Anisa Bardha

Liaised with departmental heads to perform detailed review of financial and operational metrics with the goal of identifying and capitalizing upon opportunities for process improvement, denials management and improving patient satisfaction.

Planned, prioritized and assigned task to departments during implementation of a new process or project. Coordinated with the performance improvement team to increase monthly cash flow and reduce monthly write off due to operational or clinical denials. Coordinated with training manager to develop or update training materials for front end staff.

Key results:

• Streamlined credentialing process for the providers department which resulted in a decrease in no authorization denials by 45 percent in eight months.
• Trained team members in successful strategies to meet operational and sales targets.

● Focus on development of standardized communications and responses to Psychiatrist, Therapist and Patients.

● Develop policies and procedures to support Customer Service process to be used to train new staff.

• Answer incoming calls emails from patients with a 48-hour turnaround time.

● Assist patients with requests for information, complaints, making appointments, and resolving issues

● Collect copays and deductible payments

● Maintain and update customer and referral information

● Ensure patient forms contain all necessary billing information

● Research patient accounts when phone call requires it

● Take appropriate actions in Billing Software

● Knowledge of CPT codes, ICD 10 codes and patient eligibility and benefits.

Revenue Cycle Specialist Davita Kidney Care.

• Perform duties for revenue operations department related to either medical insurance billing, collections or patient access
• Analyzing root cause for claim rejection and submitting Service Orders to Change Healthcare Clearinghouse to investigate the issues,
• Communicate with insurance payers to ensure proper insurance coverage for our patients or to ensure timely and accurate reimbursement for dialysis services rendered at our clinics
• Gathering information from provider manuals to help the Electronic Conversion Status
• Review and submit system setup requests to appropriate teams to ensure center and payer information is loaded into the billing system for accurate billing
• Identify, investigate, and resolve all rejected, denied, and outstanding insurance claims.
• Outreach to patients to obtain missing insurance information and other demographic information.
• Act as a liaison with all related parties to resolve claims and billing issues.
• Identify deficiencies in the revenue cycle management process and execute on a plan for improvement.
• Help identify process changes and opportunities for continuous improvements
• Maintain confidentiality of all company and patient information in accordance with HIPAA regulations.

• Enhanced patient experience by managing front office operations efficiently and professionally.
• Oversaw appointment scheduling and itinerary coordination for both clients and personnel.
• Managed high call volumes effectively, addressing patient inquiries and resolving issues promptly.
• Assisted in the implementation of electronic health records systems for increased efficiency and accuracy in recordkeeping.
• Maintains and performs a warm, friendly and welcoming relationship with all patients and Excels in the area of customer service.
• Verifies Patient’s insurance benefits, eligibility and deductible
• Accurately enter insurance information into computer system.
• Responsible for pre-certification/ authorization and insurance verification for all patients.
• Determines prior authorizations for procedures and medical equipment.
• Interacted with providers and other medical professionals regarding billing and documentation policies.
• Responds to correspondence from insurance companies
• Process referrals and submit medical records to insurance carriers to expedite prior authorization processes
• Manage correspondence with insurance companies, physicians, specialists and patients as required
• Look through insurance plans in a detailed manner and process required referrals
• Verify patients benefits and ensure that prior authorization and re-authorization is obtained for additional treatment