Gina Hayes
Saginaw,Texas
Summary
Accomplished Medical Claims Analyst with a proven track record at Aspirion Health Resources, adept in insurance verification and providing exceptional provider relations. Leveraged expertise in healthcare billing and critical decision-making to enhance claims processing efficiency. Achieved significant improvements in billing accuracy and compliance, demonstrating a strong ability to mentor and improve team performance. Efficient professional in insurance claims and policy processing, known for high productivity and the ability to complete tasks with precision. Specialized in analyzing claim details, navigating policy databases, and managing customer communications. Excel in problem-solving, adaptability, and teamwork, leveraging these soft skills to navigate complex situations and achieve positive outcomes.
Overview
24
24
years of professional experience
Work History
Medical Claims Analyst
Aspirion Health Resources
Atlanta, GA
03.2024 - Current
- Interpreted complex medical policies and procedures to determine coverage eligibility.
- Monitored accounts receivable balances to ensure timely collection of payments.
- Stayed current on HIPAA regulations, benefits claims processing, medical terminology and other procedures.
- Researched and resolved billing discrepancies, coding issues, and other payment problems.
- Prepared and reviewed insurance-claim forms and related documents for completeness.
- Based payment or denials of medical claims upon well-established criteria for claims processing.
- Called insurance companies to ascertain pertinent information regarding policies and payment benefits for patients.
- Provided customer service support by responding to inquiries from members, providers, employers, and insurance carriers.
- Assisted providers with resolving issues related to rejected or denied claims, including correcting errors in coding or resubmitting them according to guidelines.
- Provided customer service for inbound and outbound calls, answered questions regarding the patients' deductibles, and took patients' payments.
Front End Manager
Ventra Health
Fort Worth, Texas
05.2021 - 06.2023
- Reviewed completed work to verify consistency, quality, and conformance.
- Delivered consistent training and close mentoring support to front end employees in operations and customer service strategies.
- Managed and supervised billing department staff, including training, evaluation, and workflow distribution.
- Completed month-end and year-end closings, kept records audit-ready and monitored timely recording of accounting transactions.
- Developed and implemented efficient billing procedures to ensure timely and accurate invoice generation.
- Conducted regular audits of billing activities to ensure compliance with company policies and regulatory standards.
- Provided expert advice on billing optimization strategies, leading to a reduction in outstanding accounts receivables.
- Resolved billing issues by applying knowledge and completing in-depth research.
Billing Team Lead
Abeona Therapeutics
Fort Worth, Texas
02.2001 - 05.2021
- Assigned and monitored daily tasks to billing team members.
- Worked with team members to identify and develop process improvements.
- Participated in subordinates' tasks to facilitate productivity or help overcome difficulties.
- Ensured compliance with internal policies and external regulations related to billing operations.
- Developed strategies for improving efficiency in the billing department.
- Delegated work to staff, setting priorities and goals.
- Coordinated with other supervisors, combining group efforts to achieve goals.
- Identified areas for improvement in the existing billing system and created solutions accordingly.
Education
High School Diploma -
Alvarado High School
Alvarado05-1994
Some College (No Degree) - Legal Assistant
Tyler Junior College
Troup, TXSkills
- Training and mentoring
- Insurance policies
- Provider Relations
- Insurance verification
- Medical record review
- Critical Decision-making
- Healthcare billing
- Electronic health records (EHR)
- HIPAA compliance awareness
- Telephone etiquette
- Insurance claims processing
- Medical terminology
- Claim denial resolution
- HIPAA compliance
- Fraud detection techniques
- Claims processing proficiency
Accomplishments
Won the "Employee of the Year" Award 2016
Timeline
Medical Claims Analyst
Aspirion Health Resources
03.2024 - Current
Front End Manager
Ventra Health
05.2021 - 06.2023
Billing Team Lead
Abeona Therapeutics
02.2001 - 05.2021
High School Diploma -
Alvarado High School
Some College (No Degree) - Legal Assistant
Tyler Junior College
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