Kendra Mcpeters
Rosharon,TX
Overview
10
10
years of professional experience
Work History
Patient Access Representative
Memorial Hermann Health System
Houston, TX
03.2024 - Current
- Coordinated authorization processes to ensure timely and accurate approvals for patient services.
- Managed communication between healthcare providers and insurance companies to facilitate seamless authorizations.
- Facilitated timely renewals of ongoing authorizations by closely monitoring expiration dates and initiating renewal processes proactively.
- Calculated estimated copay based on current insurance benefits.
- Reviewed authorizations from payer to determine approved or denied items.
- Submitted for prior authorization with required documentation to appropriate funding source.
- Maintained consistent follow-up on status of prior authorization requests.
- Provided exceptional customer service to patients, addressing their concerns related to insurance coverage and authorizations promptly and empathetically.
- Assisted with financial counseling for uninsured or underinsured patients, connecting them with resources for affordable care options when necessary.
- Maintained up-to-date knowledge of insurance policies, enabling accurate evaluation of coverage eligibility criteria for patients.
- Supported revenue cycle management efforts by ensuring accurate capture of authorized services during billing processes.
- Communicated with executives about consistent customer issues.
- Maintained files and controlled records to show correspondence activities.
- Read incoming correspondence to ascertain nature of writers' concerns and to determine disposition of correspondence.
Business Office Manager
United Surgical Partners International
Angleton, TX
06.2021 - Current
- Assist the Administrator with the day to day operations of the business office. Also responsible for the day-to-day supervision of Registration, Insurance Verification and Medical Records. Essential Job Duties and Responsibilities. Coordinates with Administrator and Clinical Manager with upcoming credentialing renewals and new credentialing for all clinical staff. Knows, adheres to, and enforces all policies of the business office. Supervises business office employees and processes. Responsible for the hiring, orientation, performance reviews and training of registration and medical records staff. Responsible for thorough working knowledge of accounts receivable system including maintenance of the managed care contracts Reconciles the cash receipts to the deposit log Informs business office manager of applicable day-to-day situations Supervise all medical records activities of the center in a manner consistent with the clinical needs of the center Follows all equipment safety guidelines and is personally responsible of the business office.
- Develops and maintains policies & procedures and systems to minimize DSO and the rate of bad debt and increase the productivity of related operations and perform other activities as requested by the Administrator and assume other appropriate operational responsibilities as necessary. Manage daily work queue to prioritize high dollar claim balances. Review & work incoming insurance and patient correspondence including refund requests. Send appeals when appropriate or provide the requested medical documentation. Coordinate with Central Billing Office and check on accounts that are pending denials. Contact insurance companies to provide documents to appeal and resubmit claims before timely filing. Ability to review medical documentation to justify medical necessity. Review patient balances to ensure accuracy and follow up with patients to obtain payments. Take incoming patient phone calls to resolve inquiries, billing inquires, or outstanding balances. Review insurance payments and determine accuracy of reimbursement based on contracts, fee schedules or summary plan documents. Coordinate with Managed Care Team to ensure that we are current with yearly contracts . Reach out to the credentialing department to ensure that we are current with all credentialing applications and if there are any upcoming renewals. Leverage knowledge of Medicare, state Medicaid, and local coverage determinations (LCD’s) for claim resolution. Negotiate payment amounts for procedures with Third Party Administrators for out of network providers. Recommend an adjustment when applicable or recommend a refund for overpayments to insurance carriers or patients, providing the appropriate documentation.
Lead Insurance Verification Specialist/Patient Financial Advocate
United Surgical Partners International - Memorial Hermann Surgery Center-TMC
03.2016 - 06.2021
- Responsible for completing insurance verifications on all new cases, as well as any add-ons, ensuring that all assigned cases contain complete and accurate demographic and financial information. Accurately determine the primary and secondary (if any) payer. Knowledge of the managed care grids to ensure we are using the proper information calculate expected reimbursement. Thoroughly analyzing each insurance plan to determine if the case and payer are appropriate for the center. Detailed payment knowledge of commercial insurance and Medicare in order to make sure that the appropriate payer is used. Ensure that all Workers Compensation information is obtained and appropriate for the facility. Reviewing all procedure codes to determine if there are any services that are not covered by the insurance. Determine patient responsibility based on insurance contract and the patient’s policy limitations. Contacting patients who have a financial responsibility in a timely manner and discuss payment options. Communicate with the billing office in regards to any patients who have credits on their account to see that their refund will be processed. Work directly with center leadership on any outlying case that may need to be discussed with physician or physician office. Assisting business office team as needed.
Education
Pharmacy Technician Certification - undefined
Med Vance Institute
Houston, TX01-2005
Skills
Assisted in managing tasks using AdvantX and Availity software systems,Supported team collaboration through effective use of Encircle platform,Performed data entry at 60 WPM and 10-key speed of 9000 SPM,Utilized Microsoft Office tools for documentation and reporting,Operated Kronos, ADP, Oracle, Envi, Epic, HealthQuest, Care4, and FinThrive systems
Timeline
Patient Access Representative
Memorial Hermann Health System
03.2024 - Current
Business Office Manager
United Surgical Partners International
06.2021 - Current
Lead Insurance Verification Specialist/Patient Financial Advocate
United Surgical Partners International - Memorial Hermann Surgery Center-TMC
03.2016 - 06.2021
Pharmacy Technician Certification - undefined
Med Vance Institute