Eboni Riggins
Harvest,United States
Summary
Spearheaded healthcare revenue cycle and claims operations with over 10 years of progressive experience across hospital systems and federal healthcare environments, including DOD/VA and commercial payers such as Blue Cross Blue Shield.
Overview
10
10
years of professional experience
1
1
Certification
Work History
Collector I
Huntsville Hospital
05.2024 - 09.2024
- Processed and prioritized claim inventories to facilitate timely adjudication, denial resolution, and reimbursement in a fast-paced hospital environment.
- Conducted comprehensive audits of payer-processed claims by analyzing EOBs and remittance advice to identify denial trends, underpayments, contractual variances, and posting discrepancies.
- Analyzed payment variances by validating insurance eligibility, benefits authorizations, and patient registration data prior to claim correction.
- Utilized medical terminology and CPT/ICD-9/ICD-10 coding principles to resolve coding edits and charge capture discrepancies.
- Facilitated collaboration among patients, providers, and insurance representatives to clarify payer policies and resolve claim discrepancies.
Medical Support Assistant (Office Automation)
Womack Army Medical Dept. of Public Health-Epidemiology and Disease Control
10.2019 - 04.2021
- Executed audits and validations of patient demographics, insurance eligibility, and coverage data within CPRS/VISTA to enhance accuracy in billing claims processing.
- Implemented DOD, VA, HIPAA, and federal reimbursement regulations in registration and claims support activities.
- Developed operational tracking logs and performance reports utilizing Microsoft Excel and Word to enhance workload monitoring.
- Addressed demographic discrepancies, coverage conflicts, and benefits verification issues by collaborating with patients, providers, and administrative teams.
- Oversaw and mentored staff on CPRS/Vista navigation, registration accuracy, and office automation procedures.
Processing Assistant III (Claims & Authorizations)
Cumberland County Dept. of Social Services
04.2018 - 10.2019
- Managed high-volume claims and authorizations by verifying eligibility, interpreting benefits, and applying healthcare billing guidelines.
- Reviewed and verified claim and authorization documentation for accuracy and policy adherence, identifying discrepancies and facilitating corrections to ensure precise payment processing.
- Evaluated payer policies and benefits language to ensure accurate coverage and authorization requirements.
- Monitored claim and authorization status in Microsoft Excel and Word, utilizing structured logs, formulas, and sort and filter views.
- Resolved processing discrepancies by aligning documentation with billing standards and case records. Addressed complex variances through established procedures and communicated resolution requirements to team members and external contacts.
- Safeguarded PHI through rigorous confidentiality protocols and HIPAA-compliant management of case notes, supporting documents, and communications.
Medical Biller / Insurance Follow-Up Specialist
Robert Half
08.2017 - 04.2018
- Managed comprehensive claim and reimbursement workflows across multiple client sites, ensuring accuracy in charge review and clean claim submissions.
- Executed audits of payer-processed claims by analyzing EOBs and remittance advice to identify denial drivers, underpayments, and payment variances.
- Implemented CPT, ICD-9, and ICD-10 coding standards and medical terminology to ensure accurate billing and compliance.
- Compiled and delivered comprehensive appeal packages, ensuring inclusion of clinical documentation and audit-ready case notes.
- Utilized Excel, including pivot tables and VLOOKUP/XLOOKUP formulas, to reconcile payments and analyze payer trends.
Provider Relations Specialist
Blue Cross and Blue Shield
12.2014 - 08.2017
- Oversaw resolution of provider and member disputes related to claims denials and reimbursements, ensuring adherence to Medicare, Medicaid, and commercial billing guidelines.
- Executed comprehensive audits of payer-processed claims by analyzing claim history, EOB details, and relevant payer policies to identify underpayments, denials, and reimbursement variances.
- Investigated root causes of payment variances, focusing on payer processing issues and documentation discrepancies.
- Validated billed services by interpreting medical terminology and coding documentation in accordance with payer rules and government fee schedule guidance.
- Developed and managed dispute tracking and reconciliation logs in Microsoft Excel and Word, utilizing sorting, filtering, and formulas to enhance workflow efficiency.
- Facilitated communication of determinations and documentation requirements to providers, members, and internal stakeholders while ensuring strict HIPAA compliance.
Education
Bachelor of Science - Healthcare Administration
Capella University
10.2025
Technical Diploma - Medical Office Specialist
Kaplan College
04.2012
High School Diploma - undefined
Hoke County High School
05.2005
Skills
Auditing
Denial Management
Analytical Skills
Payment Audits
Microsoft Excel
Problem Solving
Reimbursement
HIPAA Compliance
Communication
Safety procedures
Call center experience
Assertiveness
Customer research
Certification
Previously Certified CMPC-POL, ACA Mar 2012 to Jun 2013
Timeline
Collector I
Huntsville Hospital
05.2024 - 09.2024
Medical Support Assistant (Office Automation)
Womack Army Medical Dept. of Public Health-Epidemiology and Disease Control
10.2019 - 04.2021
Processing Assistant III (Claims & Authorizations)
Cumberland County Dept. of Social Services
04.2018 - 10.2019
Medical Biller / Insurance Follow-Up Specialist
Robert Half
08.2017 - 04.2018
Provider Relations Specialist
Blue Cross and Blue Shield
12.2014 - 08.2017
Bachelor of Science - Healthcare Administration
Capella University
Technical Diploma - Medical Office Specialist
Kaplan College
High School Diploma - undefined
Hoke County High School