Erika Pettis
Union,NJ
Summary
Motivated healthcare professional seeking a full-time position to leverage my extensive skills in billing, and office management while contributing to a dynamic team that fosters professional growth and development
Overview
7
7
years of professional experience
Work History
Billing Team Lead
Newark Community Health Centers
03.2023 - Current
- Managed daily operations of the revenue cycle department, including billing, coding, and collections, ensuring timely and accurate reimbursement.
- Navigated the implementation of a new denial management system, reducing denial rates by 18% and improving recovery rates by 22%.
- Partnered with clinical and administrative teams to improve charge capture processes, resulting in a 12% increase in revenue.
- Post all payments in ECW via an 835 file or manual
- Work Charity care cases and prepare them for Audits with the state.
- Catch all invalid Prenatal Risk Assessment's (PRA'S) for proper billing purposes.
Patient Service Specialist Case Manager
Kessler Institute for Rehabilitation
04.2022 - 03.2023
- Manage a caseload of 80-90 cases
- Verify all insurance for Medicare, Medicaid and Commercial insurance
- Ensure that all cases are updated and done for all therapists
- Read reports to make sure the patient is a correct candidate for rehabilitation
- Send out all Plan of Cares to providers and adjusters to be signed to continue care
- Monitor all accounts for visits with a hard max and with shared visits with OT/ST/PT
- Send in all appeals for patients that require care due to medical necessity
- Keep track of all authorizations current and expired
- Send out all Discharges to the MD
- Have a positive relationship with all patients and ensure they are receiving the best care possible
- Follow all CMS guidelines
Botox Coordinator
St Luke's University Health Network
11.2020 - 02.2022
- Obtain Prior authorization through specialty pharmacy
- Code all claims for prior authorization submissions
- Verify all patients benefits for in network and out of network
- Verify insurance for all Medicaid Medicare and commercial plans
- Verify if patients insurance is PAR with the practice, doctor and surgical centers
- Make sure all in basket requests are completed daily
- Order all Botox supplies according to the location the patient is going to
- Obtain referrals if needed from another practice
- If ordered by Neurologist perform genetic testing to see underlying issues
- Create profiles for patients through Evicore or AIM when needed
- Alert patient of approval or denial once received
- Create appeal packages as well as schedule peer to peers on denied services
Accounts Receivables/ Billing
Riverside Medical Group
03.2020 - 11.2020
- Complete claim status via Epic
- Contact several insurances regarding missing payments
- Update CPT codes according to patients chart
- Verify patient has active coverage for DOS
- Transfer balance to patient if in self-pay guidelines
- Follow all HIPPA and PHI compliances
- Monitor reports through HIP
Patient Accounting A/R Follow Up
Lehigh Valley Health Network
07.2018 - 10.2020
- Submit appeals and corrected claims according to insurance guidelines
- Verifies accuracy of billing and patient data
- Investigate the reasons causing denials and resolve them according to state regulations and insurance carrier guidelines
- Seek resolution to problematic accounts to receive accurate payments and maximum reimbursement
- Identifies and report any trending errors to leadership
- Work with various Medicaid payers
Education
High school diploma - Science
Lincoln High School
Jersey City, NJ06.2009
Bachelor of Science - Business Administration And Management
Western Governors University
Salt Lake City, UT06-2026
Skills
- Clinical courses: Medical Assisting, Medical Billing and coding, Medical Terminology
- Computer Software : EPIC, EMR, Intelliview, ECW, Integrity, Navinet, Emdeon, Craneware, Evicore
- Medical Office Management, Word, Excel, Outlook, 40-45 WPM
- Multitasking and organization
- HIPAA compliance
- Claim submission
- Insurance verification
- Payment posting
Accomplishments
- Medical Office Technology-Certificate
- I9 Certified through DHS
Timeline
Billing Team Lead
Newark Community Health Centers
03.2023 - Current
Patient Service Specialist Case Manager
Kessler Institute for Rehabilitation
04.2022 - 03.2023
Botox Coordinator
St Luke's University Health Network
11.2020 - 02.2022
Accounts Receivables/ Billing
Riverside Medical Group
03.2020 - 11.2020
Patient Accounting A/R Follow Up
Lehigh Valley Health Network
07.2018 - 10.2020
High school diploma - Science
Lincoln High School
Bachelor of Science - Business Administration And Management
Western Governors University
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