Gabriel Appleby
Hendersonville,TN
Summary
Detail-oriented Patient Access Representative with extensive medical services background and strong work ethic. Managed patient-related accounts receivables at large medical facility and made revenue recovery the number 1 priority. Excellent communications skills and empathetic nature enabled achievement of positive outcomes.
Overview
9
9
years of professional experience
Work History
Patient Access Specialist
Covenant Health
12.2022 - Current
- Make out bound calls to patients to schedule for diagnostic tests
- Take in-bound calls of patients needing to be scheduled for diagnostic testing for 9 Facilities
- Verify the patients insurance using insurance websites or by calling
- Obtain authorizations if needed
- Verify authorizations obtained for scheduled tests
- If are accurate and valid for upcoming appointments
- Securely chat with the patient to schedule through the company website
- Collected and entered patient demographic and insurance data into computer database to establish patient's medical record.
- Received patient deductibles and co-pay amounts and discussed options to satisfy remainder of patient financial obligations.
- Collected and validated patient demographics and insurance information.
- Obtained patient's insurance information and determined eligibility for benefits for specific services rendered.
- Utilized knowledge of electronic medical record systems and medical terminology to perform diverse data entry tasks.
- Performed patient scheduling and registration functions to serve as initial contact point for medical office visits.
- Contacted insurance companies for patient medical billing operations.
Insurance Analyst
QHR Health
06.2022 - 11.2022
- Complete timely follow up of claims
- Work various commercial payers in Wyoming, New York, and Nevada
- Contact insurance companies to dispute non-payment of claims
- Report trends to supervisor to increase productivity and cash flow
- Review payer contracts and fee schedules to verify that the payer is paying at the correct rate
- Complete daily billing of incomplete UB04 and 1500 claims using SSI and Change Healthcare billing system
- Maintained strict confidentiality with all personal data as per company guidelines.
- Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
- Calculated adjustments, premiums and refunds.
- Modified, updated and processed existing policies.
- Coordinated with contracting department to resolve payer issues.
- Posted payments to accounts and maintained records.
- Prepared insurance claim forms or related documents and reviewed for completeness.
- Viewed reports regularly to make sure processing was conducted efficiently.
- Worked with outside entities to resolve issues with billing, claims and payments.
- Posted payments and processed refunds.
- Electronically submitted bills according to compliance guidelines.
- Utilized computer programs to create invoices, letters and other documents.
- Researched billing errors and discrepancies to initiate corrective action.
- Prevented impending loss and increased profitability by enforcing scheduled collection campaigns, consistently achieving targeted recovery rate.
- Prepared reports detailing billing actions, flags and other key information.
- Responded to patient, family and external payer inquiries.
- Identified and resolved payment issues between patients and providers.
- Reached out to insurance companies to verify coverage.
- Balanced and reconciled accounts.
Insurance Analyst
SOURCING
03.2021 - 06.2022
- Complete timely follow up of claims
- Work various commercial payers in California and Illinois, as well as
- Contact insurance companies to dispute non-payment of claims
- Report trends to supervisor to increase productivity and cash flow
- Review payer contracts and fee schedules to verify that the payer is paying at the correct rate
- Complete daily billing of incomplete UB04 and 1500 claims using change healthcare billing system
Insurance Specialist II
Xtend Healthcare
07.2020 - 03.2021
- Complete timely follow up of claims
- Work various commercial payers in California, as well as Alaska Medicaid
- Contact insurance companies to dispute non-payment of claims
- Report trends to supervisor to increase productivity and cash flow
- Review payer contracts and fee schedules to verify that the payer is paying at the correct rate
- Complete daily billing of incomplete UB04 and 1500 claims using Nthrive billing system
Claims Analyst
Aergo Solutions
07.2019 - 07.2020
- Complete review of unpaid and denied hospital claims to determine course of action needed to generate revenue
- Complete underpayment, DRG, Timely filing, medical necessity, and other miscellaneous appeals
- Contact insurance companies to dispute non-payment of claims
- Report trends to supervisor to increase productivity and cash flow
- Review payer contracts and fee schedules to verify that the payer is paying at the correct rate.
Payment Analyst
PhyData
07.2017 - 07.2019
- Track and trend issues with payers and internally, and work to find the root cause and solution
- Review payer contracts and fee schedules to verify that the payers is paying at the correct rates
- Add new procedure codes to the billing system
- Review incoming medical record from PARs and screen for the need of medical records to remain HIPAA compliant
- Review and complete correspondence medical record requests from payers
- Utilize payer portals to check claim status, verify allowed amounts, and submit medical records.
Education
High School Diploma -
White House High School
White House, TNSkills
- Attention to detail
- Problem solving
- Willingness to learn
- Positive Attitude
- Communication
- Self Reliance
- Teamwork
- HIPAA
- Medical Billing
- Insurance Verification
- Medical Terminology
- Hospital Experience
- EMR Systems
- ICD-10
- Epic
- Team Leadership
- Patient Health Information Access
- Medical Billing and Collections
- Diagnostic Codes
- Demographics Information
- Patient Scheduling
- Verifying Eligibility
- Payment Processing
- Phone and Email Etiquette
- Regulatory Compliance
- Insurance Billing
- Verbal and Written Communication
- Insurance Form Processing
- Authorization Verification
- EMR Updating
- Organization and Time Management
- Insurance Coordination
- Outbound Calling
- EMR
Timeline
Patient Access Specialist
Covenant Health
12.2022 - Current
Insurance Analyst
QHR Health
06.2022 - 11.2022
Insurance Analyst
SOURCING
03.2021 - 06.2022
Insurance Specialist II
Xtend Healthcare
07.2020 - 03.2021
Claims Analyst
Aergo Solutions
07.2019 - 07.2020
Payment Analyst
PhyData
07.2017 - 07.2019
High School Diploma -
White House High School