Emma Hill
ORMOND BEACH,FL
Summary
Possesses versatile skills in project management, problem-solving, and collaboration. Brings fresh perspective and strong commitment to quality and success. Recognized for adaptability and proactive approach in delivering effective solutions.
Overview
7
7
years of professional experience
Work History
ANCILLARY PRIOR AUTHORIZATION COORDINATOR
NORTHWEST NEUROLOGY
09.2022 - Current
- Improved patient satisfaction by efficiently managing prior authorization requests and ensuring timely approvals.
- Reduced errors in documentation by meticulously reviewing medical records and verifying patient information.
- Verified eligibility and compliance with authorization requirements for service providers.
- Tracked referral submission during facilitation of prior authorization issuance.
- Fielded telephone inquiries on ancillary authorization details from plan members and medical staff.
- Obtained and logged accurate patient insurance and demographic information for use by insurance providers and medical personnel.
- Maintained the confidentiality of sensitive patient information, adhering strictly to HIPAA regulations and safeguarding medical records appropriately.
- Reached out to insurance carriers to obtain prior authorization for testing and procedures.
- Assisted with medical coding and billing tasks relating to MRI, EEG and HSS ensuring correct documentation was available and codes were entered correctly.
- Processed patient payments, auto posting to the account and providing claims summary details when requested.
- Prepared and processed patient referrals
- Reached out to insurance companies to verify coverage.
- Assisted patients in understanding complex billing statements, leading to increased trust between patients and healthcare providers.
Revenue Cycle Specialist
Acuet RCM
05.2022 - 09.2022
- Receive current charges from the coding company and enter them into the billing system noting to code the modifiers correctly based on payer reimbursement specifics.
- Generate claims and clean up errors from the clearinghouse to ensure accurate and timely processing.
- Follow up on the AR from spreadsheets based on the aging of the claim and the amount due.
- Confirming claims are on file and processed according to the contract terms.
- Contact the payer regarding claims not paid correctly or denied.
- Submitting appeals or further documentation as necessary.
- Apply payments accurately into the patients accounts and when balances are due send them statements.
- Making follow up calls on older accounts' when necessary.
- Work assigned projects to review the contracts and payments to ensure that they are paid correctly.
- Providing the information to management to determine steps needed to get them processed correctly.
- Attending and leading weekly status meetings.
- Providing the client with accurate information.
- Discuss any needs or changes that are required from both Acuet RCM and the client to maintain an open line of communication to help maintain a positive relationship with the client by communication and teamwork.
Revenue Specialist
The Orthopedic Clinic of Daytona
04.2021 - 05.2022
- Work directly with insurance claims carriers, insurance authorization team, patient and other departments within the organization to ensure proper resolution of outstanding revenue claims.
- Fully work outstanding assigned insurance claims, to include researching and correcting claims, writing appeals, and facilitating submission to our EHR for appealing adverse decisions.
- Accountable for reducing delinquency for assigned accounts.
- Assist patients with understanding their balances regarding copays, coinsurances and deductibles.
Customer Service Representative
AdventHealth
08.2020 - 04.2021
- Daily interaction with patients via telephone; taking approximately 60 calls per day.
- Assist patient with understanding their benefits and reimbursements.
- Prepare Charity and Financial Assistance forms for uninsured patients.
- Address patients' questions and concerns regarding their monthly statements.
- Set up monthly payment plans for outstanding balances.
- Process payments utilizing Simplee credit card accounting system.
- Follow department policies and adhere to HIPPA guidelines.
Collections Specialist
Davita Labs
12.2017 - 08.2020
- Secured maximum reimbursement on all claims based on payer terms.
- Completed a wide range of tasks at a level which met department standards while ensuring goals and objectives were met.
- Ensured claim adjustments were applied using the appropriate payer guidelines and on department policies.
- Adhered to company policies including corporate compliance and all rules and regulations under the applicable local, state and federal agencies and accrediting bodies.
Education
High School Diploma -
Lowell Senior High School
Lowell, IN06-1996
Skills
- Detail-oriented
- Insurance verification
- Insurance authorizations
- Charge Entry
- Reliability
- Claim research
Timeline
ANCILLARY PRIOR AUTHORIZATION COORDINATOR
NORTHWEST NEUROLOGY
09.2022 - Current
Revenue Cycle Specialist
Acuet RCM
05.2022 - 09.2022
Revenue Specialist
The Orthopedic Clinic of Daytona
04.2021 - 05.2022
Customer Service Representative
AdventHealth
08.2020 - 04.2021
Collections Specialist
Davita Labs
12.2017 - 08.2020
High School Diploma -
Lowell Senior High School
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