FRANCINA H MCCREA
Summary
Analytical and results-driven Claims Resolution Analyst known for productivity and efficient task completion. Specialize in claims analysis, dispute resolution, and regulatory compliance which ensure timely and accurate claims processing. Excel in negotiation, critical thinking, and problem-solving to navigate complex claims scenarios successfully. Committed to maintaining up-to-date knowledge of industry trends and regulations to optimize outcomes.
Overview
23
23
years of professional experience
Work History
A/R, Phy & Prof Sv CBO
Orlando Health
Orlando, Florida
02.2023 - 08.2025
- Managed accounts receivable for commercial and managed care payers, ensuring billing aligns with contracts, services rendered, or insurance guidelines.
- Resolved discrepancies in accounts receivable balances for underpayments, denials, and invoices over 120 days.
- Collaborated with the Coding department to address denial in diagnosis incompatibility with CPT codes or POS, reducing errors by 15%. Worked closely with the Payment Posting department regarding posting errors and payments not posted, with copies of remittance, check numbers, and EFT for accuracy.
- Ensure compliance with HIPPA, company policies and financial regulations. and customer inquiries for efficient account management.
- Prepare weekly pivot spreadsheet detailing denials by specialties for senior management review,
Account Receivable Analyst
RHA Behavioral & Ridgeview Institute
Atlanta, GA
09.2021 - 01.2023
- Analyzed and resolved Collection and Aging accounts for varies MCO's to diminish financial discrepancies, reduce timely filing w/o, tracked and managed reimbursement in a timely manner.
- Managed over3 million USD revenue for several North Carolina Behavioral Health facilities.
- Billed/Rebilled/Recreated claims to the appropriate Medicaid payers and varies Commercial Payers: BCBS, UHC, Aetna, Cigna, etc submitted through the Clearinghouse.
- Created 835 Batches and uploaded 837's claim file to the appropriate MCO's. Uploaded weekly RA's and 835's in Eclipse and PaceNet for submission files review.
- Worked closely with Billing and Regional Managers identifying patterns/trends in denials causing missed collections while increasing revenue within 3 months by 15%.
- Researched Revenue & Cash Reports for unapplied payments, checks, deposits, account ledger, Charity Care, applied timely and contractual adjustments.
- Provided guidance on accounts receivable inquiries from other departments or external customers and vendors.
Claims Resolution Analyst
Rivermend Health LLC, Behavioral Health
Marietta, GA
02.2019 - 03.2021
- Managed over 4 million USD in revenue for IOP, PHP, and RTC charges for several Behavioral Health Facilities.
- Analyzed Aging report to identify trends and patterns causing missed collections, reducing DSO by 25% and increasing revenue by 20% within two months while exceeding goal on monthly basis.
- Collaborated with Clinical Department in regards to Authorizations, eligibility, Medical Records requests to resolve discrepancies and revenue loss.
- Modeled exceptional customer service skills with insurance companies in regards to account resolution. Contacted clients to formulate PPA, Disposition of case, COB issues, verification of benefits and claim status.
- Worked closely with Billing and Posting Department: requested Rebills, contractual adjustments review, paid not posted accounts, and underpayments. Tracked accounts with contracts for INN and OON to ensure at least 40% reimbursement and SCA proposals on case by case basis.
- Requested Reconsideration review for denied claims : COB update, no pre-cert denials and Medical Necessity. Appealed claims, if necessary, Forward Medical Records per request, for claims resolution.
Accounts Receivable Specialist
Treatment Management LLC, Behavorial Health
Atlanta , GA
12.2017 - 06.2018
- Managed 8 million USD in revenue for Red Rock Addition and Treatment for IOP and PHP OON facility charges.
- Investigated billing discrepancies and implemented effective solutions to resolve concerns and increase reimbursements.
- Reduced outstanding accounts by 25% in 3 months and worked closely with insurance companies regarding unpaid charges, Medical Records request and letters of Medical Necessity
Accounts Receivable Analyst
Milton Hall Surgical Assoc
Alpharetta, GA
07.2016 - 09.2017
- Generated over 1 million USD revenue for varies Commercial insurance, Workman's Comp, and Tricare claims.
- Examined customer payment plans, payment history, COB issues research and resolve delinquent accounts.
- Verified claims billed against reimbursements received and followed-up with Insurance companies and Billing Dept to reconcile variances
- Verified account transactions, providing weekly and monthly reporting of AR aging to senior management to maintain accounting ledgers.
Reimbursement Specialist
Gentiva Affliate of Kindred Health Services
Atlanta, GA
05.2010 - 03.2015
- Managed over 2 million USD revenue for Commercial and Workman's Comp Insurance.
- Perform tasks with minimum of supervision and direction Generated Weekly and Monthly Cash Reports, Aging Reports and Pre-Billing reports
- Led, directed and coordinated daily ERA, EOB, RX and patient payment posting
- Performed Refunds, adjustments, Misapplied Cash Moves, credit card payments, Appeals for account resolution
- Interacted with external/internal customers as necessary to resolve problems and expedite payments
Denial Management
Northside Physician Group CBIZ
Kennesaw, GA
04.2008 - 05.2010
- Appealed all Commercial and Government claims for Denial Management to include Bundled services, Non-covered services, No pre-cert and Medical Necessity
- Reviewed and researched denials that have been received as no payment/previous submitted claims with no response for all payers and service areas
- Identified root cause of denial and addressed/report denial issue with appropriate payor/internal department and supervisor
- Managed and Developed necessary department and executive level reporting on payor trends. Reduced DSO by 23% for denials by requesting reconsideration review.
Account Analyst | Team Lead
Wellstar Hospital Phoenix
Atlanta, GA
07.2002 - 10.2007
- Managed Medicaid and Commercial accounts to ensure accuracy for insurance payments and contractual adjustments while exceeding monthly goals
- Acted as subjected matter expert, answering internal and external questions and inquiries.
- Communicated with staff including members of operations, finance and clinical staff emerging trends and revenue strategies.
- Followed up with Insurance Company regarding status of claims reconsideration, eligibility, denials, utilizing insurance website to check benefits coverage. Appeal with Medical Record per request for claim resolution.
- Handled 80-100 business calls daily while working aging report weekly.
Skills
- Reimbursement & Billing
- Invoice processing and resolution
- Reconciliations & Remittances
- Denial resolution
- Revenue cycle management
- Regulatory Insurance Compliance
- Financial & Accounting Management
- EPIC, NexGen, Navicure, Salesforce, Athena, Meditect
- Resmed, Greenway, Doc Star, Emdeon/Change Healthcare
- Zirmed, Medics Premier, Fulcrum, Evolv, Avea
- Citrix, PaceNet , Cardinal Innovations NC Medicaid, Waystar, Medhost
Timeline
A/R, Phy & Prof Sv CBO
Orlando Health
02.2023 - 08.2025
Account Receivable Analyst
RHA Behavioral & Ridgeview Institute
09.2021 - 01.2023
Claims Resolution Analyst
Rivermend Health LLC, Behavioral Health
02.2019 - 03.2021
Accounts Receivable Specialist
Treatment Management LLC, Behavorial Health
12.2017 - 06.2018
Accounts Receivable Analyst
Milton Hall Surgical Assoc
07.2016 - 09.2017
Reimbursement Specialist
Gentiva Affliate of Kindred Health Services
05.2010 - 03.2015
Denial Management
Northside Physician Group CBIZ
04.2008 - 05.2010
Account Analyst | Team Lead
Wellstar Hospital Phoenix
07.2002 - 10.2007
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