Summary
Overview
Work History
Education
Skills
Timeline
Generic
CORETTA WILLIAMS

CORETTA WILLIAMS

Birmingham

Summary

Dynamic Medical Biller and Appeals Specialist with extensive experience at ENABLECOMP, excelling in claims processing and insurance authorizations. Proven track record in minimizing unpaid accounts and enhancing reimbursement accuracy through critical thinking and meticulous attention to detail. Proficient in ICD-10 codes and adept at navigating complex healthcare billing systems.

Overview

13
13
years of professional experience

Work History

Medical Biller/ Appeals Specialist

ENABLECOMP
Franklin
04.2023 - Current
  • Thoroughly investigated past due invoices and minimized number of unpaid accounts
  • Accurately entered procedure codes, diagnosis codes and patient information into billing software
  • Added modifiers as appropriate
  • Filed and submitted claims
  • Submitted refund requests for claims paid in error
  • Acted as a liaison between the business department, billers and third party payers in resolving billing and reimbursement accuracy
  • Demonstrated knowledge of HIPAA Privacy and Security Regulations by appropriately handling patient information
  • Appropriately and correctly identified errors and re-filed denied/rejected claims as they were received from the Patient Account Representative
  • Thoroughly reviewed Remittance and EOB

AR/Insurance Follow-up/ Prior Authorizations

AMERICAN FAMILY CARE
Birmingham
08.2015 - 02.2019
  • Contacted insurance companies to obtain necessary preauthorization needed for upcoming tests and procedures
  • Performed detailed medical reviews of prior authorization request, following established criteria and protocols
  • Identified reasons behind denied claims and worked closely with insurance carriers to promote resolutions
  • Used Availity, Optum to input claim, prior authorization and other important medical data into system
  • Contacted insurance carriers to obtain authorizations, notifications and precertifications for patients
  • Provided accurate information to all parties, including patients, insurance providers, healthcare staff and office personnel by using effective written and verbal communication skills
  • Notified ordering providers of denied authorizations
  • Applied knowledge of Medicare, Medicaid and third-party payer requirements utilizing on-line eligibility systems to verify patient coverage and policy limitations
  • Effectively reviewed and researched claims denials and contacted payers to verify detailed denial reasons when necessary
  • Prepared documentation and filed reconsiderations and appeals as needed
  • Identified and communicated denial/rejection trends to management
  • Identified and resolved discrepancies
  • Sent appropriate correspondence when necessary
  • Navigated and researched insurance policies & benefits for policy exclusions for patients
  • Reviewed and worked all daily correspondences received from patients and payers
  • Understood and acted on the timely filing guidelines associated with claims filing, reconsiderations, and appeals for assigned payers

Pharmacy Benefits Specialist

RXBENEFITS (RANDSTAD STAFFING)
Birmingham
09.2014 - 07.2015
  • First call resolution to help health care providers and patients with their pharmacy needs, answered questions and requests
  • Provided thorough, accurate and timely responses to requests from pharmacy operations, providers and/or patients regarding their benefit information
  • Ensured complete and accurate patient setup in CPR+ system including patient demographic and insurance information
  • Performed full benefits verification on patients for pharmacy benefits utilizing electronic resources and E1 check to load primary, secondary, tertiary, etc
  • Insurances and medical insurances to patient profile
  • Run test claims at pharmacy site to obtain a valid claim response and determine optimal reimbursement, then documented the outcome of benefits review
  • Facilitated the process for requesting prior authorizations, for applicable commercial, Medicaid, and Medicare, and facility medication claims

Grievance and Appeals Specialist

BROADPATH HEALTHCARE SOLUTIONS
Arizona
09.2012 - 08.2014
  • Logged, tracked, and ensured completions of all appeals, direct member reimbursements and grievance cases in compliance with CMS standards
  • Prepared documentation and transmitted appeals of clinical denials to the appropriate professional for review and tracking review completion to ensure final closure of the associated case
  • Participated in all aspects of the direct member reimbursement, grievance & appeal process, specifically intake, triage, coordination, and documentation
  • Researched, investigated and resolved administrative aspects of appeals and grievances from members and related outside agencies utilizing systems

Education

College in Medical Billing and Coding -

AAPC
03.2025

Associate's - Business

Full Sail University
Winter Park, FL
02.2023

Skills

  • Experience with EPIC Systems
  • Experience with Cerner Software
  • Experience with ECW
  • ZIRMED Proficiency
  • Healthcare Vocabulary
  • ICD-10 CODES
  • Insurance Eligibility Verification
  • Healthcare Billing Proficiency
  • DATA ENTRY
  • CRITICAL THINKING
  • ATTENTION TO DETAIL
  • Customer Support Expertise
  • ELECTRONIC MEDICAL RECORDS (EMR)
  • INSURANCE AUTHORIZATIONS
  • CLAIMS PROCESSING
  • DOCUMENTATION
  • INSURANCE

Timeline

Medical Biller/ Appeals Specialist

ENABLECOMP
04.2023 - Current

AR/Insurance Follow-up/ Prior Authorizations

AMERICAN FAMILY CARE
08.2015 - 02.2019

Pharmacy Benefits Specialist

RXBENEFITS (RANDSTAD STAFFING)
09.2014 - 07.2015

Grievance and Appeals Specialist

BROADPATH HEALTHCARE SOLUTIONS
09.2012 - 08.2014

College in Medical Billing and Coding -

AAPC

Associate's - Business

Full Sail University

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CORETTA WILLIAMS