ELIZABETH HENRY
Oceanside,CA
Summary
Highly enthusiastic and motivated professional with over 12 years of experience in patient and insurance services. Successfully managed accounts, analyzed contracts, processed billing transactions, created reports, posted cash, and communicated with insurance providers. Skilled in ensuring the smooth operation of shared services, identifying and resolving billing system issues, generating comprehensive reports, and providing recommendations. Proficient in collaborating with physicians and other healthcare providers to ensure adherence to billing and documentation policies, procedures, and regulations, leveraging extensive knowledge of physician practice operations. Proactive in researching, analyzing, and addressing inquiries related to compliance, medical coding, billing denials, and billable services. Capable of handling multiple tasks in a dynamic, fast-paced environment.
Overview
5
5
years of professional experience
Work History
Revenue Cycle Specialist
AM West Inc.
11.2021 - 10.2022
- Collected patient payments for services rendered, negotiated payment plans, and followed up on delinquent accounts
- Collaborated with insurance companies to determine coverage for medical procedures and treatments
- Consulted with hospital administrators regarding regulation changes that could affect billing practices
- Reviewed claims to ensure the accuracy of coded details according to industry standards
- Reviewed patient records to identify insurance coverage and possible treatment complications that affect claims processing
- Reported claims status to clients to ensure accurate communication between departments within a healthcare organization
- Reduced aging significantly within three months of hire date, worked with Medicare, Medi-Cal, major payors, private pay, LPA, and managed care
Insurance AR & Reimbursement Specialist
Torrey Pines Orthopedic Medical Group
04.2019 - 10.2021
- Reviewed claims for accuracy and completeness and identified potential issues such as duplicate billing and incorrect codes
- Resolved issues related to claims denials and appeals with insurance companies on behalf of patients and providers
- Explained insurance plans to patients and healthcare providers for a full understanding of coverage options
- Processed claims for medical services provided by healthcare providers such as hospitals, clinics, and physician offices
- Conducted investigations into fraudulent claims and suspicious activity that could indicate insurance fraud
- Prepared reports on insurance claims activities, identifying fraudulent claims and areas for improvement
- Analyzed insurance company practices and procedures to identify areas for improvements, to increase efficiency and reduce costs while maintaining the quality of service
Insurance Specialist / Analyst / Reimbursement Specialist
UCSD Health/TPOMG
01.2019 - 10.2021
- Estimated treatment plans’ cost, negotiated prices with hospitals and doctors, and processed insurance claims
- Reviewed policies to determine the coverage appropriate for the customer’s needs based on age, location, and occupation
- Interpreted federal and state laws regarding insurance regulations, including coverage requirements and policy limitations
- Researched new insurance products to determine feasibility and potential impact on revenue and profits
Patient Account Specialist II – Contract RCM
Scripps Health
10.2018 - 01.2019
- Processed insurance claims, billed patients for services rendered, and provided medical documentation of services received
- Explained insurance coverage, payment options, and filing requirements, and ensured updated patients’ medical records
- Received and processed patient payments for office visits and procedures such as X-rays and lab tests
- Reviewed insurance claims and helped patients understand the billing process, including submitting claims to insurance companies and assisting patients with filing appeals to have claims approved Prepared bills for services rendered
Revenue Cycle Specialist Medical Accounts Rep – Contract
Prometheus Labs
04.2018 - 09.2018
- Monitored patient accounts to ensure that all payments had been received on time
- Maintained medical records by recording details of medical services provided to patients
- Explained insurance coverage, billing procedures, and other information about insurance coverage to patients
- Coordinated care with physicians and other healthcare providers to ensure that patients received adequate treatment
- Processed claims for patients who had no insurance and whose insurance would not cover services rendered by the lab
Billing Specialist II - 2nd Wave Denial Specialist RCM
Golden Hour Data System
06.2017 - 01.2018
- Reviewed and processed invoices for accurate and timely payment, as well as updated and maintained vendor master files
- Investigated and resolved discrepancies between invoices and purchase orders, and processed employee expense reports
- Responded to vendor inquiries regarding invoice status and payments, and generated invoicing/payment monthly reports
- Performed sponsor review investigations to confirm third-party liability and benefits Insurance coverage issues
- Completed tasks set by regulations and standards, and updated registration information for claims submissions
- Set up monthly payment plans by the Golden Hour procedural guidelines, and contacted numerous patients by phone
Skills
- Front End to Back End RCM
- DME
- HIPAA
- Medicare
- ICD-10
- ICD-9
- CPT Coding
- Documentation Review
- ICD Coding
- Medical Scheduling
- Anatomy Knowledge
- Insurance Verification
- Medical Billing & Insurance
- Medical Coding
- Clerical Experience
- Medical Records
- Quality Assurance
- Medical Terminology
- Bookkeeping
- Data Entry
- Revenue Cycle Management
- Auditing
- Time Management
- Presentation Skills
- Verbal and Written Communication Skills
- Problem-Solving
- Solid Analytical Skills
- Project Management Skills
- Cultural Awareness
- Nextgen
Timeline
Revenue Cycle Specialist
AM West Inc.
11.2021 - 10.2022
Insurance AR & Reimbursement Specialist
Torrey Pines Orthopedic Medical Group
04.2019 - 10.2021
Insurance Specialist / Analyst / Reimbursement Specialist
UCSD Health/TPOMG
01.2019 - 10.2021
Patient Account Specialist II – Contract RCM
Scripps Health
10.2018 - 01.2019
Revenue Cycle Specialist Medical Accounts Rep – Contract
Prometheus Labs
04.2018 - 09.2018
Billing Specialist II - 2nd Wave Denial Specialist RCM
Golden Hour Data System
06.2017 - 01.2018
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