Gina Hayes
Saginaw,TX
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
25
25
years of professional experience
Work History
Revenue Cycle Specialist II
Ent Specialty Partners
Irving, Texas
02.2025 - Current
- Analyzed revenue cycle processes to identify inefficiencies and recommend improvements.
- Managed patient billing and collections, ensuring timely payment processing.
- Coordinated with clinical staff to resolve billing discrepancies and enhance accuracy.
- Implemented electronic health record systems to streamline documentation and reporting.
- Resolved customer inquiries efficiently through multiple communication channels, ensuring high satisfaction levels.
- Managed and updated customer accounts using CRM systems to maintain accurate records.
- Resolved customer inquiries through effective communication and problem-solving techniques.
- Managed high-volume call traffic, ensuring timely responses and customer satisfaction.
Medical Claims Analyst
Aspirion Health Resources
Atlanta, GA
03.2024 - 02.2025
- 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
Abeo
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.
Sales Associate
Target Optical Luxottica
Fort Worth, TX
08.2007 - 08.2013
- Enhanced customer satisfaction through personalized eyewear consultations and product recommendations.
- Managed inventory levels, ensuring product availability and organization on the sales floor.
- Trained new team members on operational procedures and customer service excellence.
- Collaborated with management to implement promotional strategies that increased foot traffic.
- Organized racks and shelves to maintain store visual appeal, engage customers, and promote specific merchandise.
- Handled cash transactions efficiently while adhering to company cash handling policies, ensuring accuracy in all financial exchanges.
- Managed returns, exchanges and refunds in accordance with store policy.
Education
Some College (No Degree) - Legal Assistant
Tyler Junior College
Tyler, TXHigh School Diploma - undefined
Alvarado High School
Alvarado05.1994
Skills
- 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
- Claims review
- Professionalism and ethics
- Paperwork management
- Verifying insurance
- Medical billing expertise
- Denial management
- Analytical problem solving
- Patient registration
- Medical billing
- Decision-making
- Team building
- Analytical thinking
- Revenue cycle management
ACCOMPLISHMENTS
Won the "Employee of the Year" Award 2016
Timeline
Revenue Cycle Specialist II
Ent Specialty Partners
02.2025 - Current
Medical Claims Analyst
Aspirion Health Resources
03.2024 - 02.2025
Front End Manager
Ventra Health
05.2021 - 06.2023
Sales Associate
Target Optical Luxottica
08.2007 - 08.2013
Billing Team Lead
Abeo
02.2001 - 05.2021
High School Diploma - undefined
Alvarado High School
Some College (No Degree) - Legal Assistant
Tyler Junior College