Florida Lacy
Euless,TX
Summary
Efficient medical billing and appeals professional with 10+ years of experience performing various accounts receivable functions. Superior familiarity with insurance verifications, billing and coding procedures, claim denial management procedures along with collections techniques and customer query resolution. Detail-oriented professional with a focus on deadlines and the assurance that all medical coding and billing is handled efficiently and without errors.
Overview
6
6
years of professional experience
Work History
Promotion - AR Appeals Specialist
CBO of Post-Acute Medical LLC
12.2021 - 03.2022
- Determined clinical reason for appeal using RA, EOP and EOB based on payer denial along with timely filing guidelines to submit to the Nurse Clinical Appeals team to write appeals
- Obtained retro authorization from payers for claim reprocessing of patient accounts.
- Timely completion of follow up on daily worklists of patient accounts with appeal status updates from insurance payers.
- Submitted appeal reconsiderations for dispute reasons based on contract terms using online payer access and phone calls to payers
- Followed up on appeal status for Medicare, Commercial and Third Party payers to finalize payment or resubmission of appeals for possible Level 2 or Level 3 submissions.
- Responded to all correspondence from clinical team nurses regarding appeal intake and management inquiries
- Assisted in refining company policies surrounding claims denials management by sharing insights gleaned from experiences working on various types of appeals cases.
- Improved the appeals success rate by researching legal precedents and staying up-to-date with current industry regulations and guidelines.
- Acted as a departmental resource on appeals matters.
Outpatient Medical Biller/Collector
CBO of Post-Acute Medical LLC
05.2021 - 12.2021
- Work closely with LTACH (Long Term Acute Care Hospitals) and IRF (Inpatient Rehab Facilities) on A/R reviews, billing, and cash collections
- Responded to Government & Commercial payers by phone or correspondence regarding claim issues to resolution
- Reviewed patient diagnosis codes to verify accuracy and completeness for efficient submission of claims
- Collaborated with healthcare providers, ensuring accurate documentation for seamless billing operations.
- Managed appeals process for denied claims, resulting in successful reimbursements from insurance companies.
- Enhanced revenue collections for the medical practice with diligent follow-ups on unpaid claims for Commercial, Medicare & Third Party payers in a timely basis.
- Conducted detailed analyses of billing cycles to identify patterns and implement strategies for reducing delays in payments.
- Aggressively worked aged accounts (120+ days) to expedite cash, reduce bad debt and A/R days
- Kept vendor files accurate and up-to-date to expedite payment processing.
- Acted as liaison between healthcare providers and insurance companies; resolved disputes quickly while maintaining positive relationships.
- Provided coaching and development for new training initiatives as requested
Medical Billing /Payment Posting Specialist
Fundamental Administrative Services LLC
05.2019 - 05.2020
- Worked closely with Skilled Nursing Facilities (SNFs) on A/R reviews and cash collections
- Ensured timely reimbursement through meticulous claims adjustments and denials management.
- Supported month-end closing activities by reconciling accounts, preparing reports, and analyzing trends in account performance.
- Scrubbed Medicare Part A & B claims for correct coding for submission to Medicare to receive timely payments
- Strengthened relationships with clients by maintaining open communication channels regarding invoicing and payment schedules.
- Navigated all internal & external billing software programs and payer websites for collections follow up
- Aided in the reduction of bad debt write-offs through diligent monitoring of aging reports and proactive collections efforts.
- Daily posted all payments to Commercial, Medicare Advantage & Medicaid insurance companies
- Facilitated smoother audit processes by maintaining comprehensive documentation of all accounts receivable activities.
- Exceeded departmental goals for cash collection through persistence, professionalism, and excellent interpersonal skills when dealing with clients or customers alike.
- Drafted & submitted appeal letters & reconsiderations for Commercial, Medicare, Medicaid denials for follow up
- Maintained working knowledge of updated new billing guidelines for Medicare, Medicaid & Commercial payer
- Handled account payments and provided information regarding outstanding monthly balances to leadership and facilities
- Consistently maintained high levels of productivity, exceeding departmental goals each month.
- Contributed to the reduction of aged accounts receivable by prioritizing oldest outstanding balances for follow-up action.
- Trained new team members on company policies, software systems, and effective accounts receivable practices for seamless integration into the role.
- Used data entry skills to accurately document and input statements.
- Generated monthly billing and posting reports for management review.
- Supported audits by providing detailed records of all posted payments and adjustments upon request.
- Submitted payment research to Hospital Districts to obtain payments for posting for all assigned facilities
- Contributed to improving departmental workflows by regularly sharing insights and feedback on processes with management.
- Verified patient eligibility for daily billing accuracy on underpaid & denied claims
- Collaborated closely with coding specialists for accurate charge capture, enabling timely and complete reimbursement from payers.
- Monitored and audited A/R for payer denials, trends, billing errors & coding issues and work for resolution
- Maintained up to date facility contracts and Letter of Agreement (LOA) payment terms to ensure accuracy in payment posting
- Reconciled accounts receivable ledger to verify payments and resolve variances.
- Contributed to a positive work environment by working closely with colleagues across departments to ensure efficient information exchange and collaboration on financial matters.
- Improved client satisfaction with clear, timely communication regarding billing issues and inquiries.
Medical Billing Analyst
Vibra Healthcare
07.2018 - 05.2019
- Company Overview: Government & Commercial
- Responsible for processing all bills for assigned LTACH and Rehab facilities using Zirmed billing system
- Daily follow up on Medicare claims with multiple FI's for payment status
- Navigate all internal and external billing software programs and payer websites
- Review accounts for adjustments, coinsurance, and secondary billing
- Document all accounts in HMS system to ensure aged accounts/issues are reported and worked
- Correct and resubmit returned Medicare claims using DDE
- Prepare monthly aging reports and meetings to provide account updates
- Maintains working knowledge of Medicare, Medicaid & Commercial billing requirements
- Verified the accuracy of patient eligibility for clean clam submission to payers
- Communicate daily to departments within facilities assigned for status updates on requested coding changes
- Maintain A/R over 30 days to ensure all accounts are balanced to zero for all facilities assigned
- Work SSI error report to correct claim issues
- Daily work the Returned to Provider report to correct claims in FISS/DDE system for immediate reprocessing
- Work with team in submitting billing for all facilities within the allotted billing timeframes
- Daily work Zirmed billing and denials for Medicare and Commercial payers as assigned
- Set up Appeals in Maven system to assist appeal manager in follow up for status
- Follow up on all Medicare replacement claims submitted for reporting to Medicare
- Updated account receivables system with denial reasons and group information
- Mail letters to secondary insurance carriers to obtain review and payment of outstanding claim balances
- Obtain & mail medical records to Government & Commercial payers for review and payment of denied claims
- Contacted payers to obtain additional information/documentation to resolve unpaid claims
- Worked through the Medicare appeals process to overturn system generated denials
- Successfully meet and exceed productivity goals and standards daily
- Submit adjustment requests and balance transfers on accounts
- Follow up on A/R accounts for root cause analysis and resolution
- Conducted monthly pre-billing review and data analysis for accuracy of invoices to customers and providers
- Evaluated aging reports to identify members to be included in monthly outbound collection calls
- Government & Commercial
Medicare Billing Specialist
CBO Insurance - Navigant Cymetrix
08.2017 - 07.2018
- Worked on behalf of inpatient hospitals to recover claim payments from Medicare
- Confer with commercial carriers for claim status and secondary payment resolution
- Updated account receivables system with denial reasons and group information
- Mailed letters to secondary insurance carriers to encourage payment of outstanding claim balances
- Contacted providers to obtain additional information/documentation to resolve unpaid claims
- Worked through the Medicare appeals process to overturn system generated denials
- Successfully meet and exceed productivity goals and standards daily
- Train employees on effective use of time management and workflow processes
- Assisted employees with questions regarding workflow and call scenarios
- Submit billing and medical coding review requests based on Medicare denial
- Assist patients with inquiries regarding account balances
- Assist clinic center staff with account inquiries
- Contact insurance providers for claim status and appeals
- Receive document and invoice medical records requests
- Submit adjustment requests and balance transfers on accounts
- Follow up on A/R accounts for root cause analysis and resolution
- Training of new team members and providing ongoing training and mentoring of team members
- Assist team members & other supervisors in account resolution for difficult account balances
- Work with project management in developing policies and job aids to assist team members
- Assisted in conducting team meetings to ensure on-going understanding of client expectations
- Meet and exceed project productivity goals on a daily basis
- Process billing requests of denied claims for submission to Commercial, Medicare & Medicaid for payments
- Transferred balances to correct payers
- Maintained current accounts through aged revenue reporting
- Complied with all HIPAA Privacy and Security Regulations to protect patients' medical records and information
Patient Account Representative
CBO Insurance - Navigant Cymetrix
06.2017 - 07.2017
- Performed all actions of follow up and collections, including making telephone calls, accessing payer website
- Identified issues or trends and provided suggestions for resolution
- Accurately and thoroughly documented all steps of collection activity performed on accounts
- Verified claims adjudication using the appropriate resources and applications
- Initiated contact via telephone and letters to patients to obtain coordination of benefit information
- Performed necessary billing functions including manual rebilling and electronic submissions to payers
- Edited claims to meet and satisfy billing compliance guidelines for electronic submission
- Managed and maintain desk inventory, completed reports, and resolved high priority & aged inventory
- Attended and participated in meetings, training seminars to develop job knowledge
- Participated in monthly, quarterly, and annual performance evaluation processes with Supervisor
- Responded in a timely manner to emails and telephone messages as appropriate
- Communicated payer & system issues; trending denial issues; escalated account issues to management
- Completed all assigned projects in a timely manner and promoted teamwork and positive morale
- Trained new employees and mentored team members with questions in absence of Project Supervisor
- Reviewed and corrected claim errors to facilitate smooth processing
- Worked with outside entities to resolve issues with billing, claims and payments
- Electronically submitted bills according to compliance guidelines
Denials Specialist / Appeal Writer / Team Leader
CBO Insurance - Conifer Health Solutions
04.2016 - 06.2017
- Validate denial reasons and ensure coding in DCM is accurate and reflects the denial reasons for inpatient hospitals
- Coordinated with Clinical Resource Center (CRC) for clinical consultations & account referrals as necessary
- Generated appeals based on dispute reasons & contract terms for payers including online reconsiderations
- Escalated payment /variance trends to Management for review and resolution
- Managed and maintained desk inventory, completed reports, and resolved high priority & aged inventory
- Performed necessary billing functions including manual rebilling as well as electronic submissions to payers
- Train new hire employees out of training classes on department goals and workflow processes
- Use in-depth knowledge of various insurance documentation requirements, for Payor specific accounts
- Used Payor-specific claims standards and procedures to appropriately dispute underpaid claims
- Set up Medicare unit for major client, Medicare collections and claims processing
- Researched Medicare claims in DDE system for collections and payments
- Trained new employees, created workflow processes and team building strategies
- Handled all supervisor calls from patients and clients as second level assistance
- Performed all actions of follow up and collections, including making telephone calls, accessing payer website
- Identified issues or trends and provided suggestions for resolution
- Accurately and thoroughly documented all steps of the collection activity performed on accounts
- Verified claims adjudication using the appropriate resources and applications
- Initiated contact via telephone and letters to patients to obtain coordination of benefit information
- Performed necessary billing functions including manual rebilling as well as electronic submissions to payers
- Edited claims to meet and satisfy billing compliance guidelines for electronic submission
- Managed and maintain desk inventory, completed reports, and resolved high priority and aged inventory
- Attended and participated in meetings, training seminars to develop job knowledge
- Participated in monthly, quarterly, and annual performance evaluation processes with Supervisor
- Responded in a timely manner to emails and telephone messages as appropriate
- Communicated payer & system issues; trending denial issues; escalated account issues to management
- Trained new employees, created workflow processes and team building strategies
- Handled all supervisor calls from patients and clients as second level assistance
- Completed all assigned projects from management in a timely manner
- Worked with supervisors in developing policies and procedures to be implemented
- Lead the team in high productivity and accuracy in documenting of account details
Education
Certified Professional Coder -
American Academy of Professional Coders
Euless, TX08.2024
Human Resources Management - Business Management
University Of Phoenix
Philadelphia, PA08.2007
High School Diploma - Business Management
Germantown High School
Philadelphia, PA06.1993
Skills
- Proficiency in Outlook
- Proficiency in Excel
- Proficiency in Windows applications
- Billing Systems & Software
- A/R Month-End Closing Procedures
- Denial Management & Research
- Billing & Collections Practices
- Time Management for Productivity Standards
- Medical Insurance – Government & Commercial
- Medical Terminology
- ICD-9 Coding
- ICD-10 Coding
- Payment Posting & Reconciliation
- Training
- Mentoring
- Development
- Operating personal computer
- 10 key
- Insurance Verification
- Typing Speed: 55 wpm
- Revenue Cycle Management
- HIPPA Privacy & Security
- Clinical Appeal Management
- Prior Authorization & Referral Management
- A/R Collections & Reporting
- Development of Processes & Procedures
- HCPC Level II Procedures
- CPT Procedures
Timeline
Promotion - AR Appeals Specialist
CBO of Post-Acute Medical LLC
12.2021 - 03.2022
Outpatient Medical Biller/Collector
CBO of Post-Acute Medical LLC
05.2021 - 12.2021
Medical Billing /Payment Posting Specialist
Fundamental Administrative Services LLC
05.2019 - 05.2020
Medical Billing Analyst
Vibra Healthcare
07.2018 - 05.2019
Medicare Billing Specialist
CBO Insurance - Navigant Cymetrix
08.2017 - 07.2018
Patient Account Representative
CBO Insurance - Navigant Cymetrix
06.2017 - 07.2017
Denials Specialist / Appeal Writer / Team Leader
CBO Insurance - Conifer Health Solutions
04.2016 - 06.2017
Certified Professional Coder -
American Academy of Professional Coders
Human Resources Management - Business Management
University Of Phoenix
High School Diploma - Business Management
Germantown High School
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