ANDREA HARRISON
Lawrenceville,GA
Summary
Skilled Accounts Receivable Specialist with 15 plus years of experience in the daily collections of high volume accounts receivable departments. Adept in managing disputes and resolved discrepancies.
Overview
11
11
years of professional experience
Work History
Accounts Receivable Team Lead
Eye Health America
Atlanta, GA
09.2019 - 04.2024
- Team Lead of 7 employees.
- Analyzed account receivable to find and resolve denials, unpaid claims, payer issues as well as internal billing issues.
- Ensured clean claims for all payers are submitted in a timely manner.
- Communicates denials and underpayment trends to Manager to help initiate training to avoid future underpayments and denials.
- Reviewed and evaluate Insurance Follow-Up processes for all payers, making recommendations for improvement to Manager.
- Monitored the AR follow up process to ensure staff has the tools and resources to correct and/or appeal denied claims in a timely manner.
- Maintained a log of coding and reimbursement issues and resolution.
- Identified trends of coding related denials and provided training to AR Team and feedback to clinical operations.
- Conducted weekly “Team Huddle” meetings to discuss payer issues and resolutions as they pertain to general opthalmology, ASC, Retina, as well as Oculoplastic services.
- Created and maintain job aids and training documents and ensure all team members received the appropriate training support.
- Worked hand in hand with leaders from other departments (Customer Service, Auth & Eligibility, Cash Posting) to ensure root cause issues within other departments are communicated and resolved, effectively improving the AR.
- Remained current on all billing regulations and guidelines.
- Reviewed and resolve Nextgen claim edits on daily basis, including reaching out to relevant clinical staff when necessary.
- Managed and maintain the flow of paper claim submissions and ensure all supporting documents are submitted when necessary.
- Identified trends within the AR to improve financial performance.
- Created and deliver appropriate onboarding, training, and development to all current and future AR team members.
- Provided timely and consistent feedback to AR Specialist regarding quality and production.
- Month end reconciliation.
CBO Account Representative
Gwinnett Medical Center
Lawrenceville, GA
08.2017 - 09.2019
- Assisted AR Team in reaching $2.7 Million Dollar AR Goal
- Worked daily hospital/physician AR report to final resolution.
- Collaborated with hospital clinical department regarding missing/invalid Prior Authorizations or provider documentation.
- Resolved billing issues identified by insurance carriers and patients.
- Resolve edits related to billing within Nextgen charge review to ensure claims are billed appropriately and in a timely manner.
- Ensured professional/hospital charges have proper billing date, ICD, CPT codes and modifiers prior to claim submission.
- Researched and retrieved patient clinical notes via "STAR" hospital billing EHR system.
- Electronically billed claims to Commercial, HMO and Managed Care payers.
- Accessed government portal, GAMMIS (Medicaid) to review and translate claim rejections and/or remittance advices to resolve unpaid or inaccurately processed claims properly and effectively, upload documentation to web portal upon request.
- Diligently filed and follow up on third-party claims.
- Navigated multiple payer websites to research and discover claim statuses and other claim information and take necessary steps to resolve.
- Escalated issues and payer trends to management for timely account resolution.
- Maintained accurate and complete records on past due accounts and collection actions.
Accounts Receivable Collections Specialist
Fusion Sleep
Suwanee, GA
12.2016 - 08.2017
- Performed Full Revenue Cycle DME medical billing.
- Generated monthly AR reports for account review and follow up, utilizing Nextgen billing software.
- Reviewed assigned accounts to determine status of claim.
- Resolved billing issues identified by insurance carriers.
- Researched and followed up on denials and request for additional information utilizing denial reports and correspondence.
- Filed appeals on denied claims when appropriate while working each account/claim.
- Processed paper and electronic claims for submission.
- Examined diagnosis codes for accuracy, completeness, specification, and appropriateness according to the services rendered.
- Reviewed and processed remittance advices, payments, adjustments, refunds and claims for all payers on a weekly basis
- Retrieved patient medical records through Nextgen billing software EHR for submission to payer as needed.
- Prepared and attached all required claims documentation including referrals, treatment plans or other required correspondence to reduce incidence of denials.
- Evaluated the accuracy of provider charges, included dates of services, procedures, level of care, location, diagnosis, patient identification and provider signature.
- Interpreted medical reports to apply appropriate ICD-9 or ICD-10 and HCPCS codes.
- Prepared monthly outside collection agency report for electronic submission.
Accounts Receivable Team Lead
GNOS Medical
Lawrenceville, GA
09.2014 - 11.2016
- Oversaw 10 staff members in AR Department.
- Updated Toxicology Billing Fee Schedules.
- Generated written correspondence and responses to clients.
- Maintained consistent client contact to ensure clients' needs were met and exceeded.
- Assisted with account set up, customer service support and client IT set up.
- Developed, maintained and managed all billing and AR procedures for specifically designed department and accounts.
- Performed updates to billing codes (advise remark codes and adjustment reason codes) within the Health Fusion billing software.
- Assisted with development of charge panels for Toxicology testing.
- Set up ERA files for new payers.
- Monitored ERA files and corrected any discrepancies.
- Follow up on all receivable balances and ensured that delinquent account holders are contacted for payments.
- Developed and implemented billing policies with a focus on continuous improvement of each billing process.
- Distributed work assignments to billing and AR team.
- Conducted regular performance audits of the billing and AR team.
- Provided support for the department and assisted with special projects, as assigned.
- Follow up on unpaid claims within the standard billing cycle timeframe.
- Verified each insurance payment for accuracy and compliance with contract discount.
- Traced payer payments/Bank deposits for outstanding claims.
- Called insurance companies regarding any discrepancy in payments, if necessary.
- Follow up with pended cases and denials.
- Reviewed all accounts for insurance or patient follow up
- Answered all patient or insurance telephone inquiries pertaining to assigned accounts
- Identified and billed secondary or tertiary insurance claims
- Compiled payment plans on delinquent accounts
- Delegated daily tasks to team members to optimize group productivity.
- Monitored team progress and enforced deadlines.
- Collaborated with management team to implement new work procedures or policies.
- Fostered positive employee relationships through communication, training and development coaching.
- Followed staffing strategies to achieve production goals
- Documented production levels and materials used to keep management informed
- Created and distributed monthly, quarterly and annual reports to management regarding performance.
- Provided training and support to keep team members motivated and working toward objectives.
- Assigned projects and distributed tasks to team members as per area of expertise.
Accounts Receivable Specialist
American Medical Accounting and Consulting
Marietta, GA
10.2013 - 09.2014
- Serve as client support to assigned clients.
- Downloaded weekly charges from client's internal web portals, reviewed charges and coding for accuracy and posted accordingly.
- Obtain needed information from individual client portal to initiate manage care authorizations and pre-certifications.
- Worked daily A/R follow up using A/R aging reports.
- Ran month Stop report used to identify and facilitate collection of both patient and unpaid insurance claims upon completion of patients' course of treatment.
- Actively set reminders to work accounts successfully.
- Reviewed and appealed unpaid and denied claims.
- Corrected and resubmitted claims for third party billing including Medicare and Medicaid.
- Requested adjustments through Medicare Re-Opening line.
- Corrected Medicaid denials via Medicaid Web Portal for real-time adjustments and/or payment.
- Processed Charity and Indigent waivers received from clinics and/or hospital.
- Processed electronic claims through the Centricity billing software.
- Worked client denials from EOB's.
Education
Associates degree -
Kent State University
Skills
- OCS Certification – American Academy of Ophthalmology
- Extensive knowledge of insurance requirements and specific payer policies
- Understanding of payer contracting and surging coding guidelines
- Understanding and knowledge of eyecare billing and coding guidelines
- Proficient with Microsoft Office Suite and related software
- Proficient with Nextgen, Availity, Trizetto and Waystar Clearinghouse and payer web portals
- Audit Procedures
- Credit and Collections
- Adjustment Posting
- Billing Dispute Resolution
- Investigative Research
- Creative Problem Solving
- Proactive and Self-Motivated
- Time Management
- Attention to Detail
- Claims Processing
- Accounts Receivable Expertise
Timeline
Accounts Receivable Team Lead
Eye Health America
09.2019 - 04.2024
CBO Account Representative
Gwinnett Medical Center
08.2017 - 09.2019
Accounts Receivable Collections Specialist
Fusion Sleep
12.2016 - 08.2017
Accounts Receivable Team Lead
GNOS Medical
09.2014 - 11.2016
Accounts Receivable Specialist
American Medical Accounting and Consulting
10.2013 - 09.2014
Associates degree -
Kent State University
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