Joy Eneliko
Torrance,CA
Summary
Dedicated and attentive collector with a strong drive to excel in the field. Committed to maintaining high levels of reimbursement and contributing to the company's overall success. Motivated by the opportunity to improve and collaborate on ways to effectively achieve personal and organizational success. Seeking to leverage skills and expertise to make a positive impact within a dynamic healthcare organization.
Overview
9
9
years of professional experience
1
1
Certification
Work History
Assistant Director of Operations
Knowtion Health
Torrance, CA
10.2022 - Current
- Manage 7 different lines of business with over 70 team members. Ensuring optimal performance and adherence not only to our organization’s policies and standards but also to our client’s
- Conduct regular meetings to maintain open lines of communication within the team and leadership, fostering a positive work environment, effective leadership, and team building
- Conduct regular operational meetings with clients to ensure effective communication with workflow, staffing, and collections meet expectations
- Conduct interviews for potential candidates looking for employment opportunities in PAR or Internal Leadership positions
- Manage time cards and allocations for 167 team members
- Present month end reports of payer behavior, collections, adjustments, aging, productivity, quality of work, and inventory pending for resolution
- Assist other projects manage inventory. Identify trends to help work population in bulk
- Promote growth and identify a team members strengths and allow the team member to focus their work efforts in that area which allows me to be able to train up effectively without causing a negative impact to the project
Supervisor
Amplus
Torrance, CA
06.2021 - 10.2022
- Oversaw daily operations of the project, ensuring smooth workflow for 20 team members and timely completion of deliverables.
- Applied strong leadership talents and problem-solving skills to maintain team efficiency and organize workflows.
- Improved collections with timely response to denials and finding effective solutions for a one touch resolve workflow.
- Increased team productivity by implementing efficient workflows and setting clear expectations for team members.
- Taking on complete inventory to identify trends and issues, deep diving to root cause the situation and collaborate with the client to address and correct.
Patient Account Representative
Amplus
Torrance, CA
11.2020 - 06.2021
- Assisted colleagues during peak periods or absences, showcasing teamwork skills while maintaining personal workload
- Researching insurance denials from both government and commercial payers
- Reviewed insurance eligibility and verified coverage details via phone and portals to minimize claim denials and delays in payment.
- Submitted claim corrections via Epic, ePremis/ Change Health, Waystar, and various payer portals.
- Composed written reconsiderations and appeals to overturn, incorrect processing, underpayments, authorization denials (no auth, auth with mismatch services, max number of services rendered, auth expired, and auth initiated but not finalized during time of service), and medical necessity
- Reviewed payer policies for medical necessity
- Review variances to determine if expected reimbursement was correct, if an adjustment or additional payment was warranted, or if the remaining was due to patient responsibility
- Identified pockets in inventory for quick collections
- Identified payer behavior that caused a delay in collections
Patient Account Rep, Secondary
US Renal Care
Long Beach, CA
11.2017 - 10.2020
- Successfully Collect Secondary and Tertiary balances
- Research and analyze all accounts for correct reimbursement
- Reconcile and identify claim denials and edit for resubmission
- Respond in a timely matter to insure claims process correctly
- Responsible for following up on claim received, processed, paid or denied and corrections that need to be made to insure full compensation
- Verified eligibility at time of service
- Written reconsiderations and appeals to overturn denials or incorrect processed claims
- Assist with special projects/ clearing old AR
- Adjust patient accounts for Bad Debt
- Post/ Reconcile recoupments
- Properly notate accounts daily
- I have up to date training for HIPAA, Healthcare Fraud, waste and abuse.
Patient Account Rep, Gov.
Silver Lake Medical Center
Los Angeles
11.2015 - 10.2017
- Taking incoming patient/ insurance calls
- Filing/ Data Entry
- Medicare crossover billing/collections
- Payment / Contractual Postings
- Reconcile outstanding accounts
- Medical Claim Status, Eligibility Verification, Appeals, Cutbacks, Capitation, CIF and Claims submission.
- Self-Pay/After Insurance Billing/ Collections.
Education
Diploma -
Long Beach Polytechnic High School
Long Beach, CA06.2003
Skills
- Strong organizational skills
- Listening skills
- Excellent communication skills
- Courteous demeanor
- Strong client relations
- 10 plus years for Customer Service
- Punctuality in performing tasks
- 10 keys
- 65 wpm
- Proficient in Microsoft Word, Excel, Publisher, PowerPoint, Outlook
- Answering phones
- Operate office equipment like scanner, printer and fax machine
- Navigation using Insurance Provider Portals
- Reimbursement knowledge
- System Experience: Epic, Cerner, MediTech, IDX, DDE, Soarian, WayStar, ePremis/ Change Health, and eClinical
Certification
CRCR certified
Additional Information
- 10+ years in medical billing and collections
- Detail oriented, organized, and able to multitask
- Analytical problem solver
- Self motivated and confident in decision making
- Project improvement and implementation
- Leadership
- Patient account management
Timeline
Assistant Director of Operations
Knowtion Health
10.2022 - Current
Supervisor
Amplus
06.2021 - 10.2022
Patient Account Representative
Amplus
11.2020 - 06.2021
Patient Account Rep, Secondary
US Renal Care
11.2017 - 10.2020
Patient Account Rep, Gov.
Silver Lake Medical Center
11.2015 - 10.2017
Diploma -
Long Beach Polytechnic High School