Billi R. Scott
Altus Healthcare
Houston,TX
1
Certification
9
years of professional experience
Insurance professional with in-depth experience in verifying insurance coverage and handling patient information to ensure smooth operations. Known for reliability and adaptability in dynamic environments, contributing effectively to team goals. Proficient in utilizing verification systems and maintaining comprehensive records while displaying strong attention to detail and collaborative mindset. Diligent with a solid background in managing insurance operations and streamline processes and improve efficiency. Strong leadership, with effective communication and problem solving.
Work History
Insurance Verification Specialist
1 Year 5 Months- Conducted comprehensive insurance verifications to ensure accurate patient coverage and eligibility.
- Collaborated with healthcare providers to resolve discrepancies in insurance information efficiently.
- Streamlined verification workflows by implementing process improvements that enhanced accuracy and reduced turnaround times.
- Trained new team members on best practices for insurance verification protocols and systems usage.
- Analyzed claims data to identify trends, contributing to strategic decisions for improving operational efficiency.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- Complied with HIPAA guidelines and regulations for confidential patient data.
- Maintained accurate records of all collection activities, ensuring compliance with company policies and industry regulations.
- Managed billing processes to ensure timely and accurate claims submissions.
- Developed standardized workflows that reduced claim denial rates significantly.
- Implemented best practices in coding and documentation for improved compliance.
Insurance Collections Rep.
1 Year- Provide collections on complex out-of-network denials and prepare appeals and other necessary actions on outstanding balances with major payors, self-funded plans, and commercial payors.
- Responds to all correspondence from insurance carriers.
- Research, appeal, and resolve unpaid insurance claims.
- Work assigned claim volume timely and efficiently with accuracy and quality.
- Initiates collection follow up on all unpaid or denied claims with appropriate insurance carriers.
- Follow all processes and procedures set by the department leadership.
- Communicated effectively with clients to resolve billing inquiries and negotiate payment plans.
- Managed collections for outstanding accounts, ensuring timely payments and reducing delinquency rates.
- Utilized CRM software to track account statuses and maintain accurate records of interactions.
- Reviewed collection reports to determine status of collections and amounts of outstanding balances.
- Played a key role in reducing account aging by proactively identifying at-risk accounts and initiating early intervention measures.
- Demonstrated exceptional problem-solving abilities in addressing complex collection scenarios, leading to successful resolutions.
- Adapted quickly to changing priorities, maintaining a high level of performance and attention to detail in the fast-paced collections environment.
Revenue Cycle Manager-Patient Collections
4 Years 7 Months- Developed new programs and processes to increase and maintain positive recovery capital.
- Managed and lead a team of 15-20 collection and customer service specialists.
- Monitor submitted healthcare claims for potential overpayments by comparing billing codes, medical records, and payer contracts.
- Analyze claim data using specialized software to identify patterns and trends of INN and OON claims processing.
- Manage negotiating settlements with providers and payers to resolve overpayment disputes.
- Developed policies and procedures adhering to HIPPA regulations and other healthcare compliance standards when handling patient data.
- Monitor, and communicate to the Director of Operations trends to production, claim reviews, recovery efforts, and communication with providers and payers.
- Interact with all employees in a mature, responsible, courteous manner to ensure a positive and professional environment.
- Strong problem-solving skills to address complex claim issues and find solutions.
- Provided training for quality improvement on State, Federal, and Managed Care regulations.
- Developed and implemented strategic workflows to enhance patient collections and financial performance.
- Analyzed revenue cycle metrics to identify trends and implement corrective actions for efficiency gains.
Customer Service Supervisor
1 Year 2 Months- Supervising and directing daily activities of the customer service department.
- Creates and implements goals, action plans, and incentives to drive desired production results.
- Carries out supervision, call monitoring, coaching, training, and feedback and disciplining.
- Acts as information source, assigning tasks, following up and giving instructions.
- Follows up and resolves customer complaints and questions.
- Conducts performance measurements, ongoing monitoring and evaluation of all customer service employees.
- Responsible for annual performance evaluations and monthly quality and productivity profile and feedback to team members.
- Monitors all outbound/inbound activities for the team members according to performance standard goals.
- Improves quality results by evaluating processes and recommending changes. Coordinates and enforces system policies, procedures, and productivity standards.
- Handles escalations on a need be basis.
- Conducts interviews and involved in the hiring process.
- Performs routine call quantity reviews on recorded or live calls according to Call Center procedures for his/her team.
- Administers performance management, recognition and disciplinary actions on a timely basis.
Customer Service Representative – Customer Service Team Lead
1 Year 7 Months- Provided problem resolutions by effectively communicating with other departments, product vendors, and the participant or client.
- Ensured all interactions with customers (both internal/external) were professional and courteous.
- Conducts performance measurements, ongoing monitoring and evaluation of all customer service employees.
- Daily follow up on all claim reports generated based on rejections, appeals and denials by the insurance carriers.
- Post contractual adjustments and transfer deductibles to patient accounts based off correspondence from insurance carriers.
- Handled escalated issues from patients and insurance payors regarding claims resubmissions, appeals, denials and unpaid or partial pay claims.
Education
Phlebotomy - Phlebotomy/Clinical Lab
Skills
Attention to detail
Patient confidentiality
HIPAA compliance
Insurance coverage verification
Eligibility determination
Medical terminology
ICD-10
NSA Negotiations
Centricity (Software System)
Go Rev (Software System)
RCM
CPT coding
Leadership
Team Development
Mentoring
Training
Management
Certification
- CMA - Certified Medical Assistant
- MLT - Medical Laboratory Technician
- PT - Phlebotomy Technician
Timeline
Insurance Verification Specialist
Altus Healthcare
03.2025 - CurrentRead More
Insurance Collections Rep.
Nutex Health Inc.
03.2024 - 03.2025Read More
Revenue Cycle Manager-Patient Collections
Roundtable Medical Consultants
03.2020 - 10.2024Read More
Customer Service Supervisor
Roundtable Medical Consultants
01.2019 - 03.2020Read More
Customer Service Representative – Customer Service Team Lead
Roundtable Medical Consultants
03.2017 - 10.2018Read More
Newbridge College
Phlebotomy from Phlebotomy/Clinical Lab
Read More