Della Booker
Brentwood,CA
Summary
Detail-oriented Patient Access Representative with extensive medical services background and strong work ethic. Managed patient-related accounts receivables at large medical facility and achieved 85-95% collection rate. Excellent communications skills and empathetic nature enabled achievement of positive outcomes.
Overview
13
13
years of professional experience
Work History
Patient Access Representative
St. Francis Memorial Hospital
08.2020 - Current
- Knowledge of Emergency Medical Treatment and Active Labor Act (EMTALA) and Consent Laws
- Time management skills and ability to manage frequent in-person patient contacts while effectively maintaining and documenting data in patient registration systems.
- Demonstrated ability to work in multiple computer systems, such as patient registration/accounting systems, telephone consoles, document imaging, scanning, payment posting, proprietary payer websites and data quality monitoring, both accurately and efficiently
- Possess verbal and written communication and active listening skills.
- Meet or exceeded 93% productivity and quality standards.
- Able to work concurrently on various tasks and projects in diverse environment utilizing decision and problem-solving and critical thinking skills, while maintaining accuracy and attentiveness to detail
- Adhere to HIPAA regulations and guidelines in maintaining confidentiality with patient’s protected health information.
- Trained new staff on hospital processes and procedures.
- Identified insurance payment sources and listed payers in proper sequence to establish chain of payment.
- Verified patient insurance eligibility and entered patient information into system.
- Provided excellent customer service to patients and medical staff.
- Self-motivated, with a strong sense of personal responsibility.
- Worked effectively in fast-paced environments.
UCSF-Admitting Worker/PAU
Insight Global
07.2019 - 07.2020
- Proficiently completed 30-50 Insurance verifications daily to determine coverages and if authorizations are required prior to patient’s service(s) using vendor websites.
- Optimum knowledge of medical terminology to read patient’s charts to understand services provided to patients.
- Proficient knowledge of government program regulations such as, but not limited to: Med-Cal, Medicare, CCS and other third-party payers.
Claims Benefit/Customer Service Specialist
Aetna Healthcare Insurance
07.2013 - 01.2017
- Provided customer service in fast-paced, call center environment to providers and members resolving claims and benefits questions by researching payments and contracts.
- If necessary, utilize website resources such as CMS, NHIC, or any others required for accurate claims processing.
- Analyzed and adjudicated Medicare medical or dental claims applying CMS and company guidelines adhering to 99% accuracy per company's expectation.
- Used IDX system for processing claims.
- Manually priced claims as required including, but not limited to, Skilled Nursing using RUGGS codes and HCPCS codes, Anesthesia, and Ambulance claims.
- Applied medical necessity guidelines, determined coverage by interpreting contracts and applying company policies & procedures, completed eligibility verification, while adhering to plan coverages along with other cost containment tools.
- Effectively responded to routine phone inquiries 70-100 calls per day and written correspondence related to claims processing issues while showing empathy and compassion.
- Routed and triaged complex claims to Senior Claim Benefit Specialist recognizing any trends that could address and resolve concerns to improve claims processing.
- Maintained 100% accuracy every year while processing 100 claims per day by utilizing all applicable system functions available ensuring accurate and timely claim processing service (i.e., utilized Claim Check, reasonable and customary data, and other post containment tools).
Assistant Manager
Popeye’s
08.2011 - 07.2013
- Demonstrated effectively leadership of 30 employees creating team spirit when training and motivating employees.
- Supervised day-to-day operations to meet performance, quality and service expectations.
- Maintained clean, safe, and organized store environment to enhance customer experience.
- Developed strong working relationships with staff, fostering positive work environment.
- Monitored cash intake and deposit records, increasing accuracy, and reducing discrepancies.
- Oversaw daily cash reconciliations, ensuring accurate financial reporting and minimizing discrepancies.
- Improved customer satisfaction by addressing and resolving complaints promptly.
- Completed regular inventory counts to verify stock levels, address discrepancies, and forecast future needs.
- Helped with planning schedules and delegating assignments to meet coverage and service demands.
- Managed inventory levels to minimize stockouts while reducing overhead costs.
- Mentored junior staff members in their professional development by offering guidance/support in their assigned roles.
- Generated repeat business through exceptional customer service and responded to customer concerns with friendly and knowledgeable service.
- Assisted in recruiting, interviewing, hiring, and onboarding of new employees to maintain adequate staffing levels.
- Collaborated with management team to develop strategic plans for business growth and improvement.
- Enforced company policies consistently while handling disciplinary actions when necessary with fairness and respect.
- Increased sales through effective merchandising strategies and targeted promotions.
- Facilitated clear communication between employees and upper management through regular meetings and updates.
Education
Bachelor of Science - Business Management
University of Phoenix
Sacramento, CA12.2024
Skills
- EPIC/APEX; Microsoft Office, Various E-mail software; IDX; Meditech; and Cerner
- Insurance Verification
- Fee Collection
- 55 WPM Typing Speed
- Professionalism and Ethics
- Data entry proficiency
- Medical terminology knowledge
- Multitasking and Organization
- Problem-Solving
- Team Collaboration
- HIPAA Compliance
- Patient Registration and Admissions
- Payment Processing
- Documentation accuracy
Timeline
Patient Access Representative
St. Francis Memorial Hospital
08.2020 - Current
UCSF-Admitting Worker/PAU
Insight Global
07.2019 - 07.2020
Claims Benefit/Customer Service Specialist
Aetna Healthcare Insurance
07.2013 - 01.2017
Assistant Manager
Popeye’s
08.2011 - 07.2013
Bachelor of Science - Business Management
University of Phoenix
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