ANDREA S. PHILLIPS
Houston,TX
Summary
Results-oriented achiever with proven ability to exceed targets and drive success in fast-paced environments. Combines strategic thinking with hands-on experience to deliver impactful solutions and enhance organizational performance.
Overview
11
11
years of professional experience
Work History
Guarantor Refund Representative
Memorial Hermann Hospital
08.2024 - Current
- Evaluate patient account credit balances and perform necessary refund, adjustment, or correction entries.
- Utilized EPIC to enter and track refund transactions, ensuring real-time account accuracy and compliance with hospital and regulatory standards while maintaining accuracy in refunds, adjustments, and corrections.
- Apply insurance policy guidelines to ensure accurate refund transactions and account reallocations.
- Processed patient refund requests with accuracy and attention to detail.
- Responded to inquiries from patients and insurance representatives regarding refund status, providing timely updates and fostering trust in the refund process.
Claims Analyst
Luminare Health
10.2023 - 08.2024
- Managed adjudication of claims according to policy provisions to ensure compliance and accuracy.
- Review claims for compliance with plan guidelines and approve or deny payment.
- Managed a diverse caseload of insurance claims, ensuring accuracy, timeliness, and compliance with industry regulations.
- Documented claims adjudication decisions clearly and concisely, ensuring timely responses to appeals and reconsideration requests.
Performance Quality Analyst
Anthem BCBS
Houston, Texas
10.2017 - 10.2023
- Establish auditing goals, expectations and ensure these are met or exceeded.
- Coached team on documentation and recordkeeping best practices to enhance compliance and accuracy.
- Set auditing goals and expectations, ensuring achievement of standards.
- Track trends and audit results
- Monitored trends and audit results to identify areas for improvement.
Customer Service Advocate
UnitedHealth Group
Sugar Land, Texas
07.2015 - 10.2017
- Assisted providers and Medicaid members with benefits and account inquiries, ensuring clarity and support.
- Assist customers with inquiries, benefits, claims and eligibility.
- Resolved customer inquiries regarding benefits, claims, and eligibility to enhance service experience.
- Assist members with scheduling appointments for members and choosing doctors.
Education
Associate of Arts -
Wharton County Jr College
Sugar Land, TXSkills
- Quality Assurance
- EPIC Systems
- Power BI
- Analytical Skills
- Quality Auditing
- Government Compliance
- Microsoft Office
- Knowledge of insurance industry (Medicaid/Medicare)
- Service Improvement
- Claims Processing Systems
- Audit Assistance
- Refund Processing
References
Available upon request.
Timeline
Guarantor Refund Representative
Memorial Hermann Hospital
08.2024 - Current
Claims Analyst
Luminare Health
10.2023 - 08.2024
Performance Quality Analyst
Anthem BCBS
10.2017 - 10.2023
Customer Service Advocate
UnitedHealth Group
07.2015 - 10.2017
Associate of Arts -
Wharton County Jr College