Chameka Williams
Manchester
Summary
Professional with proven expertise in account management and revenue cycle operations. Adept at resolving billing issues, ensuring accurate financial records, and maintaining compliance with healthcare regulations. Strong focus on team collaboration and achieving results, with flexible approach to adapting to changing needs. Known for excellent communication, problem-solving skills.
Overview
13
13
years of professional experience
1
1
Certification
Work History
Patient Account Representative
Conifer Health Care
07.2021 - 05.2025
- Communicates with insurance companies, providers and patients to obtain information regarding claims via phone, email or letter correspondence.
- Conduct thorough review of claim denials and incorrect payments, with a focus on identifying opportunities for appeal. This involves utilizing various guidelines and reference tools such as CPT, ICD-9, ICD-10, HCPCS, medical terminology manuals, Correct Coding Initiative Edits, Medicare Fee schedule, and modifier rules
- Responsible for obtaining medical records to submit to insurance companies. Navigate the prior authorization process by liaising with healthcare providers, payers, and other stakeholders to secure necessary approval for services. Initiates authorization requests with insurance companies and government payers.
- Verify claim adjudication utilizing appropriate resources and applications to ensure billing compliance guidelines are satisfied for electronic and manual submission. Verify patient eligibility for claim submission
- Post insurance and patient payments accurately, applying correct denial codes to facilitate proper account management
- Capable of processing electronic 835’s and manual payer EOBs, including the posting of insurance allowable, patient portions, denials, adjustments, contractual allowances, recoups and forward balancing
AR Credit Balance Repr/Business Analyst
11.2020 - 06.2021
- Handle insurance and patient payments for both the hospital and clinic systems, including manual receipts, electronic remittance, credit card payment, etc.
- Post zero-dollar payments (deductibles, coverage termination) and collaborate with research staff to resolve unpaid services.
- Determine if credit balance should be refunded to patient, insurance, or reverse the contractual
- Reviews credit balances to ensure accurate payments as per contractual terms and makes any necessary adjustments or corrections
- Review accounts receivable and bad debt for other open accounts and make appropriate transfers
- Verifies credit transactions, confirms correct account application, and transfers misapplied payments
Claims Specialist/Business Analyst
04.2018 - 10.2020
- Determines the nature and validity of claims by reviewing policy status, patient eligibility and supporting medical records and other documentation
- Key claim data while interpretating medical terminology, ICD, CPT, and HCPCS codes; Uses multiple core administration databases, systems, and subsystems to process and transmit claims for payment or further investigation
- Provides prompt attention to escalations submitted by policyholder.
- Process claims that may be complex and sensitive, including but not limited to paying, denying, or pending of claims based off information submitted for review.
- Analyzes billing and supporting medical documentation and uses in-house claims processing systems that include sub-systems for diagnoses and procedure to determine the nature and validity of claims.
- Understands and helps facilitate alignment among polices, program standards, work procedures and external guidelines. Identify gaps and help drive corrective action
- Identify and implement controls and procedures to mitigate risks supporting operational and strategic risk management efforts
- Remains current on regulatory policy, program standards and work procedures ensuring proper compliance with processes and requirements are followed
- Collaborate with cross-functional teams including IT, marketing, finance, and operations
- Assists in identifying and monitoring operational and strategic risks along with associated Key Risk Indicators
- Monitor project performance and deliverables to ensure alignment with business objectives
Accounting/Reconciliation Specialist
Aflac
09.2012 - 04.2018
- Reconciles and balances invoices from small to large accounts; Reviews account payments to determine disposition of funds; identifies discrepancies or account variances and takes the necessary steps to resolve issues.
- Formats excel spreadsheets for payment upload application including v-lookups, pivot tables, Installing and running macros for payment upload.
- Confirms invoice status code and reviews and deciphers all adjustment codes and notes provided by payroll account on the invoice; Applies pay codes that correspond to the adjustment codes; Applies premium payments to the payroll account once the invoice is balanced; Processed partial payments, transfer advice accounts or holding accounts and rejects.
- Assists with the coordination of activities necessary to maintain balanced accounts; Ensures prompt and accurate account calculation and adjustments; Prepares forms and letters using the letter generating system as required; Maintains effective and accurate electronic or manual filing systems, transactions, and accounting logs that provide a quick reference database; Provides back-up coverage to other teams as required.
Education
High School Diploma -
Central High School
Talbotton, GeorgiaSkills
- DETAILED ORIENTED
- DATA ANALYSIS
- CRITICAL THINKING
- DECISION QUALITY
- RESEARCH AND AUDIT SKILLS
- ROOT CAUSE ANALYSIS
Awards
LEAN SIX SIGMA YELLOW BELT, MICROSOFT OFFICE SPECIALIST CERTIFICATION, PROJECT MANAGEMENT CERTIFICATION
Certification
LEAN SIX SIGMA YELLOW BELT
MICROSOFT OFFICE SPECIALIST CERTIFICATION
PROJECT management certification
Timeline
Patient Account Representative
Conifer Health Care
07.2021 - 05.2025
AR Credit Balance Repr/Business Analyst
11.2020 - 06.2021
Claims Specialist/Business Analyst
04.2018 - 10.2020
Accounting/Reconciliation Specialist
Aflac
09.2012 - 04.2018
High School Diploma -
Central High School
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