Summary
Overview
Work History
Education
Skills
Timeline
Generic

Megatha Wilson

Rogersville,TN

Summary

Committed job seeker with a history of meeting company needs with consistent and organized practices. Skilled in working under pressure and adapting to new situations and challenges to best enhance the organizational brand. Looking forward to becoming an asset to the team at State of Franklin Healthcare Associates.

Overview

9
9
years of professional experience

Work History

Health Navigator

Main Street Rural Health
Nashville, TN
08.2023 - Current
  • Developed appropriate community resources such as mental health services, substance abuse, treatment and housing.
  • Coordinated appropriate educational material for patients, families and medical staff to accomplish best possible patient care outcomes.
  • Confirmed patients received necessary support services such as medical care, housing and public benefits.
  • Worked collaboratively with physicians, staff and other health care professionals to develop, implement and evaluate integrated and comprehensive plans of care for patients.
  • Documented patient information in appropriate systems to guarantee care coordination throughout patient care continuum.
  • Served as an advocate for patients' rights within the healthcare system.
  • Participated in continuing education activities to stay up-to-date on current trends in healthcare navigation practices.
  • Monitored changes in patient conditions and responded accordingly by adjusting care plans or making referrals as necessary.
  • Conducted thorough assessments to determine the best course of action for each patient's individual needs.
  • Attended regular meetings with staff members to discuss ongoing cases and develop new strategies for providing patient care.
  • Educated patients on self-management techniques such as stress reduction strategies and lifestyle modifications.
  • Facilitated communication between patients and healthcare providers regarding treatment decisions.
  • Identified gaps in existing services or resources for navigating healthcare issues.
  • Assessed patient eligibility for various insurance programs and helped them apply when necessary.
  • Maintained accurate records of patient interactions and progress towards goals.
  • Developed care plans to ensure that all medical needs were met in a timely manner.
  • Coordinated referrals to appropriate specialists or community programs as needed.

Billing Specialist/Collections Agent

Intellihartx
Kingsport, TN
03.2022 - 08.2023
  • Contacted insurance providers to verify insurance information and obtain billing authorization.
  • Leveraged integrated billing software to submit accurate claims.
  • Worked closely with patients to discuss payment arrangements when needed.
  • Developed financial reports detailing accounts receivable aging status.
  • Implemented new policies related to billing processes when required.
  • Answered customer inquiries regarding billings, payments, account status.
  • Investigated incorrect billings and processed refunds as necessary.
  • Performed additional duties as assigned by management team.
  • Resolved discrepancies between customers' remittances and invoices received.
  • Calculated billing charges, prepared and submitted claims to insurance companies.
  • Reviewed medical records to ensure accuracy of billing information and patient data.
  • Processed credit card transactions through Point-of-Sale terminals or online systems.
  • Maintained accurate records of collections, adjustments and denials in the system.
  • Verified insurance coverage and identified third-party payers for billing purposes.

Claims Processor

United Health Group, Optum
Minnetonka, MN
11.2015 - 03.2022
  • Verified claim data correctness in preparation for processing.
  • Processed claims according to established quality and production standards and made corrections and adjustments to solve problems.
  • Analyzed contracts and claim systems to apply appropriate benefit amounts.
  • Addressed customer inquiries to provide information and explanations on coverage and terms, expediting claims.
  • Conducted and documented comprehensive investigations to negotiate settlements or deny claims.
  • Coordinated benefits with medical insurance plans and Medicare providers.
  • Researched medical claims for validity to resolve discrepancies.
  • Reviewed history records to determine benefit eligibility for services.
  • Corresponded with providers regarding any missing or incomplete documentation needed for successful adjudication of claims.
  • Maintained accurate records of all processed claims in accordance with departmental requirements.
  • Updated job knowledge by participating in educational opportunities; reading professional publications; maintaining personal networks; participating in professional organizations .
  • Documented decisions on each claim based on research findings and applicable benefit plans.
  • Analyzed and evaluated claim forms, medical reports, bills, and other documents to ensure accuracy of data.
  • Researched discrepancies between submitted documentation and actual records to identify errors or omissions.
  • Adhered to all applicable laws, regulations, and company standards while processing claims.

Education

High School Diploma -

Lee High School
Jonesville
06-2000

Skills

  • Resource Navigation
  • Care Coordination
  • Health Education
  • Cultural Competency
  • Medical Recordkeeping
  • Community advocate
  • Medical Billing
  • Confidentiality
  • Insurance expert
  • Healthcare knowledge
  • Medical Terminology
  • Community Resources
  • Community Health Services
  • Community Resource Referral
  • Medical Advocacy
  • Critical Thinking
  • Problem-Solving
  • Social Research
  • Paperwork Organization
  • Patient Evaluation
  • Electronic Medical Record Software
  • Effective Communication
  • Coaching patients
  • Adaptability and Flexibility

Timeline

Health Navigator

Main Street Rural Health
08.2023 - Current

Billing Specialist/Collections Agent

Intellihartx
03.2022 - 08.2023

Claims Processor

United Health Group, Optum
11.2015 - 03.2022

High School Diploma -

Lee High School
Megatha Wilson