Gloria Watkins
Detroit,MI
Summary
Methodical Revenue Cycle Specialist with strong detail and in-depth understanding of billing procedures. Excellent planning and problem-solving abilities. Prepared to bring over 7 years of related experience to a dynamic position with room for career growth.
Overview
18
18
years of professional experience
Work History
AR Insurance Follow-up Specialist
Omega Healthcare Management Services
06.2023 - Current
- Processed small balance, contractual and encounter level adjustments.
- Distributed undistributed payer payments
- Enhanced claim resolution rates by diligently reviewing and analyzing outstanding insurance claims.
- Streamlined follow-up processes for improved efficiency, ensuring timely resolution of unpaid claims.
- Collaborated with insurance companies to expedite claim processing, improving cash flow management.
- Monitored aged account receivables closely to identify trends affecting payment cycles.
- Analyzed medical records and other documents to determine approval of requests for authorization.
- Analyzed errors and determined root cause for denials.
Follow-up Associate I
R1 RCM
07.2022 - 06.2023
- Follow up on 50-75 payer request for medical records and denials
- Create and submit claim appeals such as timely filing and underpaid appeals according, according to payer guidelines
- Resolve insurance claim denials by diagnosing the root cause of the rejection, obtaining additional information from various sources, updating accounts, and refiling claims
- Work with correspondence and patient’s requests
- Meet or exceed daily production goals as determined/assigned by management with high quality
- Complete various projects as assigned by management
- Acted as team SME for high dollar accounts
- Communicate trends and opportunities for improvement to management.
Office Support Associate
R1 RCM
12.2017 - 07.2022
- Completed requests submitted by Patient Financial Advocates
- Investigated and analyzed patient account issues and discrepancies
- Communicated to internal and offsite leadership to help resolve patient account concerns
- Collected and entered patient demographics and insurance data into computer database to establish patient’s medical record
- Obtained patient’s insurance information and determined eligibility for benefits for specific services rendered.
Customer Service Representative
Aerotek (Contractor for R1 RCM)
02.2017 - 12.2017
- Responds promptly to inbound calls from client hospitals regarding billing questions
- Answers patient inquiries by clarifying desired information such EOBs and billing statements
- Resolves problems by clarifying issues; researching and exploring answers and alternative solutions; implementing solutions; escalating unresolved issues
- Gathers and enters patient information into hospital host system
- Directs inbound callers to the appropriate company contact.
Customer Service Representative (Triage)
Aerotek (contractor for HAP)
09.2016 - 12.2016
- Properly directed inbound calls in phone queues to improve call flow
- Addressed customer service inquiries in a timely and accurate fashion
- Provided accurate and appropriate information in response to customer inquiries, such as information concerning premiums, cost share, eligibility, subsidies, policy changes and cancellations.
Patient Insurance Adviser
Dialog Direct (contractor for Blue Cross and Blue Shield and Blue Care Network)
07.2013 - 08.2016
- Answered high volume telephone calls from members and providers
- Properly directed inbound calls in phone queues to improve call flow
- Addressed customer service inquiries in a timely and accurate fashion
- Provided accurate and appropriate information in response to customer inquiries regarding EOBs, and information concerning premiums, cost share, eligibility, subsidies, coverage, benefits, policy changes, claims, cancellations, and reinstatements.
Processor
Salvation Army
10.2006 - 03.2013
- Inspected articles of clothes, cleaning all wearable articles, assist with sales in other departments, assist customers, replenish floor stock, and process shipments to ensure product availability, daily inventory, design displays to make the product engaging
- Maintained friendly and professional customer interactions
- Worked as a team member and exceeded targeted sales goals by 6%.
Reimbursement Specialist
Externship- University Physicians Services
09.2005 - 10.2006
- Status claims for commercial insurance, Blue Cross Blue Shield and Health Alliance Plan
- Contacted third party payers, reviewed PPOM system for pricing sheets, reviewed and entered patient account data on IDX system, post patient deductibles and coinsurance, worked aged balance sheets
- Thoroughly investigated past due invoices and minimized number of unpaid accounts
- Applied payments, adjustments, and denials into medical manager system
- Performed quality control of the data entry system to verify that claims and payments were posted correctly.
Education
Medical Billing and Insurance Coding -
Dorsey Business School
Skills
- EMR (Electronic Medical Record) ECM (Electronic Chart Manger)
- CPT and HCPCS coding
- HIPAA
- Use of EPIC System
- Appeals Process Experience
- Medical Terminology Fluency
- Insurance Verification
- Authorizations
- Claims Review
- Claims Processing
Professional Accolades
- Volunteer at Gleaners Food Bank
- R1 Stars Recipient
Timeline
AR Insurance Follow-up Specialist
Omega Healthcare Management Services
06.2023 - Current
Follow-up Associate I
R1 RCM
07.2022 - 06.2023
Office Support Associate
R1 RCM
12.2017 - 07.2022
Customer Service Representative
Aerotek (Contractor for R1 RCM)
02.2017 - 12.2017
Customer Service Representative (Triage)
Aerotek (contractor for HAP)
09.2016 - 12.2016
Patient Insurance Adviser
Dialog Direct (contractor for Blue Cross and Blue Shield and Blue Care Network)
07.2013 - 08.2016
Processor
Salvation Army
10.2006 - 03.2013
Reimbursement Specialist
Externship- University Physicians Services
09.2005 - 10.2006
Medical Billing and Insurance Coding -
Dorsey Business School