Denise Brown
Summary
Experienced professional in managed care, medical claims, and medical collections with 13+ years of experience, including Workers Compensation. Skilled in collaborating with commercial and managed care payers such as Blue Cross, Aetna, United Health Care, Medicaid, and Medicare. Known for attention to detail and exceptional customer service. Proficient in Allscripts, Nextgen, Centricity, EPIC, and other applications. Specialized expertise in ICD-10 codes for Medical Collections and Billing.
Overview
16
16
years of professional experience
Work History
Sr. Revenue Cycle Manager
Southeast Medical Group
07.2022 - Current
- Manage and supervise the daily operations of the revenue cycle team.
- Ensure all billing and collection procedures adhere to legal and health insurance policies.
- Develop strategies to improve and accelerate the revenue cycle process.
- Oversee the collection processes by developing SOP's.
- Identifying issues in the revenue cycle process and implementing solutions.
- Preparing and presenting reports on the status of the accounts and collections.
Billing Complete
03.2021 - 07.2022
- Worked all current and past due A/R.
- Collect on all unpaid CPT codes that did not pay per the contracted rate.
- Submit contractual adjustments on accounts.
- Bill patient responsibility as in coinsurance, deductibles and copays.
- Contact insurance companies to request reconsideration and follow up on appeals.
IKS Health Care
11.2019 - 02.2021
- Collect on all past A/ R for commercial and government claims.
- Responsible for reducing the A/R by accurately and thoroughly working assigned accounts in accordance with established policy and procedures.
- Review all EOB's to ensure proper reimbursement which also includes under payment and over payments.
- Pulled reports to work aging A/R to ensure we meet all appeal timely filing guidelines.
- Submitted Medical Records that are being requested by the insurance company as well as proof of medical necessity.
- Submitted appeals which included valid timely filing, Medical Necessity and various other denials the insurance has denied the claim for.
Mpower
10.2018 - 11.2019
- Company Overview: Intraoperative Neuromonitoring
- Daily contact with various insurance companies to follow up on the status of submitted appeals which included reconsiderations, level 1-3 appeals and requests for Medical Reviews.
- Submitted Medical Records that are being requested by the insurance company as well as proof of medical necessity.
- Submitted appeals which included valid timely filing, Medical Necessity and various other denials the insurance has denied the claim for.
- Added adjustments as needed which included Contractual Adjustments.
- Billed Patient responsibility which includes the patient's coinsurance, deductible and any other patient liability.
- Reviewed all payments to ensure they have been paid correctly according to the contract.
- Intraoperative Neuromonitoring
Hospital Medical Collections Representative 2
X-Tend Health Care a Navient Company
11.2016 - 10.2018
- Review all Eob's to determine if and how a claim is paid correctly.
- Submitted medical records are requested by the insurance company or to prove Medical Necessity to ensure a proper payment for all services rendered.
- Called patients to collect needed information that is being requested from the insurance company such as correct id numbers, coordination of benefits, or sending in additional requested information.
- Perform adjustments on accounts to ensure the correct contractual adjustment was taken.
- Call various insurance companies to ensure timely and proper payment of each claim worked.
- Ensure all accounts are resolved to make each account the goal to be zero after the correct resolution has been applied.
- Assist new employees with help in navigating the system and how to collect on claims.
- Responsible for investigating refunds and recoupments which included the duties of appealing and contesting any money that has been taken incorrectly by the insurance company.
Laboratory and Molecular Billing/ Collection A/R Representative ll
Caris Life Sciences
01.2012 - 01.2016
- Review and prepare claims for manual and electronic billing submission.
- Identify upfront billing errors for corrections and resubmit claims to various insurance carriers.
- Provide all necessary documentation required to expedite payments which include authorizations and referrals.
- Processed insurance and patient correspondence which include patient responsibility payments.
- Complete refunds and adjustments on accounts as required to resolve balances.
- Review past due and current A/R for all payers to collect 100% of the allowable amount.
- Daily follow up on collections on patient payments and from all commercial, workers compensation and government payers.
- Appealed all under payments along with providing itemized bills, medical records and any additional information to the insurance to ensure the billed claim will pay per the contracted rate.
- Trained each team member to work various payers and was readily available to answer any questions.
- Formatted a medical necessary appeal strategy to allow claims to process per the medical policy.
Medical Claims Analyst 1
Aetna Health Insurance
01.2009 - 01.2012
- Process Inpatient, Outpatient and Appeals with the limits of $50,000 and under.
- Analyze and approve routine claims that cannot be auto adjudicated.
- Apply Medical Necessity guidelines to determine coverage, complete eligibility verification and identify discrepancies and apply all cost containment measurements to assist in the claim adjudication process.
- Utilize all applicable system functions available ensuring accurate and timely claim processing service including Claim Check.
Education
Diploma -
Antioch High School
Health Care Management - undefined
Independence University
Skills
- Billing cycle management
- Revenue growth strategies
- Financial account oversight
- Financial budget oversight
Timeline
Sr. Revenue Cycle Manager
Southeast Medical Group
07.2022 - Current
Billing Complete
03.2021 - 07.2022
IKS Health Care
11.2019 - 02.2021
Mpower
10.2018 - 11.2019
Hospital Medical Collections Representative 2
X-Tend Health Care a Navient Company
11.2016 - 10.2018
Laboratory and Molecular Billing/ Collection A/R Representative ll
Caris Life Sciences
01.2012 - 01.2016
Medical Claims Analyst 1
Aetna Health Insurance
01.2009 - 01.2012
Health Care Management - undefined
Independence University
Diploma -
Antioch High School
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