Chauqita Harris
Cordova,TN
Summary
Motivated to support patient medical needs by efficiently verifying insurance, scheduling appointments, and organizing documents. Forward thinking and resourceful with good interpersonal skills, a strong attention to detail and a positive and upbeat mentality. Advanced abilities in Intergy, Centric, Epic, SMS Net, and EIQ system. Detail-oriented Patient Service Representative with outstanding knowledge of outpatient, in-patient and office setting treatment, and authorization. Successful at coordinating between patients and professionals and comprehensive patient education. Committed to organization and efficiency. Hardworking and reliable individual with strong ability in authorization and registration.
Overview
13
13
years of professional experience
Work History
Case Manager Reimbursement
UBC (United BioSource, LLC)
10.2024 - Current
- Provide day-to-day oversight and coordination of caseload to ensure all case elements and tasks are completed timely and ensure cases move through the process as required
- Act as single point of contact responsible for prior authorization and appeal processing communications to patients, healthcare providers, field reimbursement representatives and other external stakeholders
- Communicate patient benefits and responsibility timely and accurately
- Assess and refer patients appropriately for special programs/services when appropriate
- Performs quality checks on cases and report trends to leadership
- Responsible for good housekeeping techniques, adhering to quality and production standards while complying with all applicable company, state and federal safety and environmental programs and procedures
- Troubleshoot complex cases, spanning multiple disease-states, while interfacing with key stakeholders (internal/external) to ensure optimal start to therapy
- Report Adverse Drug Events that have been experienced by the patient in accordance pharmaceutical requirements
- Recognize a product quality complaint and forward caller/written information to a manufacturer
- Other duties, as assigned
Tax Examining Technician
IRS (Internal Revenue Service)
04.2023 - Current
- Review AMRH (Accounts Management Research Hold) freeze cases on hold to determine proper release of patient refunds, apply to any open Tax balance(s) and send letters requesting any additional information
- Researches and analyzes each case to determine the scope and nature of the complex interest calculation issues and problems
- Research or reconstruct data completing analysis of the conditions and complicating factors including numerous computational errors, multiple tax years, and multiple adjustment issues to compute complex interest calculations
- Prepares appropriate documentation and inputs adjustments, credit transfers, etc
- To current and prior year tax accounts involving complex account interrelationships or codes to override controls and incorporates computation to initiate resolution of all case issues including tax, penalties, and interest
- Research and analytical skills and proficient in reading and evaluating tax modules using IDRS, ERCS, IMS, AMS, CII, EUP and RGS
- Prepares internal procedures that provide for consistency in the application of tax law under manual computation procedures or for issues that are not covered by existing procedures
- Identifies computer conditions and programming errors resulting in inconsistent interest computations and provides analysis for the correction of computer errors
- May serve as a technical advisor, or reviewer to provide technical assistance on systemic problems and inconsistencies in the Internal Revenue Manuals (IRM)
- OJI Tax Examiner when needed and research IRM to stay updated with Tax Laws
- Complete time entry into SETR
- Performs other duties as assigned
Insurance Discovery Clerk
PathAi
03.2024 - 07.2024
- Responsible for accurate data entry of insurance information per requisitions
- Review of patient demographic compared to what was registered by laboratory staff
- Responsible for verification of charges in billing system matches final path report from LIS
- Assist in overall billing procedures to ensure accuracy of accounts
- Perform other duties as requested by the supervisor or manager as deemed appropriate
Specialist Credit Balance
Ensemble Healthcare
08.2022 - 03.2024
- Analyze applications transaction details screen and finding the credit balance amount to resolve Commercial and Medicaid insurance claim accounts with existing credit balances to initiate refunds, retractions, and/or adjustments
- Basic Knowledge of accounting principles which directly impact the Account Receivable that may include debit and credit transactions; charge transfers; contractual allowance and adjustments and financial class changes
- Knowledge of EOB’s and COB’s and how it can affect an account balance
- Analyze all applicable documentation, review of all payments, review of all adjustments, and all account comments
- Adjust the reversal contractual adjustments and finding the refund amount
- File the refund form and document the necessary and documents and send to Account Receivable
- Find the patient credit balance and cross check with previous encounters if any debit balance needs to post that amount
- Monthly reporting of outstanding credit balances
- Research and resolve accounts with an existing credit balance
- With experience in EIQ / Epic system, DDE, Availity and WPS
- Work directly with hospital and customer services to address needs efficiently and accurately
- Interact with clients through email, phone conversations, group meetings, etc
- Analyzing data related to service level metrics and Key performance indicators (KPI’s)
- Use critical and analytical problem-solving skills to resolve issues
- Develops automated reporting and forecasting tools for more efficient use of data
- Maintain update and follow all SOP guidelines in accordance with HIPAA regulations and polices
Insurance Representative
Poplar Healthcare
02.2022 - 08.2022
- Collaborate with patients, doctor’s office, third party institutions and other team members to resolve billing inconsistencies and errors
- Process insurance claims
- Review and handle patient requisitions daily for accuracy and completeness and proactively obtain any missing payer information
- Obtain correct information and update system billing software Intergy when billing information is incorrect or missing from the patient requisitions
- Ability to work in a fast-paced environment
- Ability to receive and express detailed information through oral and written communication
- Understanding of Compliance standards preferred and third-party payor requirements
- Analyze pathology reports to ensure proper billing prior to claim submission
- Assist with various projects as assigned by direct supervisor
Counselor Financial Senior
BMG/Baptist Memorial Hospital
02.2021 - 02.2022
- Assist the Supervisor with other functions and completing assigned goals
- Utilizes denial reports to assess root causes and identify trends
- Share findings with Management and provide additional training to support and meet the need of our team member and patients/ customers
- Help review, improve, and document policies and procedures
- Audit accounts daily and provide feedback
- Collaborate with Management and Supervisor to organize and support development plans with employee learning achievement and new hire teammates to become proficient in their role and completing assigned goals
- Create access and update PowerPoint presentations, and spreadsheets in SharePoint drive
- Experience with Microsoft and strategize monthly to meet our team goals
- Travel to different facility to train employees in the Mississippi and Arkansas areas as well as TN area, help to resolve employee’s issues and disputes for over 15 employees oversee and assist with interviews, new hire orientations help, induction process and decision-making
- Conducting and set meetings
- Mentored new employees on registration, authorization process and delivered constructive feedback to increase understanding of job duties
- Also managing the day-to-day activities of the team
- Works with patients, families, and staff to collect deductibles and co-pays, set up payment plans, and evaluate bad debt
- Also, negotiate and strategize patient payment arrangements
- Provide internal and external communicate to teamwork and representative to ensure reliability training
- Assists patients with initiation of the application for Charity Care and/or patient assistance drug replacement programs
- With experience in Epic system
- Serves as a resource to properly explain insurance benefits to patients, families, staff, and representatives from outside agencies as to how they pertain to the services being performed at this facility
- Understands and complies with regulatory requirements by specific insurance companies and facilitates compliance by maintaining awareness of guidelines and ensuring compliance through communication and documentation to appropriate staff
- Registers patients accurately, efficiently, and professionally to ensure data base integrity and facilitate claims processing
- Experience with reimbursement, providing documentation such as medical record, payor reimbursement analysis, and billing compliance monitoring
- Expedites patient flow through prompt and courteous service
- Responsible for the creation of a means to facilitate collaboration and standardization across all venues of care within the healthcare entity in support of treatment initiation approval process and validation of covered indications relating to the ordered / prescribed procedures
Counselor Financial
BMG/Baptist Memorial Hospital
10.2015 - 02.2021
- Advocated for patients by contacting insurance carriers and obtaining the necessary benefits information
- Liaised between physician, patient, and insurance carrier to verify that each party had necessary information
- Communicates with various Payers, referral sources for in-house and outside clinic’s, sales representatives, patients face to face and over the telephone
- Verify eligibility and benefits accurately and in a timely manner in accordance with Company policies
- Perform a treatment initiation approval process for Oncology, Neurology, Rheumatology, GI and Pulmonary physicians for biologic medication for outpatient buy & bill, specialty pharmacy for non-buy & bill infusion treatments or injections and maintain authorizations extension through for all patients as appropriate by review of ordered/prescribed services relating to insurance coverage policies and pre-certification/authorization requirements, while securing amicable payment arrangements
- Knowledge of CPT, ICD 10 codes, HCPCS coding, J and Q – Codes, using different methods and guidelines to meet medical necessity such as Medicare LCD, NCCN and Package Insert (PI) and appeal denied treatments or claims
- Experience with reimbursement, providing documentation such as medical record, payor reimbursement analysis, and billing compliance monitoring
- Follow-up on claims, reconciled any billing issues related to coding or denials
- Experienced in Epic, liaised with customers, addressed inquiries, and answer billing questions to provide outstanding customer care
- Perform each task with urgency to research any questions or issues by the team members or provider
- Manage external and internal requests via telephone or email to update eligibility and insurance information for clients, provider office and representatives
- Work first with patients to reduce their financial liabilities, ensures the collection of patient balances, deductibles, and coinsurance in an accurate and timely manner via check, cash and credit card
- Serves as a resource to patients, families, and employees to discuss financial arrangements, payments and properly explain patient financial obligation
- Keep daily spreadsheet of payments and collection free assistance such as Copay, Grants, and other Funding’s
- Assist the nurses with daily responsibility, leadership; communicate policies and goals to enhance employee skills, management, and leadership
- Also, assist new employees on registration, authorization and delivered constructive feedback to increase understanding of job duties
- Assists patients with support from manufacturers and foundations to help patients with their out-of-pocket expenses from copay assistance programs as well as Grants
- Schedule face-to-face counseling with patients needing financial assistance or charity
- Insurance verification processes using Real Time Eligibility, Passport Communications, Palmetto GBA and additional online verification processes
- Complete registration process or new and existing patients
- As well as epic
- Knowledge of precertification requirements, guidelines & medical coding
Registration Specialist
BMG/Baptist Memorial Hospital
08.2015 - 10.2015
- Answering incoming calls in a friendly, professional manner
- Register new patients, collecting all necessary information prior to appointment
- Communicate with clinical team to ensure proper appointment placement
- Completion and scanning of intake forms into the patient chart
- Maintain security of patient information
- Other duties as assigned
Patient Financial Counselor / Healthcare Marketplace Navigator
St Francis Hospital /Conifer Health Solutions
08.2011 - 08.2015
- Interview with uninsured patients and or family members for link to any government programs such as Medicaid, SSA/SSI, VOC, Health insurance plans through the Healthcare Marketplace and or other County programs
- Knowledge of FMLA and Cobra, Schedule and attend Social Security appointment as need for uninsured patients
- Explain the application process, program requirements and timelines to eligible individuals as well as assist with competition of benefits enrollments upon enrolling
- Assist and guide consumers through the discovery, application, and enrollment processes for Medicaid and/or Marketplace, based on consumer eligibility and preference
- Collect pertinent documentation required for eligibility determinations, assist patient with eligibility for any Medicaid programs, and or refer them as necessary, with questions and completion of forms or applications related to their insurance coverage
- Assist In/Out-Patient with financial liabilities to determine financial clearances and or arrangements vi bedside/telephone, arrange method of payment plans for services rendered, (i.e
- Co-pays, deductibles)
- Strategize on ways to meet monthly goals
- Discuss their financial need to determine the best payment option and plan for services, and collect payment via cash, credit card and check
- Maintain complete documentation of all activities performed on accounts while in-house and after discharge for uninsured patients
- Completed Audits on account weekly, Problem solving each account
- Ability to work independently as well as with management, and co-workers
- Attend weekly meetings with CFO, Case Managements and Supervisors
- Train and assist new employees as needed
- Assist patients with enrollment process with the Health Insurance Marketplace/Affordable Act Care to ensure enrollment for QHP with the federal state Exchange
Education
Bachelor of Science - Accounting
Strayer University
06.2018
High School -
Manassas High School
01.1994
Skills
- Great Communication
- Customer service
- Administrative support
- Knowledgeable of counseling
- Income taxes preparation
- W9
- Great problem skills
- Math skills
- Focus on detail
- Focus on accuracy
- Creative problem-solving
- Ability to drive results
- Ability to meet team goals
- Ability to work independently
- Ability to function as part of a team
- Able to multi-task efficiently
- Medical billing
- Insurance billing
- Grants
- Foundation
- Team Management
- Team Building
- Communications
- MS Office
- Business operations
- Organization
- Critical Thinking
- Strategic Thinking
- Knowledge of Insurance enrollment
- Benefits Planning
- Benefits coordination
- Medicaid
- SSI
- SSA
- SSDI Process
Websites
References
Upon Request
Timeline
Case Manager Reimbursement
UBC (United BioSource, LLC)
10.2024 - Current
Insurance Discovery Clerk
PathAi
03.2024 - 07.2024
Tax Examining Technician
IRS (Internal Revenue Service)
04.2023 - Current
Specialist Credit Balance
Ensemble Healthcare
08.2022 - 03.2024
Insurance Representative
Poplar Healthcare
02.2022 - 08.2022
Counselor Financial Senior
BMG/Baptist Memorial Hospital
02.2021 - 02.2022
Counselor Financial
BMG/Baptist Memorial Hospital
10.2015 - 02.2021
Registration Specialist
BMG/Baptist Memorial Hospital
08.2015 - 10.2015
Patient Financial Counselor / Healthcare Marketplace Navigator
St Francis Hospital /Conifer Health Solutions
08.2011 - 08.2015
Bachelor of Science - Accounting
Strayer University
High School -
Manassas High School
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