La'Tracey Watkins

Maintain the patient scheduling database and schedule all appointments for the Sleep Disorder Center to include PSG, PSG w/ PAP Titration, MWT, MSLT, PFT, and PAP-NAP. Review all incoming patient information (orders, HNP, insurance) required for SDC accreditation by the AASM and insurance compliance requirements. Adjust the provider schedule to match the RPSGT versus the patient's ratio (if the acuity level is required) for the Sleep Center. Answers incoming calls in compliance with service standards. Obtain appropriate information, including demographics and insurance information, when scheduling appointments for the Sleep Disorder Center. Returns patient and referral source phone messages. Maintains and submits a weekly Summary Report to the Clinic Manager.

Reviewed patients' accounts prior to scheduled appointments to ensure all key data elements are complete and verified. Educates and effectively communicates comprehensive financial counseling for each patient to maximize reimbursement and improve patient satisfaction for each encounter. Checked patients in and out in a professional, timely, and hospitable manner, while following UFHP check-out and cash handling policies, and demonstrating hospitality and service standards. Resolved front-end reports, work queues, and edits in a timely manner, with accurate data.

Maximized reimbursement by performing necessary revenue cycle functions pertaining to claims submission. Processed claims by requesting additional or corrected coding information, medical records or forms, prior authorization numbers from the clinic or department, and requesting EOBs. Completed claims by submitting paper claims with all necessary documentation as needed, or having claims hand-keyed to the payer’s electronic billing system. Completed research by communicating with payers via phone, fax, or payer website, and followed through to resolution. Processed flow improvements and/or trends are identified, documented, and reported to management. Identifies and shares solutions that positively impact the claims billing process. Educated and effectively communicated revenue cycle/financial information to patients, payers, co-workers, managers and others as necessary to ensure accurate processes for attaining established goals.

Collected demographic and billing information via telephone or in person in a courteous and professional manner to ensure financial reimbursement. Entered new or revised patient demographic and insurance information into the EPIC system. Determined the correct guarantor for billing using established guidelines. Information includes, but is not limited to, the patient's and guarantor's demographic data, correct plan codes, accident information, and subscriber information. Verified insurance benefits prior to the patient receiving services, including, but not limited to, limitations of coverage, determination of in-network or out-of-network benefits, out-of-pocket expenses, deductible amount, and co-pay or co-insurance amount.
Obtained pre-certification, authorization, and/or referral for facility and ancillary services. This includes Payer Specific Agreements (PSA), which are required for reimbursement from non-contracted payers. Created estimates using the system tool based on procedures and insurance benefits. Maintained and monitored assigned work queues associated with registration, referrals, and authorizations.

Documented and tracked grievances using specialized case management systems. Managed grievance processes to ensure timely resolution for all customer concerns. Communicated effectively with staff and offenders to gather information and provide updates. Facilitated meetings with team members to discuss grievance resolutions and strategies. Advised management on best practices for handling workplace conflicts proactively. Reviewed existing policies and procedures related to employee grievances for accuracy and effectiveness.

Coordinated patient care activities among nursing and medical staff. Managed unit schedules and staff assignments for efficient workflow. Facilitated communication between patients, families, and healthcare providers. Monitored inventory levels of medical supplies and ordered replacements. Acted as a liaison between hospital departments, medical staff, families, and community agencies regarding patient care issues. Facilitated communication between healthcare providers throughout the organization. Coordinated patient transfers between units and other facilities. Communicated with management to facilitate efficient unit operation. Maintained unit supplies and equipment for medical staff and patient care needs. Scheduled medical appointments and coordinated transportation to medical facilities for patients.