Da'Neisha Robinson
Loganville,GA
Summary
Veteran Billing and Claims Specialist focused on team efficiency and producing high-quality work. Excellent collaborator and relationship-builder familiar with compliance and documentation requirements. Enthusiastic about taking billing operations to the next level through proactive leadership and skilled problem solving.
Overview
7
7
years of professional experience
Work History
Account Specialist
Northside Health Care
10.2023 - Current
- Reconciled customer accounts and identified discrepancies for further investigation.
- Set up new customer accounts and updated existing profiles with latest information.
- Built strong relationships with clients, vendors and stakeholders for loyal, profitable accounts.
- Adhered to standards of quality and service as well as all compliance requirements.
- Resolved complex billing and payment issues for balanced, accurate accounts.
- Reviewed account activity to assess financial status and evaluate discrepancies.
- Completed routine and complex account updates to resolve problems.
- Prepared and submitted timely invoices, statements and payment reminders for customers.
- Analyzed financial data and generated accurate, insightful reports for management.
Patient Access Representative
Wellstar Heath System
08.2023 - Current
- Collected and entered patient demographic and insurance data into computer database to establish patient's medical record.
- Stayed calm under pressure to and successfully dealt with difficult situations.
- Obtained patient's insurance information and determined eligibility for benefits for specific services rendered.
- Providing excellent customer service by promptly answering patient inquiries.
- Received patient deductibles and co-pay amounts and discussed options to satisfy remainder of patient financial obligations.
- Educated patients on importance of preventive health care and insurance coverage.
- Performed patient scheduling and registration functions to serve as initial contact point for medical office visits.
- Utilized knowledge of electronic medical record systems and medical terminology to perform diverse data entry tasks.
- Resolved patient billing issues in line with established guidelines.
- Secured patient information and confidential medical records in compliance with HIPAA privacy rule standards to protect patient's privacy.
Sr. Patient Account Specialist
Emory Healthcare
11.2021 - 08.2023
- Accurately maintain daily performance goal of 100-plus posted payments and adjustments both
- Worked with outside entities to resolve issues with billing, claims and payments.
- Posted payments and processed refunds.
- Liaised between patients, insurance companies, and billing office.
- Electronically submitted bills according to compliance guidelines.
- Prepared reports detailing billing actions, flags and other key information.
- Monitored flags and resolved urgent items with accuracy and efficiency.
- Entered client details and notes into billing systems (Epic, Gammis, etc.) for interdepartmental access and review.
- Researched billing errors and discrepancies to initiate corrective action.
- Analyzed customer financial records to determine appropriate payment plan.
- Verified insurance of patients to determine eligibility.
- Communicated with insurance providers to resolve denied claims and resubmitted.
- Delivered timely and accurate charge submissions.
- Generated reports and analyzed trends to maximize reimbursement and reduce claim denials.
- Audited and corrected billing and posting documents for accuracy.
- Generated accounts payable reports for management review to aid in financial and business decision making.
- Offered ample support to team members with creative solutions to complex challenges regarding scheduling, conflict resolution, and medical care.
- Contributed to and helped lead employee staff meetings, reporting trends in procedures, advising leadership on resources needed and preparing information to be disseminated.
- Provided exceptional customer service to patients, answering questions and addressing concerns.
- Filed and maintained patient records in accordance with HIPAA regulations.
- Achieved high satisfaction rating through proactive one-call resolutions of customer issues.
- Compiled status and performance reports for team leaders to address company strengths and weaknesses.
Patient Access Specialist
Children's Healthcare Of Atlanta
07.2021 - 08.2023
- Secured patient information and confidential medical records in compliance with HIPAA privacy rule standards to protect patient's privacy.
- Collected and entered patient demographic and insurance data into computer database to establish patient's medical record.
- Received patient deductibles and co-pay amounts and discussed options to satisfy remainder of patient financial obligations.
- Collected and validated patient demographics and insurance information.
- Obtained patient's insurance information and determined eligibility for benefits for specific services rendered.
- Utilized knowledge of electronic medical record systems and medical terminology to perform diverse data entry tasks.
- Acted as first point of contact and set appointments for prospective clients.
- Answered phone calls and answered questions from potential customers.
- Called customers to coordinate schedules and set appointments.
- Established rapport with callers to build loyalty and support retention goals.
- Documented calls and appointments using EPIC and other billing software.
- Handled complaints and questions, and re-directed calls to other team members.
- Scheduled follow up calls with potential customers to gain interest in scheduling appointments.
- Assisted patients with understanding personalized insurance coverage and benefits.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Trained new staff on current, correct insurance verification procedures.
- Answered telephone calls to offer office information, answer questions, and direct calls to staff.
- Performed various administrative tasks by filing, copying and faxing documents.
- Managed multiple schedules and prioritized tasks to meet demands of fast-paced work environment.
- Followed up with patients to reschedule missed appointments.
- Collaborated with healthcare staff to verify alignment of appointment scheduling with clinic protocols.
- Managed complex calendars for multiple medical practitioners, verifying accuracy of all appointments.
- Confirmed appointments one day prior to minimize missed appointments and maximize clinic utilization.
- Coordinated with other departments to facilitate seamless operation and excellent patient care.
Sr. Patient Financial Service Specialist/Claims Specialist
Kaiser Permanente
05.2017 - 02.2021
- Answered 80 - 100 inbound calls daily from existing and future policyholders to answer inquiries and discuss insurance options.
- Gathered information, assessed and fulfilled callers' needs and educated on important policies and procedures.
- Identified, analyzed and researched systemic issues and made recommendations for resolution.
- Maintained confidential patient, employee and company information in compliance with company policies and regulatory requirements.
- Filed and maintained patient records in accordance with HIPAA regulations.
- Verified insurance eligibility and coverage for patients.
- Handled customer service inquiries in person, via telephone and through email.
- Applied administrative knowledge and courtesy to explain procedures and services to patients.
- Entered patient demographic and insurance data into electronic medical record system.
- Built and maintained positive working relationships with patients and staff.
- Managed patient registration process, confirming data accuracy and completeness.
- Took copayments and compiled daily financial records.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
- Verified patient insurance coverage and benefits for medical claims.
- Managed large volume of medical claims on daily basis.
- Researched and resolved complex medical claims issues to support timely processing.
- Paid or denied medical claims based upon established claims processing criteria.
- Monitored and updated claims status in claims processing system.
- Evaluated medical claims for accuracy and completeness and researched missing data.
- Identified and resolved discrepancies between patient information and claims data.
- Followed up on denied claims to verify timely patient payment and resolution.
- Used administrative guidelines as resource or to answer questions when processing medical claims.
- Generated reports on medical claims processing activities and results.
- Delivered exceptional customer service to policyholders by communicating important information and patiently listening to issues.
- Examined claims forms and other records to determine insurance coverage.
- Maintained claims data in multiple billing systems.
- Managed and motivated employees to be productive and engaged in work.
- Accomplished multiple tasks within established timeframes.
- Maintained professional, organized, and safe environment for employees and patrons.
- Resolved staff member conflicts, actively listening to concerns and finding appropriate middle ground.
- Cross-trained existing employees to maximize team agility and performance.
- Complied with HIPAA guidelines and regulations for confidential patient data.
- Assured timely verification of insurance benefits prior to patient procedures or appointments.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Achieved insurance pre-authorizations to enable timely patient procedures.
- Updated patient records with accurate, current insurance policy information.
- Managed high-volume insurance verifications within pressured timeframes for productive medical operations.
- Established and maintained relationships with insurance providers for productive communications.
- Posted payments to accounts and maintained records.
- Generated reports to track insurance verifications and claim progress.
- Trained new staff on current, correct insurance verification procedures.
- Coordinated referrals through insurance and other medical specialists and documented details in patient charts.
- Scheduled patient appointments in respective doctors' calendars and followed up with reminder phone calls.
- Registered and verified patient records before triage with most up-to-date information.
Education
Associate of Science - Biochemistry
Georgia State University
Atlanta, GA12.2024
Skills
- Payment Processing
- Verbal and Written Communication
- Electronic and Paper Filing
- Excellent Knowledge of Medicare, Medicaid, Commerical Insurance, etc
- Microsoft Office
- Provider Relations
- Claims Investigation and Research
- Client Rapport-Building
- Medical Billing
- Insurance Eligibility Verifications
- Denial Appeals Process
- Managing Delinquent Accounts
- Collections and Invoice Processing
- Pre-Authorizations
- Leadership
Timeline
Account Specialist
Northside Health Care
10.2023 - Current
Patient Access Representative
Wellstar Heath System
08.2023 - Current
Sr. Patient Account Specialist
Emory Healthcare
11.2021 - 08.2023
Patient Access Specialist
Children's Healthcare Of Atlanta
07.2021 - 08.2023
Sr. Patient Financial Service Specialist/Claims Specialist
Kaiser Permanente
05.2017 - 02.2021
Associate of Science - Biochemistry
Georgia State University