Christina M Nelson
Lawnside,NJ
Summary
Revenue cycle professional with strong background in managing billing, coding, and collections processes. Proven ability to enhance team performance and streamline operations to achieve optimal financial results. Known for effective collaboration, adaptability, and reliability. Skilled in revenue cycle management software, regulatory compliance, and customer service.
Overview
12
12
years of professional experience
1
1
Certification
Work History
Revenue Cycle Specialist II
Jefferson Hospital
11.2018 - Current
- Called insurance companies to ascertain pertinent information regarding policies and payment benefits for patients.
- Checked documentation for appropriate coding, catching errors and making revisions.
- Processed claims for payment or forwarded to appropriate personnel for further investigation
- Updated patient and insurance data and input changes into company's computer system.
- Precisely calculated refunds, premiums and adjustments.
- Retained strong medical terminology understanding in effort to better comprehend procedures.
- Evaluating the appeal and denied claims working closely with third party billing vendors
- Initiate contact with insurance companies for precertification
- Add specific data such as modifiers, payer specific information, including authorization criteria, CPT and ICD-9 code
- Trained new team members on revenue cycle best practices, contributing to a more knowledgeable workforce.
- Reached out to insurance companies to verify coverage.
- Ensured accurate billing with thorough audits of patient accounts and insurance claims.
- Maintained clear documentation of all activities related to unpaid claims or denied services.
- Improved cash flow with diligent follow-up on pending claims and appeals processes.
Access Scheduler
Children Hospital of Philadelphia
11.2017 - 01.2018
- Applied HIPAA privacy and security regulations while handling patient information.
- Verified demographics and insurance information to register patients in computer system.
- Organized and maintained records by updating and obtaining both personal and financial information from patients.
- Applied knowledge of payer requirements and utilized on-line eligibility systems to verify patient coverage and policy limitations.
- Processed patient responsibility estimate determined by insurance at pre-registration.
- Updated reference materials with Medicare, Medicaid and third-party payer requirements, guidelines, policies and list of accepted insurance plans.
- Submitted fees and claims to insurance companies manually or digitally.
- Managed front office customer service, appointment management, billing and administration tasks to streamline workflow.
- Prepared new charts, updated existing charts and managed records transfers between offices.
- Assisted with hospital admissions and paperwork.
Patient Access Representative
IMA Consulting /Thomas Jefferson University
05.2016 - 08.2017
- Verified demographics and insurance information to register patients in computer system.
- Updated reference materials with Medicare, Medicaid and third-party payer requirements, guidelines, policies and list of accepted insurance plans.
- Facilitated communication between patients, medical and administrative staff, administrative staff and regulatory agencies.
- Helped patients obtain health care services by setting up referrals.
- Prepared and submitted bills to insurance companies and patient
- Initiate contact with insurance companies for precertification
- Add specific data such as modifiers, payer specific information, including authorization criteria, CPT and ICD-9 code
- Applied HIPAA privacy and security regulations while handling patient information.
- Reconcile list of claim edits, charge errors, facility reports and hospital census
- Front desk duties include meeting, greeting, directing patients; answering and triaging telephone calls; scheduling appointments, and preparation of forms.
Medical Claims Processor / Accounts Receivable
Onsite Neonatal
11.2014 - 05.2016
- Tracked differences between plans to correctly determine eligibility and assess claims against benefits and data entry requirements.
- Based payment or denials of medical claims upon well-established criteria for claims processing.
- Called insurance companies to ascertain pertinent information regarding policies and payment benefits for patients.
- Instructed clients on amounts covered under benefits plans in easy-to-understand terminology.
- Updated patient and insurance data and input changes into company's computer system.
- Corresponded with insurance customers and agents to obtain or relay information on account status changes.
- Verified patients had proper insurance coverage prior to procedures or appointment scheduling.
OT/Speech Rehab Aide
Voorhees Pediatric Facility
07.2013 - 11.2014
- Assists the patient in doing therapy by the use of physical or mechanical methods
- Knowledge of equipment and how to use it when assisting a patient in therapy
- Knowledge of proper lifting techniques and be able to understand the behavior and needs of patients
- Transport patients to and from treatment areas, using wheelchairs or providing standing support
- Confer with physical therapy staff and others to discuss and evaluate patient information for planning, modifying, and coordinating treatment
- Observe patients during treatment to compile and evaluate data on patients' responses and progress, and report to physical therapist.
Education
Bloomfield College
Bloomfield, NJ09.2006
Haddon Heights High School
Haddon Heights, NJ09.2002
Skills
- Client service referrals
- Accurate data entry
- Eligibility analysis
- Data verification
- Claims payout management
- Analytical problem-solving
- Insurance coverage analysis
- Client support
- Policy enhancements
- Clear and concise communication
- Insurance claim form analysis
- Regulatory guideline clarification
- Organizational time strategies
- Microsoft Office proficiency
- Proficient in data entry software
Certification
Certified Revenue Cycle Representative (CRCR)
Timeline
Revenue Cycle Specialist II
Jefferson Hospital
11.2018 - Current
Access Scheduler
Children Hospital of Philadelphia
11.2017 - 01.2018
Patient Access Representative
IMA Consulting /Thomas Jefferson University
05.2016 - 08.2017
Medical Claims Processor / Accounts Receivable
Onsite Neonatal
11.2014 - 05.2016
OT/Speech Rehab Aide
Voorhees Pediatric Facility
07.2013 - 11.2014
Haddon Heights High School
Bloomfield College
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