Antoinette Nicholson
Medical Collector Analyst
Ontario,CA
Summary
To seek and maintain full-time position that offers professional challenges utilizing interpersonal skills, excellent time management and problem-solving skills. Tactful Claims Specialist with expertise in settlement preparation, claims processing and appeal filing. Diplomatic and personable professional accustomed to handling sensitive, confidential information and investigating complex liability claims. Committed to maintaining customer satisfaction and contributing to company success.
Overview
12
12
years of professional experience
5
5
years of post-secondary education
Work History
Provider Claims Specialist
Optum
El Segundo, CA
12.2022 - Current
- Provided advice to customers regarding claims, rights and insurance processes to prevent disputes.
- Generated, posted and attached information to claim files.
- Determined appropriateness of payers to protect organization and minimize risk.
Medical Collections Specialist
Lakeside Medical
Las Vegas, NV
07.2021 - Current
- Corrected, completed and processed claims for multiple payer codes.
- Researched billing errors and discrepancies to initiate corrective action.
- Entered client details and notes into system for interdepartmental access and review.
- Processed debtor payments and updated accounts to reflect new balance.
- Processed online and paper appeal submissions and refund requests.
Patient Access Representative
Alta Hospitals
Culver City, CA
10.2013 - 11.2022
- Obtained patient's insurance information and determined eligibility for benefits for specific services rendered.
- Secured patient information and confidential medical records in compliance with HIPAA privacy rule standards to protect patient's privacy.
- Collected and entered patient demographic and insurance data into computer database to establish patient's medical record.
- Received patient deductibles and co-pay amounts and discussed options to satisfy remainder of patient financial obligations.
- Stayed calm under pressure to and successfully dealt with difficult situations.
- Providing excellent customer service by promptly answering patient inquiries.
Medical Insurance Collector
MemorialCare
Fountain Valley, CA
12.2011 - 09.2013
- Reviewed provider coding information to report services and verify correctness.
- Managed large volume of medical claims on daily basis.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
- Responded to correspondence from insurance companies.
- Followed up on denied claims to verify timely patient payment and resolution.
- Identified and resolved discrepancies between patient information and claims data.
- Researched billing errors and discrepancies to initiate corrective action.
Education
Associate of Arts - Business Administration
Santa Rosa Junior College
Santa Rosa, CA 09.1984 - 05.1987
High School Diploma -
Palisades Charter High School
Pacific Palisades, CA 09.1980 - 06.1983
Skills
Extensive Medical/Dental billing and collections experience; Knowledge of ICD-9, CPT-4, HCPCS coding; Proficient with DME, Medicare, Medi-Cal, CMS 1500, UB-04 and HMO Guidelines; Knowledge of most aspects of radiology exams and laboratory test Working experience with Medicom, Medical Manager 920, Millbrook, Envision (SMS), Meditech, MDT Systems, Passport, Centricity Physicians, EMDEON, MS4, Epic, Paragon, and Microsoft
Timeline
Provider Claims Specialist
Optum
12.2022 - Current
Medical Collections Specialist
Lakeside Medical
07.2021 - Current
Patient Access Representative
Alta Hospitals
10.2013 - 11.2022
Medical Insurance Collector
MemorialCare
12.2011 - 09.2013
Associate of Arts - Business Administration
Santa Rosa Junior College
09.1984 - 05.1987
High School Diploma -
Palisades Charter High School
09.1980 - 06.1983