Catherine Hurst
Basehor
Summary
Diversified in many aspects of healthcare:
Highly rated customer service - patient centered care with face to face, phone, or in writing. Daily communication with external parties as well.
High level of understanding state and federal regulations regarding patient care and documentation.
Detail oriented regarding patient accounts, billing, insurance, and payments, quality assurance tracking and reports.
Flexible with changes.
Enjoy both team collaboration and self guided work.
Have over 15 years of experience working in the Department of Veterans Affairs in financial, daily operations, customer service, and legality related to patient care and billing.
Overview
24
24
years of professional experience
Work History
Financial Accounts Technician
Department Of Veterans Affairs
07.2018 - Current
- Expedited claim processing times by developing expertise in payer-specific guidelines and requirements.
- Served as a liaison between healthcare providers and payers to ensure prompt resolution of any disputes or discrepancies that may have arisen during the claims process.
- Corrected, completed and processed claims for multiple payer codes.
- Developed strong knowledge of various payer systems to maximize reimbursement opportunities for clients across diverse networks.
- Audited and corrected billing and posting documents for accuracy.
- Organized electronic health records for easy access during the claims process, improving overall efficiency in the department.
- Improved patient billing accuracy by reviewing and verifying insurance claims information.
- Contributed to overall departmental goals and objectives by consistently maintaining high levels of professionalism, accuracy, and productivity in all tasks performed.
- Processed billing calls and answered questions from patients and third-party carriers.
- Processed online and paper appeal submissions and refund requests.
- Utilized various software programs to process customer payments.
- Responded to customer concerns and questions on daily basis.
- Helped identify trends in denied claims data which led to targeted staff education and continuous improvement of the reimbursement process.
- Resolved complex insurance issues by working closely with patients, providers, and payers to find mutually agreeable solutions.
- Collaborated with medical coders to ensure accurate diagnostic codes were applied to claims, minimizing rejections due to coding errors.
- Maintained strong relationships with insurance companies, facilitating smooth communication and prompt claim resolution.
- Kept vendor files accurate and up-to-date to expedite payment processing.
- Used data entry skills to accurately document and input statements.
- Trained new team members on medical reimbursement processes, fostering a knowledgeable and competent workforce.
- Reduced claim denials by conducting thorough research and addressing discrepancies before submission.
- Ensured compliance with all federal regulations related to medical billing practices, protecting organizations from potential audits or penalties.
- Demonstrated strong organizational and time management skills while managing multiple projects.
- Gained extensive knowledge in data entry, analysis and reporting.
- Participated in team projects, demonstrating an ability to work collaboratively and effectively.
- Used strong analytical and problem-solving skills to develop effective solutions for challenging situations.
- Proven ability to learn quickly and adapt to new situations.
MEDICAL REIMBURSEMENT TECHNICIAN
DVA - CPCPAC
06.2011 - 07.2018
- Responsible for the verification of Veterans' insurance coverage for inpatient and outpatient services
- Verifies benefits, policy number, pre-certification requirements, insurance contact information, and effective dates of coverage
- Responsible for all reimbursable insurance related to billing activities including consideration of professional services and facility services, sharing agreements, Medicare, and pharmacy billing
- I ensure that all billable cases are identified so that bills are generated and that insurance company data is accurate to ensure maximum revenue is obtained
- On a daily basis I identify any issues with our insurance database regarding the organization, carriers, or providers and report that information to management in a timely fashion
- I keep up to date on payer agreements, whether local, regional, or national, as well as database file modifications and share this information with staff and management to ensure the accuracy of patients files
- I have prepared reports as needed and am capable of compiling necessary reports within the insurance and other databases
- On a daily basis I review and maintain our insurance database so that all information is kept accurate and current
- I utilize the electronic insurance verification daily and report any trends, patterns or discrepancies immediately to management
- I am continuously involved in special projects for corrective actions that need to be done within certain deadlines and are completed within established policies or guidelines
- I have utilized the updates and software implementations in accordance with policies and update management on any discrepancies found
- I continuously obtain information required for tort cases, workman's compensation, OWCP, and personal injury cases
- I validate claims for billing purposes ensuring eligibility and obtains referrals questionable coding for review
- Assists with researching and resolving problems related to patients insurance file which allows others within our CPAC to posts payments, adjustments, denial codes, and non-payment collections
- I have assisted with performing follow-up on explanation of benefits received from third-party carriers to maximize revenue and review insurance files to ensure consistency with insurance policy terms
- I use the telephone daily to contact 3rd party payors, patients, and fellow co-workers to resolve issues or obtain new information to complete the veterans insurance file
- I provide patient assistance when needed or get patient to appropriate area that can assist when I am unable to answer
- Also, I utilize electronic inquiries regarding patient accounts to answer questions or correct issues within the veterans insurance file by determining the best course of action while adhering to CMS, VA and VHA regulations, and any veterans eligibility guidelines
- Most work is completed through ICB or Vista and utilize Huron management tools for over four years of experience
- I maintain a pleasant and professional manner when communicating with the veterans, co-workers, and outside sources
- I am highly skilled in reviewing data and able to correct any errors or processes
- Extremely knowledgeable of the laws, rules, and regulations or guidelines pertaining to the veterans health care eligibility, means and co-payment testing as well as MCCR billing
- I have extensive knowledge of the revenue process as I am in constant contact with other areas within and outside the CPAC
- This teamwork is used to solve any problems or discrepancies that may lie within any one or few of our revenue processes
- Was also assigned POC and timekeeper duties.
- Assisted in training new employees on best practices for efficient insurance verification processes and procedures.
- Chased insurance companies to achieve accurate and timely payments.
- Optimized productivity within the department by prioritizing tasks according to urgency and importance levels.
- Trained new staff on current, correct insurance verification procedures.
- Demonstrated a high level of professionalism and attention to detail in all aspects of insurance verification specialist role, consistently exceeding performance expectations.
- Completed paperwork, recognizing discrepancies and promptly addressing for resolution.
- Proven ability to develop and implement creative solutions to complex problems.
- Skilled at working independently and collaboratively in a team environment.
- Worked effectively in fast-paced environments.
- Ensured compliance with HIPAA regulations while managing sensitive patient information during the verification process.
PROGRAM SUPPORT ASSISTANT
DVA - CPCPAC
07.2012 - 09.2012
- Provide answers to customer service inquiries regarding accounts receivables, means and co-payment testing and health insurance related issues
- Had daily contact with veterans regarding eligibility and financial status
- Assisted Veterans with write-offs, payment plans, or any other service vet may inquire about
- Provide helpful and courteous assistance to insurance carriers, as well as other VA medical centers and business entities, conveying a professional businesslike attitude
- Review first party receivables
- Assisted in VISA with first party bills by creating write-offs or payment plans that required adjustments and time tables set up for payments if needed
- Collect, compile and/or track data and program information in support of revenue
- Prepare, execute and/or track revenue program specific information
- Organize and retrieve computerized data, generate reports of data, review data for inconsistencies and refer to appropriate area for completion
- Enter information into tracking system and maintain accurate program specific data for maximum reimbursement
- Conduct proactive accounts receivable follow up and analysis on various account receivables
- Reports were run weekly and monthly to check for any areas that may have need to be reviewed again for lacking information, missing payments, and general discrepancies
- Had access to TOP to assist veterans and insure any debt collection taken was accurate and fair.
- Planned and coordinated logistics and materials for board meetings, committee meetings, and staff events.
- Opened and properly distributed incoming mail to promote quicker response to client inquiries.
- Followed detailed directions from management to complete daily paperwork and computer data entry.
- Proofread and edited documents for accuracy and grammar.
- Performed wide-ranging administrative, financial and service-related functions.
Radiology/QA Technologist
Cushing Memorial Hospital
04.2005 - 06.2011
- My first responsibility was to take care of patients by performing quality radiologic procedures on critical and non critical patients in a compassionate manner while being efficient
- My knowledge regarding the classification of systems is extensive do to my previous coding position and having to work first hand with patients, disease, and pathology
- I have over 10 years of understanding of acceptable diagnosis and symptoms (ICD-9 codes) related to the exams (CPT/HCPCS) I perform
- I had to utilize patients medical record to verify procedures prior to being performed establish that they met the criteria to be performed whether it was a diagnosis, symptoms, or labs
- I participated in a call rotation that I had to be available and ready to proceed to work at any given time during my scheduled off hours
- I was also in charge of the mammography department's quality assurance program for over almost 6 years (2 years were training)
- It required I perform physical tests on the equipment weekly, monthly, and quarterly to assure that they are operating in accordance to regulations provided through the FDA to maintain our program
- I compiled this information in a standard format to be reviewed yearly for certification purposes
- I was in charge of pulling various reports from our database and tracking the information which was kept on file for our yearly inspection from the FDA
- Information was kept via automated computer systems, spreadsheets (excel), database applications (access), graphics applications and various software applications (DOS and Windows) designed specifically for hospitals quality assurance programs
- I oversaw physicians and technologists ensuring that they met the minimum requirements to practice mammography and the data was tracked and recorded by myself
- Reports were done daily, weekly, monthly, and quarterly to track information required by the FDA and State of Kansas to practice
- I was in charge of monitoring staff ensuring that they were kept up to date with education and credentials
- Simple and complex problems and work processes were monitored and comprehensively analyzed on a routine basis to ensure all levels of program were being met and enabling me to recommend any improvements to our program
- Patient information was tracked for cancer registries and overall quality of care
- I myself had to maintain yearly licenses with continuing education and documented exams
- Extensive knowledge was required of federal rules and regulations, our organizations policies, missions and goals to maintain the QA program was run efficiently and lawfully
- There was continuing communication within the hospital with fellow nurses, doctors and ancillary staff on a daily basis from patient care to inventory control
- I also assisted with answering multi line phones and giving excellent customer service whether it be scheduling appointments or assisting a doctor's office with information
- Part of my responsibilities included intake and registration of patients for their appointments
- This involved interviewing the patient for pertinent info needed to complete the scheduling/registration process
- I was provided extensive training on our scheduling program and was often consulted by others for assistance
- My knowledge of private insurances and their eligibility as well as Medicare benefits helped to ensure that the patients were being scheduled in a timely fashion and according to medical necessity as well as adhering to hospital and department guidelines
- I had to routinely analyze our scheduling within our department for any conflicts or issues such as overbooking or staff discrepancies that may hinder patient care
- I was part of a program, called practice counsel, for over 2 years
- This committee consisted of fellow employees from various departments who would meet monthly and use fact finding techniques and recommend any improvements in our processes that related anywhere from patient care to the revenue processes within the hospital
- Internal audits, patient/employee satisfaction surveys were all used to gather information on our services
- Any areas of concern were brought up during our meetings and as a team we would brainstorm to find solutions, improvements, or modifications we could use to correct deficiencies or increase our strengths
- This information was then presented to senior staff shortly after in an informal setting
- These changes or modifications were then re-evaluated within 60-90 days to ensure the quality of care was still being met
- All of these responsibilities required a thorough knowledge of internal and external (Joint Commission/OSHA/Medicare) guidelines ensuring our goals while maintaining high level of quality care
- Daily communication was maintained in a professional and compassionate matter whether in person, emails, letters, or phone
- I was also a diversity educator within the hospital, training new employees on diversity in the workforce.
- Coordinated inventory supplies and equipment to maximize team productivity.
- Worked flexible hours across night, weekend, and holiday shifts.
Medical Records Technician
Dwight D. Eisenhower VA
10.1999 - 04.2003
- My primary duties were coding of medical records, mainly outpatient visits, but also assisted with inpatient, psych, surgery, and ancillary coding
- In a timely manner, I would abstract necessary information and assign the appropriate CPT or ICD-9 codes that most accurately describe the encounter or procedure
- For inpatient stays I would find the primary reason for the stay and that secondary diagnoses are properly sequenced to assure maximum allocation under the Diagnostic Related Groupings system, some of which were very complex stays
- I would review lab and radiology tests performed and make sure an appropriate symptom or diagnosis was documented
- I would assist with medical record audits to verify completeness, accuracy, and compliance with regulatory requirements such as Joint Commission
- I also provided assistance to physicians and staff by educating them on documentation and medical necessity as well as correcting deficiencies
- I was also able to provide assistance to patients, authorized representatives, and third parties with information requests while observing the Privacy Act (HIPPA) as well as Freedom of Information Act guidelines
- All the data entered helped to insure that the VA revenue process ran smoothly
- I was also involved in peer review for quality assurance as well as collecting data for tumor registries
- I have over 4 years of using VA databases and software designed specifically for the Veterans Affairs Hospitals
- I have extensive knowledge of medical terminology, anatomy, and disease processes
- I have over ten years experience with electronic medical records (CPRS) as well as paper format
- I worked with minimal supervision while having periodic checks of my coding by peers and supervisor and had to maintain over 90% accuracy
- I am physically capable of handling this job, standing, sitting, bending, and lifting of moderately heavy items.
- Maintained strict confidentiality of sensitive patient information in compliance with HIPAA regulations.
- Verified accuracy of patient information in medical records.
- Supported medical staff by providing organized and accurate medical records.
- Expedited release-of-information requests by verifying authorization forms and providing requested documents promptly.
- Followed up with medical staff regarding missing information in patient records.
- Assisted in audits and investigations involving medical records, contributing to the identification of potential areas for improvement in documentation processes.
- Utilized electronic medical record systems to store, retrieve and process patient data.
- Assisted in preparation of medical records to release to other medical facilities requesting for patient history and information.
- Reviewed charts and flagged incomplete or inaccurate information.
- Obtained necessary signatures on information release forms to obtain medical and treatment records from other service providers.
- Conducted thorough research on complex medical coding issues when necessary, ensuring accuracy and compliance with insurance reimbursement guidelines.
- Reduced billing errors by accurately assigning ICD-10 codes to diagnoses and procedures in accordance with official guidelines.
- Ensured timely processing of medical records requests by efficiently coordinating with healthcare providers, insurance companies, and legal representatives.
- Analyzed complex medical records to identify discrepancies in accuracy and completeness.
- Developed strong working relationships with physicians, nurses, and other healthcare professionals to ensure accurate recordkeeping practices were upheld consistently across all departments.
- Demonstrated strong attention to detail while cross-referencing medical records for completeness and consistency, identifying potential errors and facilitating prompt resolution.
- Supported administrative staff in maintaining current knowledge of billing requirements and regulatory changes through regular training sessions.
- Participated in team projects, demonstrating an ability to work collaboratively and effectively.
- Used classification manuals to gain additional knowledge of disease and diagnoses processes.
- Monitored changes in coding regulations to provide recommendations for compliance.
- Reviewed medical records for completeness and filed records in alphabetic and numeric order.
- Reviewed, analyzed, and managed coding of diagnostic and treatment procedures contained in outpatient medical records.
- Maintained accuracy, completeness, and security for medical records and health information.
- Generated and maintained statistical data related to medical records.
- Verified signatures and checked medical charts for accuracy and completion.
- Resourcefully used various coding books, procedure manuals, and on-line encoders.
- Used critical thinking to break down problems, evaluate solutions and make decisions.
- Identified issues, analyzed information and provided solutions to problems.
Education
Associate's degree - Radiologic Sciences
Colorado Technical University
05.2005
Skills
- Telephone and email etiquette
- Proficiency in MS word, excel, power point and email
- Document Preparation
- Process Improvements
- Trend Analysis
- Purchase order creation
- Data Entry
- Quality Assurance
Additional Information
55 wpm, 10,000
Job Related Training
- VA Privacy and Information Security Awareness and Rules of Behavior
- Prevention of Workplace Harassment/No FEAR
- CBO-CPAC Internal Control Training for All CPAC Staff
- VHA CO Compliance and Business Integrity Awareness
- Privacy and HIPAA Training
- Getting Started With Public key Infrastructure - PKI
- Military Cultural Awareness
- CBO (July 2011): Reasons Not Billable Training for Users
- Bridges to the Bottom Line - Exploring the Revenue Cycle - Learning Map
- CBO (October 2010): National Training on Service-Connected and Special Eligibility Authority
- Customer Service Excellence
References
- Duke Eldridge, Self Employed, Physicist, 316-371-6491, dukeeldridge@yahoo.com
- Melissa Waters, KU Medical Center, Nurse, 913-991-0905
- Gina Leffert-Page, Encompass Medical, Manager - Mammographer, 913-302-1032, gleffert@emcompassmed.com
Timeline
Financial Accounts Technician
Department Of Veterans Affairs
07.2018 - Current
PROGRAM SUPPORT ASSISTANT
DVA - CPCPAC
07.2012 - 09.2012
MEDICAL REIMBURSEMENT TECHNICIAN
DVA - CPCPAC
06.2011 - 07.2018
Radiology/QA Technologist
Cushing Memorial Hospital
04.2005 - 06.2011
Medical Records Technician
Dwight D. Eisenhower VA
10.1999 - 04.2003
Associate's degree - Radiologic Sciences
Colorado Technical University
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