Summary
Overview
Work History
Education
Skills
Assessments
Timeline
Generic

Beverly Reed

Lakeland,FL

Summary

Persistent Team lead experienced in supervising, training and motivating 24 team members. Skillful in redesigning processes for efficiency gains, analyzing sales trends and service reports and mentoring and guiding employees in performing assigned duties. Results-oriented professional committed to exceptional, responsive service in all interactions with customers and employees. Experienced and reliable Team Manager with successful history leading and motivating staff members to exceed goals. Offers excellent communication and organizational skills. Adept at resolving conflicts and addressing emerging issues. Strong leader and problem-solver dedicated to streamlining operations to decrease costs and promote organizational efficiency. Uses independent decision-making skills and sound judgment to positively impact company success.

Overview

5
5
years of professional experience

Work History

Denial Specialist-Manager

Aspirion
11.2021 - Current
  • Efficient time and WIP management to meet set deadlines
  • Reach daily, weekly, and monthly goals
  • Review and analyze documentation including but not limited to client system, payor portals, clinical summaries, provider notes or explanations of benefits to obtain knowledge and understanding of account history, past actions, patient treatment course, and current status of claim/denial
  • Review denied claims to determine appropriate action to resolve issues as assigned
  • Communicate via telephone with various insurance carriers to resolve claims issues as needed based on company protocol
  • Investigate and ensure that questions and requests for information are responded to in a timely and professional manner resulting in the accurate resolution of assigned accounts
  • Efficiently and legibly document account information into Advicare's Health Information System and/or the client(s) Patient Accounting System using Advicare's established account noting criteria to ensure the maximization of collection dollars
  • Consistently and properly update all required fields in the Advicare Health Information System including but not limited to issue types, root cause, deadline dates, claim number and appeal numbers
  • Generate appeals, including online reconsiderations, based on the dispute reason and contract terms specific to the payor according to Advicare protocol and program type
  • Request Bill correction and re-submission when appropriate
  • Follow specific payer guidelines for appeals submission
  • Work special projects as needed
  • Work collaboratively and effectively with all other departments and functions to maximize operational efficiency and ensure accuracy and consistency in addressing denial issues
  • Primarily telephone communications with carriers to resolve claims
  • Documenting account information into our Health Information System and/or Hospital Patient accounting system
  • Generating letters and faxes for written correspondence with patients, employers, and carriers.
  • Trained new team members by relaying information on company procedures and safety requirements.
  • Coached team members in techniques necessary to complete job tasks.
  • Worked different stations to provide optimal coverage and meet production goals.
  • Evaluated employee skills and knowledge regularly, training, and mentoring individuals with lagging skills.
  • Minimized resource and time losses by addressing employee or production issue directly and implementing timely solutions.
  • Designed strategic plan for component development practices to support future projects.
  • Developed monthly and daily production output plans to deliver on customer service and financial metrics.
  • Supervised team members to confirm compliance with set procedures and quality requirements.
  • Promoted high standerds through personal example to help each member understand expected behavious and standards.
  • Monitored time and attendance, enforcing compliance with company procedures relating to absenteeism.
  • Held weekly team meetings to inform team members on company news and updates.
  • Resolved staff member conflicts, actively listening to concerns and finding appropriate middle ground.
  • Managed and motivated employees to be productive and engaged in work.
  • Maximized performance by monitoring daily activities and mentoring team members.
  • Evaluated employee performance and conveyed constructive feedback to improve skills.
  • Approved and denied PTO request.
  • Approved and denied timesheets

Client Service Representative

Availity
07.2020 - 08.2021
  • Assisting providers with claims rejection, authorizations, referrals, and eligibility and benefits
  • Handling every call professionally
  • Providing one on one assistance through zoom sessions to help complete professional, facility, and dental claims.

Billing and Referral coordinator

Northeast Florida Lung Clinic
03.2019 - 04.2020
  • Communicating with each customer in a clear and concise manner, handling every patient professionally
  • Work between the patient and insurance for account payables
  • Overseeing all monthly AR reports
  • Expedited patient referrals to specialty offices, faxed medical records, answered patient and specialty office calls and completed referral requests
  • Ability to work independently and unsupervised maintaining a superior work ethic
  • Called insurance companies for patients to obtain benefits and precertification
  • Established a close working relationship with diagnostic imaging centers to facilitate urgent scheduling of MRI's and CT Scan's for high risk patients
  • Knowledgeable with CPT and ICD-9 codes
  • High level of proficiency relating to medical terminology and strong healthcare background
  • Scheduling procedures and giving the patients explanation of the procedure.

Education

Associate of Applied Science -

Ultimate Medical Academy
Clearwater Beach, FL
05.2017

High School Diploma -

Kathleen Senior High School
Lakeland, FL
06.2010

Skills

  • Medical Billing (2 years)
  • Medical Administrative
  • Patient Registration (1 year)
  • Medical Terminology Medical Records Management
  • Meaningful Use
  • Medical Practice Management Systems
  • Introduction to CPT ICD-9-CM
  • ICD-10-CM Coding
  • Charge Entry
  • Payment Posting (1 year)
  • Denials (1 year)
  • Appeals (1 year)
  • Referrals Accounts Receivable
  • Electronic Health Records (EHR) (1 year)
  • Electronic Medical Records (EMR) (1 year)
  • Greenway Insurance Verification
  • Reimbursement Systems
  • Medical Basics and Healthcare Claim Cycle Healthcare Payers
  • Managed Care (HMO, PPO, and POS) (2 years)
  • Medicare / Medicaid Government Payers Third Party Payers
  • HIPAA Compliance
  • Medical Charts
  • Basic Anatomy & Physiology
  • Medical Office Experience
  • Hospital Experience
  • Clerical Experience (2 years)
  • Medical Scheduling
  • Triage
  • Patient Care (3 years)
  • Vital Signs
  • Phone Etiquette
  • Electronic Health Records
  • ICD-10 Proficiency
  • Problem Solving
  • Claim Adjustment
  • Payment Posting
  • Attention to Detail
  • Appeals Processing
  • Insurance Verification

Assessments

  • Medical billing, Proficient, 02/2021, Understanding the procedures and forms used for medical billing
  • Work style: Reliability, Highly Proficient, 05/2020, Tendency to be dependable and come to work
  • Delivery driver, Proficient, 02/2021, Interpreting instructions or signs and solving problems
  • Work motivation, Highly Proficient, 05/2020, Level of motivation and discipline applied toward work

Timeline

Denial Specialist-Manager

Aspirion
11.2021 - Current

Client Service Representative

Availity
07.2020 - 08.2021

Billing and Referral coordinator

Northeast Florida Lung Clinic
03.2019 - 04.2020

Associate of Applied Science -

Ultimate Medical Academy

High School Diploma -

Kathleen Senior High School

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Beverly Reed