LATAYJA PRIDE
JACKSONVILLE,FL
Summary
Medical Biller with comprehensive experience in healthcare billing and revenue cycle management. Skilled in accurately coding diagnosis, procedures and medical services, ensuring compliance with federal regulations insurance policies, and HIPPA standards. Proficient in claim submission, payment posting, denial management, and appeals processes to optimize reimbursement. Strong knowledge of ICD-10, CPT, and HCPCS coding systems. Familiar with EHR systems and billing software such as Epic, E-Clinical Works, Cerner and Athena. Demonstrates exceptional attention to detail, analytical skills, and the ability to resolve complex billing issues. Excellent communicator, collaborating effectively with healthcare providers, insurance companies, and patients to ensure clear understanding and resolution of billing-related inquiries.
Overview
12
12
years of professional experience
1
1
Certification
Work History
Medical Billing & Denials Specialist
Cancer Specialists of North Florida
Jacksonville, FL
06.2023 - 10.2023
- Reviewed and interpreted insurance denial cases, ensuring compliance and effectiveness in claim appeal strategies.
- Recorded and organized daily logs of denied claims, ensuring enhanced accuracy in reporting.
- Reviewed and revised patient demographic data, ensuring accuracy for seamless claim processing.
- Reviewed and processed insurance denials, facilitating claims appeals to optimize revenue cycle efficiency and compliance with payer agreements.
- Analyzed patient accounts and managed claim verification processes, maintaining detailed records of denied claims.
- Streamlined billing operations through diligent research of credit balances and timely preparation of refunds for supervisory review.
- Facilitated communication with insurance companies to expedite claim resolutions, minimizing revenue loss for the organization.
- Optimized data entry processes for precise patient demographic information, resulting in improved claim submission efficiency and reduced processing times.
- Conducted comprehensive analysis of insurance denials, executed claim appeals, and maintained accuracy in reimbursements to optimize revenue cycle performance.
HCC Risk Adjustment Coder
RISK
Jacksonville, FL
01.2023 - 05.2023
- Daily key punching into computer when needed to assure accuracy of billing for all services rendered in patients account in a timely manner
- Ensure completion of documentation and coding on the EMR when needed on charges entered in patient's accounts for a correct and complete billing claim
- Verify the appropriateness of the ICD-10 code to include required supporting documentation and treatment plans
- Make sure that all pertinent diagnosis codes go out on the claim and add Dummy procedure codes when necessary. Conducted thorough reviews of clinical documentation, ensuring accurate ICD-10 coding and adherence to CMS guidelines for complete billing claims.
- Meticulously verified diagnosis codes, supporting documentation, and treatment plans, adding necessary dummy procedure codes for comprehensive claims.
- Implemented MEAT/TAMPER methodology to optimize EMR documentation, improving coding precision and compliance with industry standards.
AR Follow-Up/Patient Financial Services Rep. II
Baptist Behavioral Health
Jacksonville, FL
10.2018 - 01.2023
- Effectively work from daily AR report
- Perform follow-up on denied claims either on website or placing phone calls to insurance carrier
- Navigate effectively and efficiently through insurance websites
- Verify insurance eligibility and benefits; obtain LCD's/Carrier Policies
- Understand managed care authorizations and limits to coverage such as the number of visits
- Research credit balances providing feedback and/or prepares refunds for approval by supervisor
- Process correspondence requests; respond to customer inquiries in a timely manner
- Provide weekly review of rejected claims and find resolutions
- Report all insurance company trends to the AR Team Lead that might be hindering payment/adjudication
- Maintain production standard of 40-50 accounts/day
- Contribute to special projects, as assigned by the AR Team Lead
- Contact patients to collect on outstanding accounts
- Audit patient accounts for patient credits and insurance credits
- Collected payments through payment system
- Helped patient's with inquiries related to their bills by explaining deductibles, copays and co-insurances
- Discussed financial assistance options for patient's that were in bad debt or collection status
- Set up and maintained payment plans for patients
- Worked returned statements by researching to find updated through multiple systems
- Pulled self-pay and hospital charity reports
- Submitted patient and insurance refund requests
- Worked in high volume call area assisting patients with questions pertaining to their accounts
- Changed filling order of insurances to ensure claims were submitted to the correct payers and adjustments are listed correctly on patients account
Charge Poster/Coder
Jacksonville Spine and Pain Center
Jacksonville, FL
10.2016 - 10.2018
- Oversaw collection and entry of charges for services rendered by in-house providers and external facilities.
- Streamlined report processing and review within billing system to enhance accuracy of billing operations.
- Conducted daily audits of all charges, ensuring accurate code entry and application of appropriate billing modifiers.
- Supported billing specialist in coding accuracy and error resolution processes.
- Streamlined billing record maintenance by scanning documentation and electronically categorizing documents within electronic medical record (EMR) system.
- Supported billing specialist by maintaining up-to-date billing database with accurate physician and coding information.
- Ensured timely entry of all charges and communicated delays to supervisor.
- Assisted in educational activities to enhance team knowledge. Reviewed coding and billing updates to maintain compliance. Supported staff in understanding changes in coding practices.
- Rectified discrepancies in billing charges to ensure accuracy.
- Executed daily submission of charge batches to ensure timely processing.
- Validated and confirmed successful submission of charge batches with clearinghouse.
- Collaborated with providers and scribes to clarify misinformation regarding patient encounters.
Medical Insurance Biller and A&R Specialist
First Coast Billing Group Inc
Jacksonville, FL
03.2016 - 09.2016
- Investigated collection methodologies and implemented strategic upgrades to elevate overall operational performance.
- Restructured claims processing workflows through strategic redesigns to improve accuracy and streamline operations.
- Performed detailed analysis and improvement of claim denial management processes, focusing on financial efficiency.
- Supervised creation and implementation of patient information programs, focusing on clear communication of financial responsibilities.
- Analyzed billing issues in partnership with healthcare providers, leading to improved payment processing timelines.
Medical Billing and Coding Specialist
Brown Fertility
Jacksonville, FL
08.2014 - 01.2016
- Facilitated patient understanding of fertility processes to enhance navigation and support throughout treatment.
- Streamlined pre-authorization document management and appointment scheduling to enhance workflow efficiency.
- Designed and implemented payment plan strategies aimed at improving outstanding balance oversight.
- Managed patient records and appointment schedules to enhance operational efficiency.
- Designed and launched billing strategies aimed at improving efficiency in revenue cycle management.
Insurance Billing Associate, Physician Account Manager
Cerner
Jacksonville, FL
03.2012 - 08.2014
- Addressed billing denials to optimize reconciliation workflows and minimize processing time.
- Maintained detailed patient records to support accurate tracking of account activities and enhance care quality.
- Directed management of insurance billing operations to guarantee accurate patient demographic data entry and thorough analysis of denials for optimal financial outcomes.
- Enhanced cash flow by streamlining payment collection processes, ensuring accurate verification of insurance information and prompt co-pay processing.
- Implemented new charge and payment posting strategies to improve financial performance through increased accuracy and reduced processing time.
- Engaged with healthcare providers and insurance companies to streamline resolution of intricate billing challenges, ensuring timely reimbursements.
Education
Diploma/Certificate - Medical Billin & Coding
Everest University
Jacksonville, FL05-2012
High School Diploma -
James S. Rickards High School
Tallahassee, FL05-2004
Skills
Achieved accurate medical coding to enhance billing processes and reduce errors Improved understanding of medical terminology to facilitate effective communication Streamlined medical claims processing to expedite reimbursements and reduce delays Enhanced appeals management to resolve disputes and improve claim success rates Strengthened HIPAA compliance to protect patient information and maintain confidentiality Optimized collection management to increase revenue recovery and minimize losses Delivered accurate medical billing to ensure timely payments and customer satisfaction Maintained high-quality data entry to support efficient patient record management Improved denial management processes to reduce claim rejections and enhance revenue Maximized account receivables efficiency to ensure timely collections Verified insurance information to ensure accurate patient coverage and eligibility Leveraged Allscripts to improve patient data management and operational efficiency Enhanced Epic systems utilization to streamline electronic medical records Improved EMR systems functionality to support better patient care documentation Strengthened anatomy knowledge to enhance coding accuracy and compliance
Certification
Certified Professional Coder, Certified Professional Coder, Jun 2023 - Jun 2024
Timeline
Medical Billing & Denials Specialist
Cancer Specialists of North Florida
06.2023 - 10.2023
HCC Risk Adjustment Coder
RISK
01.2023 - 05.2023
AR Follow-Up/Patient Financial Services Rep. II
Baptist Behavioral Health
10.2018 - 01.2023
Charge Poster/Coder
Jacksonville Spine and Pain Center
10.2016 - 10.2018
Medical Insurance Biller and A&R Specialist
First Coast Billing Group Inc
03.2016 - 09.2016
Medical Billing and Coding Specialist
Brown Fertility
08.2014 - 01.2016
Insurance Billing Associate, Physician Account Manager
Cerner
03.2012 - 08.2014
Diploma/Certificate - Medical Billin & Coding
Everest University
High School Diploma -
James S. Rickards High School