Jessica Spear
Alsip,IL
Summary
I have full revenue cycle experience in many different specialties and with both large and small practices. I have spent recent years building practice revenue cycle standard operating protocols to maximize reimbursement both through insurance and patient collections. I have consulted for providers just starting out and for established practices with major challenges throughout the revenue cycle. With over 17 years of hands on experience in many different specialties, I have become a full revenue cycle expert. My certifications demonstrate the importance of continuing education as laws and regulations change frequently in the healthcare industry, ensuring that billing practices are meeting the highest standard.
Overview
17
17
years of professional experience
1
1
Certificate
Work History
Access Team Lead
Northwestern Medicine
10.2022 - Current
- As a team lead for the financial clearance center, I oversee the day to day operations for over 9 outpatient hospital oncology infusion centers
- This includes assisting staff with escalated issues, communicating with various departmental leadership teams to streamline care, escalating cases to the appropriate teams as needed and teaching, coaching and mentoring staff
- I also perform quality assurance reports and review monthly hospital and professional denial reports
- As a team lead, I am also responsible for the training and development of new and established staff and assist in building the training program in our department.
Financial Clearance Specialist
Northwestern Medicine
01.2022 - 10.2022
- Responsible for verifying insurance coverage and securing authorizations of specialty pharmacy and oncology medications administered in the office
- Submission of pre-determinations, medical records and prior authorizations, as well as, authorizing specialty pharmacy orders for Urology and Neurology treatments
- Use of EPIC, web based software including Availity, Navinet and Passport to approve procedures for large health system
- Verify insurance benefits, coordinate with clinical and support staff, contact patients for pertinent information and update clinic as needed
- Identify and update management of trends and changing policies and requirements as needed.
Medical Billing Coordinator
PRG
07.2021 - 12.2021
- I worked closely with the VP of Operations to manage daily billing operations for the entire company
- I also provide daily support to the Senior Billing Operations team by facilitating monthly client meetings and assisting the Senior Executive team with various projects
- I am also responsible for conducting internal quality assurance audits and special projects as requested
- Special projects include coding frequency and/or analysis reports, reviewing medical billing audits, coordinating provider follow-up, and maintaining client databases.
Senior Claims Integrity Specialist-Team Lead
SkinCure Oncology
06.2019 - 05.2021
- I have successfully developed a positive, hardworking and motivated team of 11 employees while in my leadership role
- This includes incorporating team building activities, delegating tasks and projects and maintaining positive working relationships between team members
- I also coordinate and develop the training programs for new hires
- My role has extended out so that I ensure a smooth workflow throughout all departments, not just my own
- I routinely perform documentation audits to ensure accuracy and validity of charges billed
- My focus has also been on patient experience and I’m skilled in the area of patient collections and follow up
- As the team leader, I also handle escalated accounts and provide mid level management assistance to my superiors
- I’m responsible for researching new or unusual claim denials and am skilled at preparing formal appeals and reconsideration requests based on that information
- Follow up on superficial radiation therapy claims
- Work monthly account receivable reports
- Work with practices to resolve patient disputes
- Answering patient billing calls
- File appeals and reconsiderations as needed
- Daily charge approval and charge entry
- Answering patient billing calls
- Report any new denial trends to management
- Use of various EMR systems and billing software
Claims Integrity Specialist
SkinCure Oncology
06.2018 - 06.2019
- Follow up on superficial radiation therapy claims
- Work monthly account receivable reports
- Work with practices to resolve patient disputes
- Answering patient billing calls
- File appeals and reconsiderations as needed
- Daily charge approval and charge entry
- Answering patient billing calls
- Report any new denial trends to management
- Use of various EMR systems and billing software
Billing Specialist/Patient Financial Coordinator
Gynecological Cancer Institute of Chicago
08.2016 - 01.2018
- Oversee patient billing, follow up and collections
- Payment posting, charge entry, denial management, appeals and pricing reconciliations
- Coordinating with front desk staff and providers to ensure accurate coding and billing
- Secondary and Tertiary Claims
- Analyze production data to gather quarterly revenue trends
- Insurance authorizations and verifications
- Contracting and credentialing and development of long-term profitable partnerships
- Reimbursement tracking for chemotherapy and infusible medications
Insurance Verification Coordinator
Family Eye Physicians
01.2014 - 08.2016
- I oversaw the daily insurance verifications and HMO referrals for four office locations ; charge entry, payment posting, appeals, denial management, inpatient and outpatient procedure coding; medical collections; patient financial counseling; responsible for the training and performance of four to eight employees; insurance A/R; workman's comp, home health, DME and SNF billing
Medical Billing Manager
Quality Billing Specialists
05.2006 - 11.2013
- I oversaw the daily billing functions for multiple high volume practices; RVU calculations and fee schedule pricing; contracting and credentialing; reimbursement analysis reporting; inpatient and outpatient procedural coding; government healthcare billing; responsible for meeting with physicians to discuss quarterly progress and projected growth; EMR, practice management software and clearinghouse setup
Education
Certified Professional Biller CPB - Certification
09.2020
Coursework Towards An A.A - Healthcare Administration
2012
G.E.D -
2004
Skills
- CPT Coding
- Medical Billing
- ICD-9
- Medical Collection
- Insurance Verification
- Medical Coding
- Medical Records
- Medical Office Experience
- QuickBooks
- Anatomy Knowledge
- Transcription
- Medical Receptionist
- Medical Scheduling
- Accounts Receivable
- Data Entry
- Triage
- Physiology Knowledge
- HIPAA
- Auditing
- Cerner
- Phone Etiquette
- Medical Terminology
- Quality Assurance
- ICD Coding
- Medicare
- Analysis skills
- Communication skills
- Ophthalmology
- Customer service
- Microsoft Excel
- Certifications and Licenses
- Identifying differences in materials, following instructions, and detecting details among distracting
- Information
- Full results: Expert
- Medical billing — Expert
- November 2021
- Understanding the procedures and forms used for medical billing
- Protecting patient privacy — Highly Proficient
- Understanding privacy rules and regulations associated with patient records
- Full results: Highly Proficient
- Management fit — Proficient
- December 2021
- Measures the traits that are important for success in management positions
- Full results: Proficient
- Indeed Assessments provides skills tests that are not indicative of a license or certification, or continued
- Development in any professional field
- Additional Information
- Key Qualifications:
- ICD-9, ICD-10, CPT, HCPCS I & II
- Patient Financial Liaison
- HIPPA and patient confidentiality
- Medicare, Medicaid and HMO/PHO Billing
- Efficiency, Auditing and growth reports
- Skilled Team Leader
- Medical Collections
- Experienced in EMR and practice management software
- Electronic Health Records Systems
- Team Leadership
- Payment Processing
- Eligibility Determinations
- Patient Data Management Systems
- Office Supplies and Inventory
- Patient Identification
- Insurance Company Knowledge
- Regulatory Compliance
- Insurance Authorizations
- Phone and Email Etiquette
- Financial Documentation
- Patient Health Information Access
- Team Collaboration
- Process Improvement
- Verbal and Written Communication
- Registration Coordination
- Referral Coordination
- Insurance Billing
- Prepare Reports
- Insurance Coordination
- Organization and Time Management
- EMR
Certification
BILLING (10+ years)
EMR (7 years)
COLLECTIONS (4 years)
CREDIT (4 years)
HEALTH MAINTENANCE ORGANIZATION (2 years)
ICD-10, Certified Professional Biller (CPB)
September 2020
AAPC Certified Professional Biller CPB
Assessments
Basic attention to detail — Expert
December 2021
Timeline
Access Team Lead - Northwestern Medicine
10.2022 - Current
Financial Clearance Specialist - Northwestern Medicine
01.2022 - 10.2022
Medical Billing Coordinator - PRG
07.2021 - 12.2021
Senior Claims Integrity Specialist-Team Lead - SkinCure Oncology
06.2019 - 05.2021
Claims Integrity Specialist - SkinCure Oncology
06.2018 - 06.2019
Billing Specialist/Patient Financial Coordinator - Gynecological Cancer Institute of Chicago
08.2016 - 01.2018
Insurance Verification Coordinator - Family Eye Physicians
01.2014 - 08.2016
Medical Billing Manager - Quality Billing Specialists
05.2006 - 11.2013
AAPC - Certified Professional Biller CPB, Certification
Axia College - Coursework Towards An A.A, Healthcare Administration
Richard J. Daley College - G.E.D,
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