted figures on a monthly basis; suggested corrective action plans when necessary.
- Optimized the use of available resources by regularly reviewing workload distribution among team members, adjusting assignments as needed.
- Maintained accurate records of all authorization requests, ensuring timely follow-up and resolution.
- Reduced turnaround time for authorizations by identifying bottlenecks and addressing them proactively.
- Collaborated with healthcare providers to obtain necessary medical information for accurate decision-making on authorizations.
- Educated employees on specific QA standards and confirmed maintenance of standards.
- Assured consistent quality of production by implementing and enforcing automated practice systems.
- Reported problems and concerns to management.
Billing and Follow Up Rep II
Trinity Health
08.2020 - 06.2023
- Successfully managed multiple projects simultaneously while maintaining high standards of performance
- Utilized knowledge of billing and services to resolve denial issues efficiently and effectively
- Navigated multiple computer systems and applications and utilized search tools daily
- Prepared reports to summarize operational results and financial performance
- Administered and created training and awareness presentations or materials
- Work extensively with the Military & Community Mental Health Denial Accounts, reaching out to payors single-handedly, to assure claims are processed accordingly and paid on time
- Recognized for consistently achieving high levels of accuracy in processing complex authorization requests under tight deadlines.
- Maintained accurate records of all authorization requests, ensuring timely follow-up and resolution.
- Reduced turnaround time for authorizations by identifying bottlenecks and addressing them proactively.
- Identified opportunities for improvement in internal processes, recommending changes that led to increased efficiency and accuracy.
- Documents claims billed, paid, settled, and follow-up in appropriate system(s)
- Identifies and escalates issues affecting accurate billing and follow-up activities
- Provided outstanding customer service and support to payors/clients, resolving inquiries efficiently and effectively
- Work extensively with the Community Mental Health Accounts and Payors single-handedly, to assure claims are processed accordingly and paid on time
- Performs all routine follow-up functions
- Adheres to proactive practices which include contacting the payer directly for payment due on accounts and reviewing and responding to all mail correspondence in a timely and accurate manner
- Review and research claim rejections, make corrections, take corrective actions, and/or refer claims to appropriate colleagues to ensure timely and accurate claim resolution
- Documents claims billed, paid, settled, and follow-up in appropriate system(s).
- Managed a diverse portfolio of clients, ensuring that each received tailored solutions aligned with their specific requirements.
- Exceeded performance targets through diligent work ethic and focus on results-driven tasks.
- Provided valuable input resulting in new opportunities for growth and development.
- Reviewed authorizations from payer to determine approved or denied items.
- Submitted for prior authorization with required documentation to appropriate funding source.
- Typed acknowledgment letters to persons sending correspondence.
- Gathered records pertinent to specific problems, reviewed for completeness and accuracy and attached records to correspondence as necessary.
- Completed form letters in response to requests or problems identified by correspondence.
- Edited letters and written material for correspondence.
- Developed comprehensive training materials for new hires, fostering a smooth onboarding process and knowledge sharing among team members.
- Expedited the appeals process for faster resolutions by streamlining procedures and workflows.
- Entered appeal requests in appeals module.
- Processed and finalized appeals and grievances within agreed-upon turnaround time.
- Provided outreach for additional information for appeals and grievances.
- Negotiated collective bargaining agreements.
- Remained knowledgeable regarding company policies and procedures and current developments within operational departments.
- Submitted verbal and written notification to members and providers.
- Completed documentation of final appeals or grievance determination using appropriate templates.
- Obtained additional documentation required for case review.
- Examined case to initiate clinical review.
- Rendered decision for non-clinical complaints using sound, fact-based decision making.
- Provided excellent customer service by actively listening to customer concerns and empathetically addressing their needs throughout the appeals process.
Billing and Follow Up Rep I
Trinity Health
06.2019 - 08.2020
- Successfully managed multiple projects simultaneously while maintaining high standards of performance
- Utilized knowledge of billing and services to resolve denial issues efficiently and effectively
- Navigated multiple computer systems and applications and utilized search tools daily
- Prepared reports to summarize operational results and financial performance
- Administered and created training and awareness presentations or materials
- Work extensively with the Military & Community Mental Health Denial Accounts, reaching out to payors single-handedly, to assure claims are processed accordingly and paid on time
- Review and research claim rejections, make corrections, take corrective actions, and/or refer claims to appropriate colleagues to ensure timely and accurate claim resolution
- Documents claims billed, paid, settled, and follow-up in appropriate system(s)
- Identifies and escalates issues affecting accurate billing and follow-up activities
- Provided outstanding customer service and support to payors/clients, resolving inquiries efficiently and effectively
- Developed relationships with payors by providing prompt responses to requests and inquiries
- Work extensively with the Community Mental Health Accounts and Payors single-handedly, to assure claims are processed accordingly and paid on time
- Performs all routine follow-up functions
- Adheres to proactive practices which include contacting the payer directly for payment due on accounts and reviewing and responding to all mail correspondence in a timely and accurate manner
- Review and research claim rejections, make corrections, take corrective actions, and/or refer claims to appropriate colleagues to ensure timely and accurate claim resolution
- Documents claims billed, paid, settled, and follow-up in appropriate system(s).
Benefits Specialist
Automated Benefit Services
10.2017 - 04.2019
- Processed employee life event changes, ensuring timely updates to benefits and coverage for qualifying events such as marriage or the birth of a child.
- Participated in annual benefit plan review meetings with senior leadership, providing data-driven insights and recommendations for future plan design adjustments.
- Managed COBRA compliance, ensuring timely notifications and accurate administration for former employees.
- Assisted in resolving complex benefits issues, leading to increased employee satisfaction and retention rates.
- Increased employee satisfaction by implementing comprehensive benefits programs and initiatives.
- Updated HRIS systems as needed to reflect benefit-related changes accurately, maintaining up-to-date records for all team members.
- Performed benefits audits to identify discrepancies and opportunities for improvement in plan design or administration.
- Maintained thorough knowledge of industry trends and best practices within the realm of employee benefits, enabling informed decision-making and strategic planning efforts on behalf of the company.
- Explained benefits to plan participants in easy to understand terms in order to educate each on available options.
- Efficiently managed multiple competing priorities while maintaining excellent attention to detail in administering complex benefit plans for employees across different job functions.
- Provided exceptional customer service to employees, addressing concerns regarding their benefits packages.
- Served as a liaison between employees, insurance carriers, and brokers to resolve complex benefits-related issues effectively.
- Conducted regular audits of benefit enrollments, ensuring compliance with company policies and applicable laws.
- Reduced errors in benefit enrollments by implementing rigorous quality control checks during all stages of the process.
Provider Services Representative
United Healthcare
08.2015 - 10.2017
- Analyzed performance metrics for assigned territory, identifying opportunities for growth and improvement within the network.
- Ensured compliance with regulatory requirements by conducting thorough audits of provider files and documentation.
- Provided exceptional support for credentialing processes including application completion, background checks, primary source verification activities as well as ongoing maintenance tasks such as recredentialing requests.
- Coordinated with internal departments on behalf of providers to ensure timely payment resolution for claims disputes or other financial matters.
- Improved communication between providers and insurance companies, leading to better understanding of policy coverage and claim status.
- Promoted positive relationships between the organization and its network providers through timely responses to inquiries and effective issue resolution.
- Collaborated with cross-functional teams to resolve complex provider issues, resulting in improved provider relations.
- Educated providers on billing procedures, coding guidelines, and reimbursement policies for optimal claim submissions.
- Delivered exceptional customer service to every customer by leveraging extensive knowledge of products and services and creating welcoming, positive experiences.
- Educated customers about billing, payment processing and support policies and procedures.
- Managed high-volume workloads while maintaining a high level of accuracy on all submitted authorizations, showcasing strong attention to detail.
- Worked closely with clinical teams to gather needed information in a timely manner, supporting optimal patient care delivery.
- Provided exceptional customer service by answering questions, resolving issues, and guiding providers through the authorization process.
- Verified by telephone or internet eligibility and benefits for third-party payer insurance from information provided on patient registration form.
- Facilitated better communication between departments through proactive engagement with other teams involved in the prior authorization process.
- Increased accuracy of insurance coverage validation by utilizing available tools and resources to verify eligibility requirements quickly.
- Ensured compliance with HIPAA regulations by maintaining strict confidentiality in handling sensitive patient information.
- Collaborated with healthcare providers to expedite the process of obtaining necessary medical documentation for approvals.
- Tracked referral submission during facilitation of prior authorization issuance.
- Contacted insurance companies to obtain prior authorization for medical procedures and medications.
- Prepared and distributed denial letters, detailing reasons for denial and possible appeal measures.
- Conducted comprehensive reviews of claim denials, identifying errors or discrepancies that led to successful reversals on appeal.
- Implemented best practices for documenting case notes, improving record-keeping accuracy, and aiding team members in tracking progress on ongoing cases.
- Achieved higher success rates on appeal cases by closely analyzing denial reasons and crafting persuasive arguments for reconsideration.
- Rendered decision for non-clinical complaints using sound, fact-based decision making.
- Examined case to initiate clinical review.
- Obtained additional documentation required for case review.
- Completed documentation of final appeals or grievance determination using appropriate templates.
- Submitted verbal and written notification to members and providers.
- Entered appeal requests in appeals module.
Education
Bachelor of Science - Health Administration
DeVry
Chicago, IL05.2020
High School Diploma -
Henry Ford High School
Detroit, MI06.2003
Skills
- Team Building
- Ethical Conduct
- Emotional Intelligence
- Performance Evaluation
- Task Prioritization
- Project Management
- Goal Setting
- Problem Solving
- Time Management
- Decision Making
- Negotiation and Persuasion
- Quality Assurance Practices
- Audit documentation preparation
- Delegation Skills
- Effective Communication
- Expectation setting
- Staff Discipline
- Employee Motivation
- Leadership and supervision
- Dispute Resolution
- Grievance management
- Performance Management
Certification
CRCR
References
References available upon request
Timeline
Supervisor
Trinity Health
06.2023 - Current
Billing and Follow Up Rep II
Trinity Health
08.2020 - 06.2023
Billing and Follow Up Rep I
Trinity Health
06.2019 - 08.2020
Benefits Specialist
Automated Benefit Services
10.2017 - 04.2019
Provider Services Representative
United Healthcare
08.2015 - 10.2017
Bachelor of Science - Health Administration
DeVry
High School Diploma -
Henry Ford High School