Diana Jackson
Atlanta,GA
Summary
Dynamic healthcare leader with a strong commitment to community well-being, recognized for driving organizational success through innovative solutions. Proven expertise in multi-tasking and time management, delivering positive outcomes in fast-paced environments. Strong analytical abilities and attention to detail facilitate the development of ethical business strategies. Skilled in building relationships and rapport across diverse teams, enhancing collaboration and communication for improved training and workflow optimization.
Overview
6
6
years of professional experience
Work History
Patient Account Specialist III/VA Claims Specialist
Emory Hospital
Atlanta, GA
09.2023 - 01.2025
- Perform routine research billing compliance audits of research accounts to ensure billing compliance, using the informed consent document, clinical trial agreement, and study budgets.
- The Research Billing Specialist will utilize the Epic eMR system and the OnCore Clinical Trial Management System (CTMS) financial functionality to track billable items, and be responsible for following up with study teams if billing information is missing or improperly captured.
- Perform detailed reviews of protocols, budgets, informed consent documents, sponsor contracts, Notices of Grant Awards, FDA letters, and other relevant research documents to determine qualifying status, and conduct a comprehensive Medicare Coverage Analysis review, making sure to document the rationale for final decisions or recommendations.
- Resolve high-priority and aged inventory.
- Reviews all accounts assigned for collection prior to, during, or after admission and discharge.
- Performs progressive collection steps to discuss and clear balances on multiple accounts.
- Bills are submitted to third-party payors, when appropriate, by hard copy or electronic submission.
- Performs special billing tasks such as combined and split bills as needed
- Responsible for all aspects of insurance follow-up and collections, including making telephone calls, accessing payer websites, and filing appeals.
- Independently assesses Claim Edit, Transaction Editing System, Clearinghouse, or other applicable billing edit messages to resolve any issues preventing the release of physician or hospital claims from systems.
Patient Account Representative
Peidmont
Atlanta, GA
05.2022 - 06.2023
- Resolved billing issues by collaborating with relevant parties.
- Filed patient appeals based on comprehensive research into denied claims.
- Worked closely with insurance companies to obtain authorization for services rendered.
- Analyzed EOB statements from insurance firms to ensure accuracy against provider charges.
- Evaluated claim denials by third-party payers to find reimbursement solutions.
Account Resolution Coordinator
Atlanta Medical Center
10.2021 - 04.2022
- Researched, analyzed, and resolved account discrepancies.
- Investigated unresolved patient claims, escalating them as necessary.
- Handled pending claims and prepared appeals.
- Conducted regular follow-ups to collect overdue claims.
- Generates reports to identify issues in accounts receivable.
- Collaborated with multiple CMO and Managed Care insurance firms.
- Managed Explanation of Benefits (EOBs) from various major insurance companies, including BCBS, Aetna, United Healthcare, Cigna, Medicare and Medicaid.
- Complete tasks promptly and report obstacles to the lead specialist for swift resolution.
- Analyzed payor trends concerning zero payments, payment variances, billing issues, and denials.
Account Receivable and Collection Representative
Piedmont Physicians
09.2019 - 10.2021
- Conducted thorough research to resolve account balances.
- Investigated outstanding patient claims and resolved or escalated to appropriate level.
- Managed pending claims from the aging basket.
- Follow up at regular intervals to collect outstanding unpaid claims
- Generates detailed reports to resolve accounts receivable issues.
- Working various commercial and government insurance companies
- Collaborated with EOBs from various major insurance companies.
- Managed scheduling and registration for patients.
Account Receivable Specialist II
Hexaware
05.2019 - 08.2019
- Investigated and addressed tracers for improved accuracy.
- Resolve or elevate issues related to pending patient claims.
- Drafted and submitted appeals for pending cases.
- Follow up at regular intervals to collect outstanding unpaid claims
- Prepares reports to identify and resolve accounts receivable
- Interacted daily with a wide range of insurance organizations.
- Handled Explanation of Benefits for various insurers including Cigna, Kaiser, and Medicare.
Education
Master of Project Management -
University of Management & Technology
Arlington, VAMaster of Healthcare Administration -
Columbia Southern University
Orange Beach, ALMedical Office/Billing Coding -
ETI Career Institute
Atlanta, GASkills
- Revenue Cycle Management
- Compliance with HIPAA Standards
- NextGen EHR Proficiency
- Navicure Proficiency
- Proficient in EPIC EHR
- Citrix
- Experience with N’Thrive
- Proficient in Palmetto GBA Operations
- Health Information Systems Knowledge
- Proficient in Gammis
- Proficient in Palmetto GBA Operations
- Availity Proficiency
- OneSource Proficiency
- Familiarity with Athena Clinical System
- Experience with the VACNN veterans' website
- Experience with EPIC Processes
- Athena Communicator
- Workday Experience
- Oncore Proficiency
- Employee Onboarding
- Medical Coding Knowledge
- Accounts Receivable Strategy
- Facilitating Refund Transactions
- Preauthorization Process Optimization
- Accurate Revenue Reconciliation
- Policy & Procedure Compliance
Timeline
Patient Account Specialist III/VA Claims Specialist
Emory Hospital
09.2023 - 01.2025
Patient Account Representative
Peidmont
05.2022 - 06.2023
Account Resolution Coordinator
Atlanta Medical Center
10.2021 - 04.2022
Account Receivable and Collection Representative
Piedmont Physicians
09.2019 - 10.2021
Account Receivable Specialist II
Hexaware
05.2019 - 08.2019
Master of Project Management -
University of Management & Technology
Master of Healthcare Administration -
Columbia Southern University
Medical Office/Billing Coding -
ETI Career Institute
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