Summary
Overview
Work History
Education
Skills
Timeline
Generic

Heather Clark

Mansfield,TX

Summary

Healthcare professional with strong experience in reimbursement processes including billing, coding, and insurance verification. Proven ability to manage complex billing issues, ensure compliance, and maximize revenue recovery. Proactive and goal-oriented professional with excellent time management and problem-solving skills. Known for reliability and adaptability, with swift capacity to learn, quickly evolving needs in fast-paced environment. Committed to leveraging these qualities to drive team success and contribute to organizational growth.

Overview

18
18
years of professional experience

Work History

Reimbursement Specialist/Authorization Specialist

RemX McKesson
Remote
10.2023 - Current
  • Enter data, including patient records, physician profiles, and insurance contracts
  • Used data entry skills to accurately document and input statements.
  • Increased accuracy by diligently reviewing and verifying patient eligibility, coverage, and benefits information.
  • Demonstrated adaptability with changing insurance requirements, maintaining up-to-date knowledge through continuous education efforts.
  • Ensured compliance with HIPAA regulations while managing sensitive patient information during the verification process.
  • Assured timely verification of insurance benefits prior to patient procedures or appointments.
  • Updated patient records with accurate, current insurance policy information.
  • Made contact with insurance carriers to discuss policies and individual patient benefits.
  • Achieved insurance pre-authorizations to enable timely patient procedures.
  • Coordinated with care teams across various departments to ensure seamless integration of verified coverage information into overall treatment planning.

Insurance Specialist/Department Lead

Baylor Surgicare at Fort Worth
Fort Worth
08.2019 - 10.2023
  • Processed eligibility and benefits verification and authorization requests.
  • Tracked pending authorizations to resolve discrepancies and avoid revenue loss.
  • Acted as subject matter expert, answering internal, and external questions and inquiries.
  • Ensured regulatory compliance through diligent monitoring of company practices and adherence to guidelines.
  • Trained new hires on company policies and procedures, ensuring a seamless transition into the Insurance Specialist role.
  • Determined client needs and financial situations by listening and scheduling fact-finding appointments.
  • Monitored changes in insurance industry to stay compliant with relevant laws and regulations.
  • Collected premiums on or before effective date of coverage.
  • Mentored new hires within the department, providing guidance on company policies and procedures as well as job-specific tasks.
  • Led team to achieve high performance standards through consistent coaching and feedback.
  • Oversaw daily operations of the department, ensuring smooth workflow and adherence to deadlines.
  • Identified areas for improvement within the department, developing action plans to address those needs effectively.
  • Optimized customer experience by delivering superior services and effectively troubleshooting issues.
  • Evaluated staff performance and provided coaching to address inefficiencies.
  • Collected, arranged, and input information into database system.
  • Enhanced customer satisfaction by addressing insurance-related inquiries and resolving issues promptly.
  • Communicated effectively with members of operations, finance, and clinical departments.
  • Streamlined policy management by regularly updating client information and tracking policy changes.
  • Simplified complex insurance concepts for clients, facilitating informed decision-making regarding policy options.

Behavior Interventionist/Inclusion Co-Teach

Birdville ISD
Haltom City
08.2014 - 08.2019
  • Delivered high-quality instruction that accommodates diverse learning styles while addressing specific behavioral needs of individual students.
  • Improved student behavior by developing and implementing tailored intervention plans.
  • Completed observations of students in classroom and social situations.
  • Helped students build skills to navigate typical academic and social situations.
  • Established rapport with each student, building trust and fostering a safe environment conducive to learning and growth.
  • Met with teachers to establish goals for students in intervention program.
  • Developed positive relationships with students to foster supportive learning environment.
  • Developed and implemented behavior management plans to improve student behavior.
  • Facilitated small group instruction to address individual learning needs.
  • Designed individual education plans to encourage student growth according to different learning abilities and needs.

Medical Coder/Biller

Fort Worth Surgery Center
Fort Worth
01.2007 - 01.2014
  • Reduced claim denials by meticulously reviewing patient insurance information and coding practices.
  • Implemented quality control measures to identify potential errors before submitting claims, reducing rejections significantly.
  • Accurately entered patient demographic and billing information in billing system to enable tracking history and maintain accurate records.
  • Delivered timely and accurate charge submissions.
  • Conducted regular audits of billing records to ensure accuracy and completeness, enhancing overall financial performance for the practice.
  • Reviewed patient diagnosis codes to verify accuracy and completeness.
  • Reviewed patient records, identified medical codes, and created invoices for billing purposes.
  • Reduced instances of denied claims, carefully reviewing and rectifying coding errors before submission.
  • Audited and corrected billing and posting documents for accuracy.
  • Reported repeated issues to supervisors and other departments, collaborating to identify issue roots and rectify problems.
  • Participated in team meetings to discuss progress and results, providing ideas and suggestions for improvement.
  • Identified and documented quality discrepancies for management to develop resolutions.

Education

Some College (No Degree) - Nursing

Tarrant County College
Fort Worth, TX

Skills

  • HCPCS coding
  • HIPAA compliance
  • Microsoft office
  • Claims processing
  • ICD-10 coding
  • Data recording
  • Policy evaluation
  • Managed care
  • Medical billing
  • ICD 9 coding
  • Payment posting
  • Insurance verification
  • Medicaid
  • Medicare
  • Commercial insurance
  • Teamwork and collaboration
  • Customer service
  • Problem-solving
  • Attention to detail
  • Time management
  • Organizational skills
  • Effective communication
  • Adaptability and flexibility
  • Deadline oriented
  • Self motivation
  • Quality control
  • Billing data verification
  • Multitasking
  • Data analysis

Timeline

Reimbursement Specialist/Authorization Specialist

RemX McKesson
10.2023 - Current

Insurance Specialist/Department Lead

Baylor Surgicare at Fort Worth
08.2019 - 10.2023

Behavior Interventionist/Inclusion Co-Teach

Birdville ISD
08.2014 - 08.2019

Medical Coder/Biller

Fort Worth Surgery Center
01.2007 - 01.2014

Some College (No Degree) - Nursing

Tarrant County College

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Heather Clark