Brenda Jackson
Bethlehem,GA
Summary
Results-oriented Healthcare Revenue Cycle professional with expertise in medical billing, claims resolution, and insurance reimbursement. Skilled in analyzing accounts, researching payer requirements, and resolving discrepancies to ensure accurate reimbursement. Strong understanding of insurance eligibility, payer guidelines, and healthcare billing processes, with a proven ability to collaborate across departments to address complex issues.
Overview
21
21
years of professional experience
Work History
Account Representative
PIEDMONT HEALTHCARE
Athens, GA
03.2020 - Current
- Review and analyze healthcare accounts to identify outstanding balances, billing issues, payment discrepancies, and other account-related concerns.
- Investigate claim denials and reimbursement issues, utilizing payer guidelines and claim information to identify the reason for nonpayment or incorrect payment.
- Researched payer requirements and claim-related issues, determining appropriate resolutions and outlining next steps.
- Prepare and submit corrected claims when billing errors or payer-specific requirements are identified.
- Review billing details including units, modifiers, revenue codes, and other claim elements to ensure claims are submitted appropriately.
- Research and resolve complex account issues while maintaining accuracy and attention to detail.
- Work with healthcare providers and internal departments to address account questions and facilitate timely resolution.
- Analyzed account activity to identify ongoing issues, initiating additional research or follow-up.
- Maintained strong provider relationships through timely communication and effective problem-solving.
Team Lead
NORTHSIDE HOSPITAL ATLANTA
Lawrenceville, GA
06.2010 - 03.2020
- Led healthcare teams while supporting efficient departmental operations and quality patient service.
- Coordinated departmental processes ensuring compliance with healthcare regulations and established procedures.
- Trained and mentored new employees on company procedures, systems, compliance standards, and departmental expectations.
- Trained and mentored new employees on company procedures and compliance standards, enhancing team readiness.
- Coordinated communication between departments to facilitate timely resolution of operational and patient-related concerns.
- Facilitated communication between departments to resolve operational and patient-related concerns promptly.
- Served as a resource for staff by providing guidance, problem-solving support, and assistance with complex issues.
- Supported management initiatives and helped ensure departmental goals and performance expectations were met.
Patient Access Representative
NORTHSIDE HOSPITAL ATLANTA
Lawrenceville, GA
01.2006 - 06.2010
- Registered patients and accurately collected demographic and insurance information.
- Verified insurance eligibility and benefits to support appropriate patient access and reimbursement.
- Facilitated patient scheduling and navigation through complex healthcare processes to enhance access to care.
- Clarified insurance coverage and procedure requirements to patients, ensuring understanding of benefits.
- Maintained accurate patient information while adhering to HIPAA and confidentiality requirements.
- Collaborated with clinical and administrative staff to facilitate efficient patient flow and service delivery.
- Addressed patient questions and concerns by thoroughly researching procedures, policies, and account details.
- Trained new team members on registration procedures, hospital systems, and departmental processes.
Education
High School Diploma -
Winder-Barrow High School
Winder, GASkills
- Claims correction
- Claim denial resolution
- Underpayment analysis
- Claim resubmission
- Insurance verification
- UB-04 Claim Knowledge
- Payer types
- Account evaluation
- Medical billing
- Interdepartmental Coordination
- Problem Resolution
- Client Relations
Additional Qualifications
- Extensive healthcare industry experience
- Revenue cycle and medical billing experience
- Experience working with commercial insurance payers and Medicare-related billing requirements
- Experienced in researching claim issues and payer-specific requirements
- Strong analytical, organizational, communication, and problem-solving skills
- Proven ability to learn new systems, processes, and payer requirements quickly
Timeline
Account Representative
PIEDMONT HEALTHCARE
03.2020 - Current
Team Lead
NORTHSIDE HOSPITAL ATLANTA
06.2010 - 03.2020
Patient Access Representative
NORTHSIDE HOSPITAL ATLANTA
01.2006 - 06.2010
High School Diploma -
Winder-Barrow High School