Denise Williams

•Account reconciliation for Primary Care Organization arm of Humana. Manage and reconcile 26 bank accounts across 18 states daily.
•Assist in Managing a team of 2 delegating daily, weekly and monthly tasks.
•Research claim payments, denials, recoupments, refund requests to find solutions to all claim issues.
•Route insurance refund checks to payers.
•Fill out forms to have checks not cashed reissued to the PCO
•Research which bank account checks belong to and obtain explanation of benefits for checks that did not come with one.
•Proficiency in payer websites such as Availity, Payspan, Zelis, Cigna for CHP, Etc.
•Lead our team through the successful transition from PCO EMR from eClinical Works to Athena.
•Proficiency in multiple EMR systems.
•Proficiency in Microsoft office (excel, outlook, word, etc.)
•Proven track record of meeting deadlines and providing through and thoughtful work.
•Self starter with a proven track record of improved process improvement suggestions resulting in PCO process improvement changes.

Perform receptionist duties including answering phone calls, screening calls, taking messages, and providing accurate information.
· Keep EMR up to date and correct billing information.
· Perform clerical duties related to clinical services.
· Assist in care and maintenance of office environment.
· Maintain and organize patient medical information including insurance information, letters, forms, etc.
· Complete all FMLA & disability paperwork per patients request.
· Collect payments for said paperwork.
· Verify patients’ insurance.
· Complete prior authorization/pre-cert process for clinical procedures and surgeries.
· Support marketing efforts.
· Schedule patients for surgery and call outpatient surgery patients to inform them of surgery time/date.
· Collect Superbills and census daily to submit to billing department.
· Participate in proactive team efforts to achieve departmental and company goals.
· Provide leadership to others through example and sharing of knowledge/skill.
· Participate in education sessions specific to corporate needs or job duties – locally or remotely, as needed.
· Provide training to other employees – locally or remotely, as needed.
· Maintain confidentiality of sensitive information.
· Participate in all mandatory trainings relating to applicable healthcare laws and regulations, and demonstrate full compliance with those regulations, including without limitation, HIPAA, OSHA, OIG, Federal, State and local laws and regulations.

• HIPAA compliance certification
• PCMH clinic recognition via NCQA
• RGVACO Golden Star of excellence for 2016 and 2017
• CPR and BLS certification
• Highly experienced with CPT, ICD-10 and HCPCS coding
• Strong knowledge of medical laws and ethics
• Strong knowledge of insurance policies, procedures, and third-party billing
• Knowledge of FMLA, short term disability, long term disability and COBRA
• Proficient in Microsoft Office Applications
• Strong communication skills with excellent presentation skills
• Ability to multi-task
• Adaptive to high-stress situations
• Reconciles billings with the accounts received ledger
• Monitors the billing metrics database
• Identifies of simplification and automation opportunities
• Manages and ensures compliance with control objectives
• Develops and prepares reports and metrics
• Utilizes metrics to improve performance
• Supports internal and external auditors
• Updates billing policies, procedures, methods, and guidelines
• Communicates with management on day-to-day issues
• Leads team to improve office collections, communicate issues, and implement ideas
• Performs daily activities of billing and auditing of assigned claims
• Ensure compliance with company policies, and state and federal regulatory bodies