Detail-oriented professional with strong analytical and communication skills. Experienced in streamlining claims processes and resolving discrepancies to enhance efficiency and ensure accurate reimbursements.
Overview
11
11
years of professional experience
1
1
Certification
Work History
Payment Adjustment Review- Remote
Ensemble Health Partners
Cincinnati, OH
12.2020 - Current
Analyzed denied and unpaid claims to identify discrepancies and root causes.
Evaluated payment discrepancies to determine underlying factors contributing to delays in payment.
Oversaw posting of contractual adjustments and denial resolutions according to payor contracts, enhancing claims processing efficiency.
Coordinated follow-up efforts with payors to address and expedite outstanding claims resolution.
Coordinated documentation and submission of technical and clinical appeals to facilitate timely outcomes.
Addressed payment variances and ensured prompt, accurate reimbursement processes.
Collaborated with management to identify trends and resolve root causes of issues.
Documented all interactions accurately to ensure comprehensive tracking of contact information and pertinent data.
Self-motivated, with a strong sense of personal responsibility
Daily productivity 100%.
HMS Financial Support Specialist
Shared Services Center
Fort Smith, AR
10.2016 - 11.2020
Managed denial submissions and ensured compliance with insurance payor requirements to facilitate efficient claims processing.
Daily balancing of payor accounts.
Review of accounts for accuracy and reconciliation of transactions.
Ensure variances are corrected and posted appropriately.
Making all corrections for contractual adjustment, denials, late charges and non covered services.
Apply corrections to patient demographics, charges, adjustments and payments.
Precertification Coordinator
Sparks Health System
Fort Smith, AR
01.2015 - 10.2016
Oversaw collaboration with insurance providers on pre-certification processes to ensure prompt and accurate approvals.
Conducted comprehensive reviews and validations of patient documentation to uphold accuracy and meet insurance compliance standards.
Engaged with medical personnel to convey pre-certification updates and outline essential follow-up procedures.
Conducted regular reviews of insurance policies and regulatory updates to inform and optimize pre-certification practices.
Ensured accuracy and validity of all processed orders.
Facilitated communication with insurance companies to confirm client benefits and eligibility status.
Supported training initiatives and fulfilled various operational duties to enhance team performance.
<ul><li>Profile: Record to Reporting (R2R)</li><li>Performing financial reporting and controlling for across all the entities (in Hyperion and Oracle = JD Edward).</li><li>Performing End to End P&L finalization (Review of accruals, Negative Cash Accrual, prepaid amortization schedule, FX Adjustments, creation, deletion and capitalization of fixed assets, posting of depreciation etc.) & taking calls with Controllers during Months end for further review of P&L.</li><li>Banking process includes positive pay exceptions, stop payment, voiding checks with AP team. Checks movement to unclaimed property. Payment proof, remittance details.</li><li>IFRS lease computation complying with IFRS 16 in CoStar – Real Estate Manager system (this is only for lease).</li><li>Preparation of webforms and variance analysis report and sharing with stakeholders with detailed information.</li><li>Performing Balance sheet reconciliation with adherence of policy and clearance of open items along with relevant details of lines which is overaged however will be staying for long time (i.e.- Bonus and dividends, Common Stocks, Security Deposits).</li><li>Facilitating team operations by discussions through the sharing of information and knowledge, identification of teamwork issues, development of problem-solving recommendations, and recommendations of standardizing team operations.</li><li>Cross train resources in order to have backup of each other to help team synergy helping team members to take leaves when required without bothering of work/process deliverables.</li><li>Conduct weekly, biweekly and monthly meetings with stake holders as per their agreement.</li><li>Create opportunities for team members to provide input on procedures/processes and share their expertise with other team members.</li><li>Working knowledge of ERP systems People Soft, ART (Reconciliation software of Oracle), JD Edward, Teradata, Cetova, Hyperion (HFM), Cadency, Blackline, SAP, NetSuite, Workday Adaptive, Coupa, Tableau, CoStar, Alteryx.</li><li>PROCESS IMPROVEMENTS</li><li>Given 12 lean ideas in area of Month End Close journals, Balance Sheet Reconciliations, and Bank Reconciliations.</li><li>Part of a green belt project on quality of reconciliations and BOT implementation (work in progress) – controllership impact</li><li>Bring automation & Marco enabling dash board MIS reporting for monthly SLA, KPI, IC balances, Cash forecasting etc.</li></ul> at Genpact India Pvt. Ltd<ul><li>Profile: Record to Reporting (R2R)</li><li>Performing financial reporting and controlling for across all the entities (in Hyperion and Oracle = JD Edward).</li><li>Performing End to End P&L finalization (Review of accruals, Negative Cash Accrual, prepaid amortization schedule, FX Adjustments, creation, deletion and capitalization of fixed assets, posting of depreciation etc.) & taking calls with Controllers during Months end for further review of P&L.</li><li>Banking process includes positive pay exceptions, stop payment, voiding checks with AP team. Checks movement to unclaimed property. Payment proof, remittance details.</li><li>IFRS lease computation complying with IFRS 16 in CoStar – Real Estate Manager system (this is only for lease).</li><li>Preparation of webforms and variance analysis report and sharing with stakeholders with detailed information.</li><li>Performing Balance sheet reconciliation with adherence of policy and clearance of open items along with relevant details of lines which is overaged however will be staying for long time (i.e.- Bonus and dividends, Common Stocks, Security Deposits).</li><li>Facilitating team operations by discussions through the sharing of information and knowledge, identification of teamwork issues, development of problem-solving recommendations, and recommendations of standardizing team operations.</li><li>Cross train resources in order to have backup of each other to help team synergy helping team members to take leaves when required without bothering of work/process deliverables.</li><li>Conduct weekly, biweekly and monthly meetings with stake holders as per their agreement.</li><li>Create opportunities for team members to provide input on procedures/processes and share their expertise with other team members.</li><li>Working knowledge of ERP systems People Soft, ART (Reconciliation software of Oracle), JD Edward, Teradata, Cetova, Hyperion (HFM), Cadency, Blackline, SAP, NetSuite, Workday Adaptive, Coupa, Tableau, CoStar, Alteryx.</li><li>PROCESS IMPROVEMENTS</li><li>Given 12 lean ideas in area of Month End Close journals, Balance Sheet Reconciliations, and Bank Reconciliations.</li><li>Part of a green belt project on quality of reconciliations and BOT implementation (work in progress) – controllership impact</li><li>Bring automation & Marco enabling dash board MIS reporting for monthly SLA, KPI, IC balances, Cash forecasting etc.</li></ul> at Genpact India Pvt. Ltd