ANDREA WILLIAMS
Epic Credentialed Resolute Hospital Billing Trainer
McDonough,GA
Summary
Hospital Billing Professional with extensive Claims Medical processing, customer service and insurance experience. Possess advanced knowledge of private insurance processes and codes, experienced biller in hospital, nursing facilities, dental, and vision claims with accurate and detail-oriented with knowledge of benefits, eligibility and appeals. Highly-motivated employee with desire to take on new challenges. Strong worth ethic, adaptability and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.
Overview
33
33
years of professional experience
Work History
Hospital Biller
Catholic Health/ION COLLIER CONSULTING
05.2022 - 06.2023
- Responsibilities included billing high dollar accounts via Epic electronically
- Correction of denials via Epic for resubmission to commercial and government payers
- Submission of appeal letters to payers and reconsiderations via Availity and UnitedHealthcare for review for reimbursement
- Calling all commercial payers to obtain information regarding billing, appeals and denials.
Biller/Follow Up Representative
Humboldt General Hospital
08.2022 - 04.2023
- Responsibilities included but were not limited to high dollar submission via WQ via Cerner for all commercial payers
- Follow up on high dollar claims that were submitted via placing phone calls to the payers
- Billing submission via billing system via SSI billing system
- Weekly meetings with manager, Director, coding department regarding outstanding A/R
- Working spreadsheets for timely filing accounts for correction and resubmission and appeal
- Submitting appeals with submission of medical records attachment and appeal letters to payer.
Soarian Biller A/R Follow up Rep
Yakima Hospital
11.2021 - 08.2022
- Responsibilities included but were not limited to high dollar electronic submission to Commerical payers and Government payers
- Review of credit balances to determine if true refund or adjustment was needed
- Appeal submissions to commercial payers regarding denials
- Daily production-based responsibilities working from work queue
- Review of correspondence from commercial payers and resubmission and correction of errors
- A/R follow up on submission of claims sent to the payer.
Epic Remote Biller
Epic Remote Physician A/R Health, University of California
07.2021 - 01.2022
Remote Epic Refund Specialist
UCSD
04.2021 - 07.2021
- Responsibilities include but are not limited to the processing of overpayments regarding credit reports
- Submission of recoupment letters to government payers, commercial payers and self-pay
- Tracking and trending and submitting reports of different payers regarding credits posted on account
- Weekly meetings with manager to advise of trends that are listed for commercial payers
Remote Epic A/R Representative
Allscripts
Chicago, Illinois
02.2021 - 04.2021
- Effectively manage complex payer denials by assimilating and submitting
- Timely management and resolution of unpaid claims as assigned
- Timely resolution of denials including follow up with payers and clients
- Secondary claims management
- Claim Adjudication for authorization updates for submission via web portal for government payers
- Achieved goals set forth by supervisor regarding error-free work, transactions, processes and compliance requirements.
RCM Specialist
, Texas
07.2019 - 01.2021
- Ni2Health
- Responsibilities included but were not limited to the processing of overpayments regarding credit reports
- Submission of recoupment letters to government payers, commercial payers and self-pay
- High production of adjustments regarding credits that were not overpayments
- Report daily to management/client on percentage of aging that was worked on a weekly basis
- Analytical and processing of tracking trends with payers regarding credit balances on accounts
- Special projects worked per management/client request
R Representative
, Pennsylvania
05.2019 - 04.2020
- Responsibilities included but were not limited to claims adjudication of Inpatient and Outpatient claims in the amount of $5K and above
- Submission of COB denials letters regarding authorization and EOB issues
- High production of adjustments to help clean A/R aging off the account
- Submission of appeals thru payer web portal along with appeal letter
- Verification of insurance coverage and updating of primary and secondary payers via Epic
- Special projects given by manager to complete per deadline
- Tracking and trending of denials with weekly meetings with manager to advise trends regarding denials and corrections.
Remote Follow up/Hospital Biller
10.2018 - 03.2019
- KSMF (Kentucky Services Medical Foundation)
- Electronic Submission of Inpatient and Outpatient claims to commercial payers and government payers
- Responsibilities included but were not limited to appeals of denied accounts
- Weekly skype meetings with team lead and manager regarding tracking and trending of denied claims
- Correction of rejected claims via clearinghouse report
- Submission of Excel spreadsheets to Vice President and Denials Manager showing correction and revenue regarding denials that were corrected and submitted.
Virtual Insurance Representative
New Castle, Delaware
06.2018 - 01.2019
- HBCS
- Electronic claims processing of Inpatient and Outpatient claims via IBAX and FACS system for client in a HIGH DEMAND production-based environment via UB04/1500 HCFA
- Submitted electronic medical record upload for appeal regarding denials per client request
- Submitted letter of appeal to overturn erroneous denials
- Working analytical reports and identified trends in errant billing practices or incorrectly denied claims
- Precisely completed appropriate claims paperwork, documentation and system entry
- Worked with coding department and case management department regarding denials submission
- Thoroughly researched newly identified diagnoses and/or medical procedures to expand skills and knowledge
- Diligently submitted claim processing and followed up on third party claims
- Verification of insurance coverage and updating of primary and secondary payers via FACS system and Epic.
HB/Resolute Trainer
Epic Credentialed
Mt. Laurel, New Jersey
11.2017 - 04.2018
- Developed and administered pre/post training proficiency assessments and class evaluations
- Collaborated with the Training Manager and Principal Trainers to develop tip sheets based on end user needs assessments
- Classroom training for ALL departments regarding Hospital Billing workflows on Inpatient and Outpatient for Big Bang Implementation
- Implementation of correct workflows for Denials, Billing, Collections, Follow up and patient access workflow
- Cross trained in Cadence module
- Mentored and trained super user and end users
- Post Go Live Support
- Collaborated with the Business Analysts, Managers, Directors, and super user and end users by participating and implementing business office workflow
- Assisted in the development of the Hospital Billing (HB) curriculum, training workflow and evaluation of testing of the live environment
- Collaborated with managers to evaluate the results and revise the HB training curriculum as needed.
Epic Go Live Trainer
Nashville, Tennessee
10.2017 - 11.2017
- Vanderbilt Hospital
- Assist in the development of the Hospital Billing (HB) curriculum, training workflow and evaluate the testing of the live environment
- Develop and administer pre/post training proficiency assessments and class evaluations
- Conduct an end user needs assessment, evaluate the results and revise the HB training curriculum as needed
- Collaborate with the Training Manager and Principal Trainers to develop tip sheets based on end user needs assessments.
Epic Go Live Trainer, U Mass Hospital
Boston, Massachusetts
09.2017 - 10.2017
- Assist in the development of curriculum, of the training environment and the testing of live environment
- Provide Employee education based on assessment of learning needs of the learner evaluate the results of the skills assessment and observations to review and revise training as needed
- Collaborates with the Epic training manager and Principal trainers on input for training and training materials
- Assist in the development and validation of the training environment and the testing of the live environment
- Assists in the development of skills assessment program for the Epic system.
Banner Health
Epic Go Live Trainer
Tucson, AZ
07.2017 - 09.2017
- Provide Employee education based on assessment of learning needs of the learner Evaluate the results of the skills assessment and observations to review and revise training as needed
- Collaborates with the Epic training manager and Principal trainers on input for training and training materials
- Responsibilities include but are not limited to collections and billing of HIGH dollar Medicare HMO payers
- Submission of appeal letters to receive additional reimbursement regarding erroneous denials
- Submission of reports to client regarding tracking and trending of denials
- Strong computer and written skills
- Team player
Medical Consultant
Frasier Consulting, Dekalb Medical Hospital
Atlanta, GA
01.2017 - 07.2017
- Responsibilities include but are not limited to electronic processing of HIGH dollar Inpatient and Outpatient claims to Georgia Medicaid CMO payers
- Trending and tracking and developing project plans and strategies in line with a client’s business needs
- Submission of Appeal letters to Medicaid CMO payers along with medical records to obtain additional reimbursement payment for different levels of care for Emergency Room services
- Submission of Excel spreadsheets to Vice President and Denials Manager showing correction and revenue regarding denials that were corrected and submitted
- Training full time employees regarding policies and procedures pertaining to hospital billing and collections.
Hospital Billing Analyst
Lifepoint Healthpoint
12.2016 - 12.2016
- Responsibilities include but not limited to Electronic high dollar Inpatient/Outpatient billing via MedAssets system
- Appeals and Denials via DDE system for Medicare claims
- Write letter of appeal to overturn erroneous denials
- Working analytical reports and identified trends in errant billing practices or incorrectly denied claims.
Government
Biller Atlanta GA, Emory Hospital
02.2016 - 10.2016
- Responsibilities include but are not limited to electronic processing of inpatient and outpatient claims on a UB04 form for commercial claims and government payers Medicare and Medicaid via Xactimed system
- Also responsible for updating of denied claims once they are returned by coders Assisting of training new temporary employees on system
- Correction of rejected claims via clearinghouse report
Medical Consultant Rowlett
ABLM
, TX
04.2015 - 12.2015
- (Advanced Bottom-Line Management
- Responsibilities include but are not limited to SNF (Skilled Nursing Facility) processing in a production-based environment via Vision system
- Claims processing for high dollar inpatient, outpatient and dental claims on HCFA 1500 via Vision and McKesson system for commercial, Medicaid and Medicare payers
- Help with facilitating with regulatory issues, such as complying with insurance and safety plans, keeping patient information confidential
- Develop project plans and strategies in line with a client’s business needs
- Help clients identify and resolve potential problems, such as in workflow or company processes and also offer advice for optimizing hospital, health center or medical-center facility performance.
Appeals Coordinator
Atlanta, GA
06.2011 - 04.2015
- Grady Health System
- Electronic claims processing of high dollar Inpatient, Outpatient, Dental and Skilled Nursing Facilities claims via QicLink and Trizotte clearinghouse in a production-based environment on UB04 forms
- Correct and resubmit Georgia Medicaid denials via AS400 and follow up by contacting HP Georgia Medicaid system
- Write letter of appeal to overturn erroneous denials
- Working analytical reports and identified trends in errant billing practices or incorrectly denied claims
- Precisely completed appropriate claims paperwork, documentation and system entry
- Correctly coded and billed medical claims for various hospital and nursing facilities
- Thoroughly researched newly identified diagnoses and/or medical procedures to expand skills and knowledge
- Maintained updated knowledge of coding requirements through continuing education and certification renewal
- Diligently submitted claim processing and followed up on third party claims.
GA Medicaid Cust Serv Rep, Hewlett Packard
Tucker, GA
11.2010 - 06.2011
- Researched denied claims and eligibility related issues for members and providers and understood the caller’s issue and primarily resolved it on the telephone
- Logged every contact with customer/provider thru incoming/outgoing telephone calls as well as other means into the customer contact management system
- Basic knowledge in the field of Customer Relations
- Demonstrated verbal communication and customer service skills
- Verified patient’s eligibility and claim status with providers via AS400
- Determined prior authorizations for medication and outpatient procedures.
Overpayment Analyst
HCA
Norcross, GA
08.2009 - 10.2010
Patient Account
Georgia Medicaid Biller/Collector
Norcross, GA
05.2006 - 08.2009
- Service
- Initiated refunds & identified overpayments to clear credit balance, reviewed reimbursement worksheet with attached documents to resolve credit balances via Epic system and Artivia system
- Researched returned hospital refund checks
- Applied voids to accounts as necessary & reissued refunds
- Documented collection system clearly and concisely
- Worked mail inquiries in a timely manner
- HCA Patient Account Services
- Claims processing electronically for Georgia Medicaid and commercial claims via Epremis system based on a production type environment
- Processed daily close activities for assigned group of practices and ensured that statements were sent out accordingly
- Responsible for processing electronic claims to primary and secondary insurance carriers via Epremis claims system
- Performed account follow up via Artiva system and resolution of accounts denied by payers
- Submitted electronic billing for California Medicaid along with follow up for previous billed claims
State SNF Medicaid Biller Conyers
, GA
10.2005 - 05.2006
- Beverly Healthcare
- Electronic claims processing via McKesson system
- Order and receive insurance related transactions for claims processing
- Completion of census reports regarding number of patients in short term nursing facility
- Collections, working denials, and entering of demographic information for new residents who arrive in Nursing home.
Education
Epic Credentialed HB/Resolute Hospital Billing Trainer -
12.2017
Yellow Belt Lean Six Sigma certification -
12.2014
CPAR (CERTIFIED Patient Account Representative) -
02.2012
Skills
- Diverse skills include experience with
- Windows (2000 Microsoft, Word Excel, Vision, Advantix, SolAce, Outlook, Artiva, QicLinks, Trizetto Clearinghouse, Cerner, Soarian, MedAssets, Contract Management, CPSI, Quadax,Paragon HPF, ChartMaxx, NCTracks web portal, NPPES/NPI Registry, Works and Office, Epic, Epremis, McKesson and AS400 systems
- SKILLS
- Medical Terminology expert
- Claims processing and collection procedures expert for UB04 and 1500 HCFA Hospital inpatient and outpatient claims processing/records
- Excellent problem solver
- Close attention to detail
- Outpatient surgery coding specialist
- HCPCS Coding Guidelines
- DRG and PC grouping
- Understands insurance benefits
- Excellent verbal communication
- Research and data analysis
- Epic Credentialed Hospital Billing Trainer
- Instructor-Led training (ILT) in a classroom environment
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Quote
Judge a man by his questions rather than his answers.
Voltaire
Timeline
Biller/Follow Up Representative
Humboldt General Hospital
08.2022 - 04.2023
Hospital Biller
Catholic Health/ION COLLIER CONSULTING
05.2022 - 06.2023
Soarian Biller A/R Follow up Rep
Yakima Hospital
11.2021 - 08.2022
Epic Remote Biller
Epic Remote Physician A/R Health, University of California
07.2021 - 01.2022
Remote Epic Refund Specialist
UCSD
04.2021 - 07.2021
Remote Epic A/R Representative
Allscripts
02.2021 - 04.2021
RCM Specialist
07.2019 - 01.2021
R Representative
05.2019 - 04.2020
Remote Follow up/Hospital Biller
10.2018 - 03.2019
Virtual Insurance Representative
06.2018 - 01.2019
HB/Resolute Trainer
Epic Credentialed
11.2017 - 04.2018
Epic Go Live Trainer
10.2017 - 11.2017
Epic Go Live Trainer, U Mass Hospital
09.2017 - 10.2017
Banner Health
Epic Go Live Trainer
07.2017 - 09.2017
Medical Consultant
Frasier Consulting, Dekalb Medical Hospital
01.2017 - 07.2017
Hospital Billing Analyst
Lifepoint Healthpoint
12.2016 - 12.2016
Government
Biller Atlanta GA, Emory Hospital
02.2016 - 10.2016
Medical Consultant Rowlett
ABLM
04.2015 - 12.2015
Appeals Coordinator
06.2011 - 04.2015
GA Medicaid Cust Serv Rep, Hewlett Packard
11.2010 - 06.2011
Overpayment Analyst
HCA
08.2009 - 10.2010
Patient Account
Georgia Medicaid Biller/Collector
05.2006 - 08.2009
State SNF Medicaid Biller Conyers
10.2005 - 05.2006