Catrina Williams
Madison,MS
Summary
Experienced Operations Manager in the health care industry with a proven ability to resolve complex issues using strong critical thinking skills. Recognized for proactively identifying and developing solutions for process inefficiencies. Possesses comprehensive knowledge of project and program management techniques. A natural leader who excels at motivating teams to achieve business goals and targets under pressure. Seeking an opportunity to apply skills and contribute to long-term company growth.
Overview
16
16
years of professional experience
Work History
Reimbursement Analyst
MS Center for Advanced Medicine
Madison , MS
08.2023 - Current
- Identified potential areas of improvement within existing reimbursement systems.
- Reviewed and processed medical, dental and vision claims for accuracy and completeness.
- Maintained records of all claims filed with insurance companies and government agencies.
- Managed multiple tasks simultaneously while meeting tight deadlines.
- Reviewed patient account balances to ensure that payments are properly applied against outstanding debts.
- Processed appeals when denials were received from third party payers.
- Monitored changes in regulations and guidelines from various third-party payers.
- Analyzed patient accounts to identify discrepancies in billing codes or charges.
- Performed audits of invoices submitted by healthcare providers for payment processing.
- Resolved denied claims by verifying information with providers and payers.
- Corresponded with providers regarding payment disputes and other issues related to reimbursements.
- Conducted research on coding requirements for diagnosis, procedures, modifiers.
- Provided customer service support to clients inquiring about their reimbursement status.
- Educated physicians, staff, patients and stakeholders on service documentation for procedures and coding requirements.
- Advised supervisors and clinicians of billing deficiencies to support charge capture.
- Researched rejections, investigating problems to appeal claims.
- Determined medical necessity, using individual insurance carrier regulations.
- Reviewed uninsured accounts, verifying medical assistance application process, charity care application and drug replacement program availability.
- Coded patient care records to provide accurate information for billing.
- Maintained confidentiality and integrity of patient data.
- Checked documentation for appropriate coding, catching errors and making revisions.
- Collaborated with fellow team members to manage large volume of claims.
CENTER ADMINISTRATOR
AFC URGENT CARE
11.2021 - 07.2023
- Manages operations for the clinic
- Manages all non-physician clinic staffing
- Manages reimbursement protocols and assure all patient charts are complete and accurate
- Maintains work schedules for all non-physician staff
- Supervise, evaluate, and discipline non-physician staff
- Ensure staff compliance with company policies and procedures, as well as state and federal regulations
- Ensure all staff is adequately trained to perform assigned duties, safely and effectively
- Ensure medical care is delivered in accordance with provider's instruction
- Resolve all patient and staff complaints
- Human Resources, including but not limited to, onboarding for new employees, managing time sheets, and payroll.
- Audit codes and charges to ensure accurate billing and reimbursement.
- work with providers to ensure the charges are complete for services provided
DIRECTOR OF REIMBURSEMENT
MAGNOLIA MEDICAL CLINIC
08.2020 - 10.2021
- Managed reimbursement staff to ensure billing and receivables accuracy
- Retrieved and posted manual and electronic EOB's
- Performed file maintenance setups for EOB's and insurance in NEXTGEN system
- Performed recoupments, denials, and audits for all insurance companies
- A/R and software cleanup on old accounts
- Completed system and payer rejections to ensure billing continuity
- Instructed staff on inefficiencies at reception and verification to improve claim transfer.
OPERATIONS/REIMBURSEMENT MANAGER
HEALTH CARE MEDICAL INFUSION
03.2008 - 12.2019
- Monitored project schedules for special projects with insurance companies
- Recruit, hired, and trained employees for reimbursement and intake departments
- Mentored and coached all employees
- Identified inefficiencies in operations and made recommendations for improvement
- Resolved issues with referral sources and patients to ensure adequate care
- Credentialed and recertified insurance and accrediting bodies
- Monitored the progress of reimbursement to ensure all accounts were received in a timely manner
- Made sure intake orders were processed accurately and in a timely manner
- Maintained a good working relationship with peers in order to have a steady flow of operations
- Developed policies and protocols for operations efficiency.
Education
B.S. - HEALTH CARE ADMINISTRATION
JACKSON STATE UNIVERSITY
12.2018
Skills
- Problem solving
- Effective communication
- Time management
- Leadership
- Payment posting
- HIPAA Compliance
- Claims Processing
- Insurance Verification
- Medical Billing
- Revenue Cycle Management
- Medicaid knowledge
- Policy analysis
- Financial Accounting
- Clerical writing
- Microsoft Office
- Eligibility Verification
- Policy evaluation
- Commercial insurance
- Data Recording
- Administrative writing
References
REFERENCES AVAILABLE UPON REQUEST
Timeline
Reimbursement Analyst
MS Center for Advanced Medicine
08.2023 - Current
CENTER ADMINISTRATOR
AFC URGENT CARE
11.2021 - 07.2023
DIRECTOR OF REIMBURSEMENT
MAGNOLIA MEDICAL CLINIC
08.2020 - 10.2021
OPERATIONS/REIMBURSEMENT MANAGER
HEALTH CARE MEDICAL INFUSION
03.2008 - 12.2019
B.S. - HEALTH CARE ADMINISTRATION
JACKSON STATE UNIVERSITY
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