Denise Reed
Oklahoma City,OK
Summary
Meticulous Healthcare Administrator with more than two decades of professional experience. Eager to apply academic expertise and demonstrated proficiency to excel in a role within your organization. Known among colleagues for adeptness and ingenuity. I am committed to delivering on your companies objectives with unwavering reliability.
Overview
23
23
years of professional experience
1
1
Certification
Work History
Director of Patient Access and Insurance Auth
Community Hospital
Oklahoma City , OK
01.2023 - Current
- Develop and mentor employees while maintaining standardized admission procedures for accurate data collection and insurance information.
- Ensure positive patient experiences and effective coordination between clinical and administrative teams.
- Address patient grievances and oversee direct patient admissions, staffing, policies and practices.
- Establish policies for patient confidentiality HIPAA compliance, while adhering to CMS and DNV regulations.
- Analyze operational metrics to enhance processes and achieve 98% accuracy in registered accounts and copay collections.
- Report directly to the Chief Operating Officer
- Provide strategic input for registration processes and develop departmental budgets.
- Resolve escalated issues, often coordinating with other departments
- Conducted regular meetings with department heads to review progress on strategic initiatives.
- Created detailed plans outlining timelines, goals, budgets, staffing needs and other requirements for projects.
- Served as a public spokesperson at industry events or conferences.
- Assessed employee performance against established benchmarks or targets.
- Partnered with staff to create professional development plans to support personal and business growth.
- Mentor and train and team of 60+ employees on Commercial and CMS guidelines, CPT codes and ICD-10.
- Ensure patient satisfaction through Press Ganey and manage co-pays and payment agreements.
- Implement new processes for tracking pending cases and monitor verification progress through Epic EMR
- Review referral and authorization for accuracy and coding for surgeries.
- Verify insurance information for optimal reinbusement and minimal denials.
Clinic Operations Manager
Integris
Oklahoma City, OK
10.2021 - 01.2023
- Managed daily operations of the clinic, including overseeing patient flow, registration processes, billing services, medical records maintenance and other administrative functions.
- Organized staff schedules, including assigning tasks, tracking time off requests, and ensuring adequate coverage.
- Recruited, trained, evaluated and supervised clinical staff members in accordance with organizational standards.
- Resolved customer service issues quickly and efficiently by responding to inquiries from patients or their families in a professional manner.
- Maintained relationships with insurance companies for accurate claims processing.
- Provided guidance on regulatory requirements related to healthcare laws and ethical standards of practice.
- Collaborated with external vendors on procurement contracts for medical equipment or services at competitive prices.
- Attended meetings with senior leadership team members regarding strategic planning initiatives.
- Devised training programs for new and existing employees.
- Supervised internal and external communications by answering queries and complaints.
- Managed a team of healthcare professionals, including hiring, training, and performance evaluations.
- Implemented patient satisfaction initiatives to improve service quality and address grievances.
- Monitored clinic budget, controlled expenses, and optimized resource allocation.
- Coordinated with medical staff to ensure adherence to clinical protocols and patient satisfaction.
- Communicated with patients with compassion while keeping medical information private.
- Built work schedules and staff assignments, taking workload, space and equipment availability into consideration.
- Maintained awareness of government regulations, health insurance changes and financing options.
Lead Patient Access Specialist III
Oklahoma Heart Hospital
Oklahoma City, OK
12.2013 - 10.2021
- Researched patient eligibility, coverage information, and benefit levels.
- Verified insurance authorizations with payers via telephone or web-based systems.
- Processed prior authorization requests in accordance with departmental guidelines.
- Tracked authorization statuses using electronic databases or manual filing systems.
- Coordinated communication between providers, patients, payers, and other departments as needed.
- Assisted with scheduling appointments, verifying insurance coverage, and collecting payments.
- Performed accurate cash handling procedures for copayments, deposits, and other transactions.
- Verified patient eligibility for services through various online systems or by calling the insurance companies directly.
- Maintained confidentiality of protected health information according to HIPAA guidelines.
- Checked insurance benefits, received payments and provided receipts.
- Adhered to HIPAA guidelines and maintained integrity of hospital policies and procedures.
- Maintained current knowledge of ICD-10 codes, CPT codes, HCPCS codes, DRG's.
- Verified accuracy of diagnostic codes assigned by providers through ICD-10-CM coding conventions and CPT coding guidelines.
- Provided coverage for the Patient Access Department on an on-call basis as needed.
Patient Access Specialist II/Quality Data Spec.
Oklahoma Heart Hospital
Oklahoma City , Ok
02.2002 - 12.2013
- Assessed internal controls within insurance organizations to identify areas of non-compliance.
- Double-checked and reviewed documentation for denied and accepted insurance claims.
- Developed a working knowledge of insurance plans, including Medicare and Medicaid regulations and requirements.
- Identified discrepancies in patient's insurance coverage or benefits, ensuring accuracy of data entered into system.
- Researched third party payer guidelines related to prior authorizations, coding and billing processes.
- Greeted customers and answered inquiries regarding services provided.
- Monitored and operated PBX switchboard to route incoming calls to appropriate personnel.
- Responded promptly to emergency calls for assistance.
- Processed applications for admission and maintained accurate records.
- Ensured compliance with all applicable laws, regulations, standards, and policies related to registrar activities.
Education
Bachelor of Science - Healthcare Adminstration
Mid America Christian University
Oklahoma City, OK05-2018
Skills
- Healthcare management
- Staff Development
- Employee Supervision
- Critical Thinking
- Epic Systems
- Employee Recruitment and Hiring
- Organization and Time Management
- Analytical Thinking
- Customer Relations
Certification
- Epic Certification Oct 2021
- CPR Certification Jan 2002-Current
Timeline
Director of Patient Access and Insurance Auth
Community Hospital
01.2023 - Current
Clinic Operations Manager
Integris
10.2021 - 01.2023
Lead Patient Access Specialist III
Oklahoma Heart Hospital
12.2013 - 10.2021
Patient Access Specialist II/Quality Data Spec.
Oklahoma Heart Hospital
02.2002 - 12.2013
Bachelor of Science - Healthcare Adminstration
Mid America Christian University
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