DeAngela Hamilton
Brandywine,MD
Summary
Critical thinking professional with talents in validating workflows, maintaining a knowledge of policy changes to insurance plans and sharing best practices with management. A reliable Revenue Cycle Analyst known for successfully handling various tasks in deadline-driven environments.
Overview
9
9
years of professional experience
Work History
Associate Revenue Cycle Analyst
Natera
05.2023 - Current
- Function as a work leader, providing operational support, training staff, and conducting audits on work quality.
- Performs analysis, trends, presents opportunity areas, and prioritizes initiatives for performance improvement for the designated revenue cycle function.
- Analyze financial and statistical data related to revenue cycle, creating in-depth reports.
- Establishes an ongoing working relationship with other departments to streamline tasks and duties in effort to improve overall revenue cycle performance.
- Assist with developing appropriate workflows and tracking for the designated revenue cycle function.
- Leads weekly meetings to review key metrics, workflows, trends, and performance improvement opportunities.
- Acts as an educator on performance improvement requirements in operations and methodologies to related teams and departments.
- Assist with the creation and documentation of processes, including work instructions, desk procedures, guide aids, and other reference or instructional content.
- Liaison with internal departments to promote ongoing communication, and collaboration on cross functional projects related to denials management.
- Leading and directing others in areas of responsibility such as research, denials and appeals.
Appeals Specialist
Invitae
09.2021 - 09.2022
- Improved the efficiency of the appeals process by reviewing and analyzing claim denials and discrepancies.
- Managed a high volume of cases, prioritizing tasks effectively and meeting strict deadlines for appeals resolutions.
- Streamlined workflows for faster decision-making, evaluating medical records and other documentation to support appeals decisions.
- Reduced claim denial rates with thorough pre-appeal reviews, identifying potential issues before submission.
- Enhanced client satisfaction with timely resolution of appeals, addressing concerns thoroughly and professionally.
- Conducted thorough research on industry trends, staying informed on best practices for effective appeals management.
- Developed strong relationships with providers, fostering open communication channels for more efficient resolution of claim disputes.
- Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
- Generated, posted and attached information to claim files.
- Prepared insurance claim forms or related documents and reviewed for completeness.
- Mentored new team members on departmental protocols and best practices, fostering a positive learning environment within the team.
Patient Access Specialist
Alpha Consulting
11.2020 - 09.2021
- Educated patients on how to access medication through reimbursement and affordability programs.
- Managed day to day activities of patient and health care provider support requests and deliverables across multiple communication channels in a Contact Center i.e. Phone, Fax, Chat, eMail, etc.
- Performed intake of cases by verifying patient insurance eligibility and entered all relevant information into salesforce.
- Coordinated all appropriate aspects of patient case management through to completion, using effective interpersonal skills to manage interactions.
- Performed in-depth research into patient's pharmacy insurance benefits, prior authorization and appeal requests on behalf of the provider.
- Educated Health Care Providers and patients on available resources, programs, and financial assistance options to optimize their healthcare experience.
Patient Account Representative III
University Of Maryland Faculty Physicians
02.2019 - 11.2020
- Performed account investigation, follow-up and collections on unusual and complex physician and hospital accounts.
- Served as Team Lead and Trainer for junior level staff.
- Identified trends in unpaid accounts, developing targeted solutions for improved revenue recovery.
- Ensured compliance with healthcare regulations while processing claims and managing patient accounts.
- Collaborated with the medical staff to ensure proper documentation and coding for accurate billing.
- Enhanced patient satisfaction by promptly addressing inquiries and resolving account issues.
- Achieved a significant reduction in aged accounts receivable through diligent follow-up efforts with both patients and insurers.
- Kept up-to-date on industry trends, sharing knowledge with team members to support their professional development and enhance overall performance.
- Conducted regular audits of patient accounts to identify errors or inconsistencies that required correction or adjustment.
- Optimized workflow within the team through effective delegation of tasks based on skill level, priority, and workload balance.
- Developed strong relationships with key contacts at insurance companies to expedite resolution of claim disputes or other account-related issues.
- Demonstrated adaptability in navigating complex payer guidelines to maximize reimbursement opportunities for the organization.
- Identified insurance payment sources and listed payers in proper sequence to establish chain of payment.
Reimbursement Specialist
Aerotek
07.2019 - 02.2020
- Ensured timely payment of claims by promptly addressing and resolving any discrepancies or issues with insurance providers.
- Streamlined reimbursement processes by implementing efficient filing and tracking systems.
- Guided office staff on how to effectively complete prior authorization forms and appeals documentation to achieve positive results.
- Demonstrated adaptability and a commitment to ongoing professional development, embracing new software systems and process changes with enthusiasm and ease.
- Optimized turnaround times for prior authorization requests, collaborating closely with physicians and clinical staff to expedite necessary treatments.
- Maintained accurate case files, updating relevant information as needed to ensure efficient record-keeping practices.
- Exhibited strong attention to detail when evaluating eligibility criteria for medication coverage, minimizing instances of inappropriate denials or delays in treatment access.
- Streamlined communication between healthcare providers, pharmacists, and insurance companies to facilitate seamless patient care.
- Prepared and distributed denial letters, detailing reasons for denial and possible appeal measures.
- Fielded telephone inquiries on authorization details from plan members and medical staff.
- Improved patient satisfaction by efficiently managing prior authorization requests and ensuring timely approvals.
Sr. A/R Billing and Coding Specialist
Johns Hopkins University
03.2018 - 02.2019
- Conducted thorough audits of patient files to ensure proper documentation and accurate invoicing.
- Implemented quality assurance measures to minimize errors in data entry, leading to increased claim approval rates from insurers.
- Assisted with staff training on updated medical coding systems, ensuring accuracy across all team members'' workloads.
- Collaborated with the collections department to address overdue accounts and recover outstanding payments.
- Reduced account receivables aging through diligent follow-up on outstanding claims and prompt resolution of denials.
- Facilitated clear communication between medical providers, insurance companies, and patients for smooth billing operations.
- Achieved timely reimbursements from payers by submitting clean claims that adhere to payer-specific guidelines.
- Processed insurance company denials by auditing patient files, researching procedures, and diagnostic codes to determine proper reimbursement.
- Resolved coding discrepancies through in-depth analysis and collaboration with physicians, ensuring appropriate reimbursement for services rendered.
- Monitored trends in medical billing denials, implementing corrective actions to prevent future occurrences of similar issues.
- Developed a comprehensive understanding of ICD-9/10-CM, CPT, and HCPCS codes to ensure proper use in medical coding assignments.
- Enhanced accuracy of medical coding by implementing a thorough review process and cross-checking system.
- Trained new team members by relaying information on company procedures and safety requirements.
- Collaborated with other department leads to streamline workflows, improve interdepartmental coordination, and achieve business goals collectively.
- Enhanced overall team performance by providing regular coaching, feedback, and skill development opportunities.
Lead Customer Service Representative
Johns Hopkins University
06.2015 - 03.2018
- Monitored delinquent accounts and initiated collections actions when necessary, recovering outstanding balances while maintaining positive customer relationships.
- Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers.
- Communicated with insurance providers to resolve denied claims and resubmitted.
- Researched CPT and ICD-9 coding discrepancies for compliance and reimbursement accuracy.
- Provided exceptional customer service to both patients and insurance representatives, resolving inquiries quickly and professionally.
- Communicated with patients for unpaid claims for HMO, PPO and private accounts and delivered friendly follow-up calls for proper payments to contracts.
- Located errors and promptly refiled rejected claims.
- Efficiently processed refunds or adjustments for patients when necessary, ensuring accuracy and compliance with company policies.
- Managed patient accounts effectively, resolving discrepancies and addressing outstanding balances in a timely manner.
- Coached team members in techniques necessary to complete job tasks.
- Trained new team members by relaying information on company procedures and safety requirements.
- Collaborated with other department leads to streamline workflows, improve interdepartmental coordination, and achieve business goals collectively.
Education
High School Diploma -
Frederick Douglass High School
Upper Marlboro, MD06.1988
Skills
- Verbal and written communication
- ICD9/ICD10 & CPT coding 120 hours course completion
- Revenue cycle analysis
- Reports for senior management
- Account and revenue tracking
- Proficient in Microsoft Excel
- Proficient in AMD, LIMS, Salesforce, Xifin & Epic
- Proven ability to train, motivate and supervise staff
- Reimbursement reconciliation; contracting with insurance companies
- Revenue Cycle workflow process, etc
- Denial Management
- Revenue Cycle Management
- Data Analytics
- Analytical Problem Solving
- Claims review
- Analyzing claims
- Analytical research
Timeline
Associate Revenue Cycle Analyst
Natera
05.2023 - Current
Appeals Specialist
Invitae
09.2021 - 09.2022
Patient Access Specialist
Alpha Consulting
11.2020 - 09.2021
Reimbursement Specialist
Aerotek
07.2019 - 02.2020
Patient Account Representative III
University Of Maryland Faculty Physicians
02.2019 - 11.2020
Sr. A/R Billing and Coding Specialist
Johns Hopkins University
03.2018 - 02.2019
Lead Customer Service Representative
Johns Hopkins University
06.2015 - 03.2018
High School Diploma -
Frederick Douglass High School