LaTrena Shoals
Oklahoma City,OK
Summary
To seek and maintain full-time position that offers professional challenges utilizing interpersonal skills, excellent time management and problem-solving skills.
Overview
19
19
years of professional experience
Work History
Medical Biller
Family Care Home Health Agency
10.2004 - Current
- Streamlined billing processes by implementing efficient procedures to improve accuracy and reduce errors.
- Enhanced revenue collections for the medical practice with diligent follow-ups on unpaid claims.
- Reduced claim denials by meticulously reviewing patient insurance information and coding practices.
- Ensured timely payments from insurance providers through submission of accurate and complete claims.
- Maintained compliance with industry regulations by staying updated on changes to medical billing codes and requirements.
- Improved patient satisfaction levels with clear explanations of their financial responsibilities and available payment options.
- Resolved discrepancies in accounts receivable reports, contributing to improved cash flow management.
- Managed appeals process for denied claims, resulting in successful reimbursements from insurance companies.
- Implemented quality control measures to identify potential errors before submitting claims, reducing rejections significantly.
- Negotiated favorable payment terms with third-party payers, improving overall revenue collection rates.
- Established strong relationships with insurance representatives, facilitating prompt resolution of billing issues.
- Conducted regular audits of billing records to ensure accuracy and completeness, enhancing overall financial performance for the practice.
- Organized filing system for patient records, expediting access to essential documents when needed.
- Reviewed outstanding balances owed by patients; initiated collection actions if necessary resulting in improved account recovery efforts.
- Acted as liaison between healthcare providers and insurance companies; resolved disputes quickly while maintaining positive relationships.
- Communicated with insurance providers to resolve denied claims and resubmitted.
- Verified insurance of patients to determine eligibility.
- Accurately entered patient demographic and billing information in billing system to enable tracking history and maintain accurate records.
- Posted payments and collections on regular basis.
- Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers.
- Adhered to established standards to safeguard patients' health information.
- Filed and updated patient information and medical records.
- Liaised between patients, insurance companies, and billing office.
- Generated reports and analyzed trends to maximize reimbursement and reduce claim denials.
- Prevented financial delinquencies by working closely with managers to resolve billing issues before becoming unmanageable.
- Audited and corrected billing and posting documents for accuracy.
- Used data entry skills to accurately document and input statements.
- Generated monthly billing and posting reports for management review.
- Created improved filing system to maintain secure client data.
Patient Financial Navigator
OU Health Sciences Center
11.2019 - 03.2022
- Enhanced patient satisfaction by addressing financial concerns and providing personalized financial guidance.
- Streamlined the financial assistance application process for patients, resulting in reduced wait times and increased approval rates.
- Collaborated with insurance providers to verify coverage and resolve billing disputes, improving patient trust and ensuring timely payments.
- Educated patients on available resources, payment options, and insurance benefits to promote informed decisionmaking.
- Facilitated prompt resolution of patient billing inquiries by coordinating with internal departments and external agencies as needed.
- Conducted thorough assessments of patient eligibility for charity care programs, securing vital financial support for those in need.
- Served as a reliable point of contact for patients throughout their treatment journey, addressing concerns promptly and maintaining open lines of communication.
- Increased efficiency in the financial clearance process by implementing standardized procedures for collecting required documentation from patients.
- Negotiated payment plans with patients experiencing financial hardship, minimizing write-offs while supporting continued access to care.
- Established strong relationships with multidisciplinary teams to ensure seamless coordination of care from a financial perspective.
- Improved staff performance through targeted training sessions focused on best practices in patient financial navigation techniques.
- Coordinated with clinical staff to address potential financial barriers to care, ensuring timely provision of necessary services for patients.
- Assisted in the development and implementation of internal policies and procedures related to patient financial navigation functions.
- Provided compassionate support for patients facing end-of-life decisions by educating them on available resources and assisting with complex financial arrangements.
- Verified patient insurance eligibility and entered patient information into system.
- Answered incoming calls, scheduled appointments and filed medical records.
- Provided excellent customer service to patients and medical staff.
- Processed payments using cash and credit cards, maintaining accurate records of transactions.
- Facilitated communication between patients and various departments and staff.
- Followed document protocols to safeguard confidentiality of patient records.
- Applied administrative knowledge and courtesy to explain procedures and services to patients.
- Compiled and maintained patient medical records to keep information complete and up-to-date.
- Engaged with patients to provide critical information.
- Offered simple, clear explanations to help clients and families understand hospital policies and procedures.
- Delivered support to medical staff in completion of patient paperwork.
- Organized patient records and database to facilitate information storage and retrieval.
- Recommended service improvements to minimize recurring patient issues and complaints.
- Helped address client complaints through timely corrective actions and appropriate referrals.
- Contributed to revenue cycle improvements through diligent follow-up on outstanding accounts receivable balances.
- Developed comprehensive financial plans for patients, taking into account individual circumstances and long-term healthcare needs.
- Assisted in reducing bad debt by closely monitoring delinquent accounts and initiating appropriate collection actions when necessary.
Patient Account Specialist III
Integris Central Business Office
03.2017 - 09.2019
- Enhanced patient satisfaction by efficiently managing billing inquiries and resolving discrepancies.
- Streamlined account management processes for improved efficiency and accuracy in recordkeeping.
- Reduced outstanding balances by diligently following up on overdue payments and negotiating payment plans.
- Maintained high levels of data accuracy with meticulous attention to detail in processing insurance claims and updating patient records.
- Collaborated with interdisciplinary teams to optimize billing procedures and ensure timely reimbursements from insurance providers.
- Expedited claim resolutions by skillfully navigating complex insurance policies, regulations, and guidelines.
- Improved cash flow by consistently meeting or exceeding collection targets through proactive account monitoring and follow-up efforts.
- Supported a positive patient experience with empathetic communication during financial discussions, addressing concerns with professionalism and understanding.
- Enhanced team productivity by sharing knowledge, best practices, and providing cross-training opportunities for colleagues in the Patient Accounts Department.
- Assisted patients in understanding their financial responsibilities by explaining healthcare benefits, coverage limitations, and out-of-pocket costs clearly and concisely.
- Contributed to departmental goals for lowering A/R days by prioritizing accounts based on aging reports, taking appropriate action steps to expedite collections or adjustments as needed.
- Fostered strong relationships with insurance representatives to facilitate smooth communications regarding claim submissions, denials, appeals, or underpayments issues that arose during processing stages.
- Increased revenue recovery rates by identifying trends in denied claims, researching root causes, implementing corrective measures to prevent future occurrences accordingly.
- Developed comprehensive documentation of collection activities on individual accounts for accurate tracking of progress towards resolution milestones established within department guidelines.
- Provided exceptional customer service while assisting patients with questions about their bills or payment options via phone calls or written correspondence.
- Ensured compliance with all applicable laws, regulations, policies governing medical billing practices, and patient privacy by staying current on industry changes.
- Proactively identified potential issues in patient accounts, communicating with other departments as necessary to resolve discrepancies that could impact billing accuracy or timely reimbursements from insurance carriers.
- Collaborated closely with the Medical Records Department to obtain required documentation for claim submissions or appeals promptly as requested by insurance carriers.
- Safeguarded patient confidentiality while handling sensitive financial information by adhering to strict HIPAA regulations and organizational privacy policies.
- Worked with outside entities to resolve issues with billing, claims and payments.
- Posted payments and processed refunds.
- Contacted patients after insurance was calculated to obtain payments.
- Electronically submitted bills according to compliance guidelines.
- Reconciled statements with patient records.
- Monitored flags and resolved urgent items with accuracy and efficiency.
- Responded to patient, family and external payer inquiries.
- Utilized computer programs to create invoices, letters and other documents.
- Responded to customer inquiries and provided detailed account information.
- Entered client details and notes into system for interdepartmental access and review.
- Maintained accurate records of customer accounts, payments and payment plans.
- Worked with customer to create debt repayment plan based on current financial condition.
- Listened to customers and negotiated solutions that met creditor and debtor needs.
- Researched billing errors and discrepancies to initiate corrective action.
- Established relationships with customers to encourage payment of delinquent accounts.
- Processed debtor payments and updated accounts to reflect new balance.
Senior Patient Account Representative
Legacy Medical Management
11.2014 - 03.2017
- Enhanced patient satisfaction by efficiently resolving billing discrepancies and addressing account inquiries.
- Streamlined the revenue cycle process for increased efficiency and timely reimbursements.
- Managed high-volume accounts, ensuring accurate and prompt payment of outstanding balances.
- Negotiated with insurance companies to secure maximum reimbursement for services rendered.
- Maintained strict confidentiality while handling sensitive patient information in accordance with HIPAA regulations.
- Collaborated closely with clinical staff to ensure proper coding of diagnoses and procedures for accurate billing purposes.
- Reduced aged accounts receivables by implementing effective follow-up strategies with patients and insurers.
- Provided exceptional customer service, addressing patient concerns and explaining complex billing processes in a clear manner.
- Improved collections rate by proactively identifying trends within outstanding accounts and developing targeted solutions.
- Ensured compliance with all federal, state, and local regulations governing medical billing practices through continuous education on industry updates.
- Boosted departmental productivity by streamlining workflows, eliminating redundancies, and implementing best practices across teams.
- Strengthened relationships between patients, providers, and insurers through open communication channels promoting transparency in financial matters.
- Reconciled account discrepancies to maintain accurate records of payments received from both patients and insurance companies.
- Formulated strategic plans aimed at increasing patient retention rates by offering various payment plan options tailored to individual financial needs.
- Initiated thorough audits of past-due accounts to identify areas requiring immediate attention or potential writeoffs.
- Increased accuracy of billing statements through meticulous attention to detail and thorough verification of patient information.
- Worked with outside entities to resolve issues with billing, claims and payments.
- Posted payments and processed refunds.
- Contacted patients after insurance was calculated to obtain payments.
- Electronically submitted bills according to compliance guidelines.
- Reconciled statements with patient records.
- Monitored flags and resolved urgent items with accuracy and efficiency.
- Responded to patient, family and external payer inquiries.
- Verified patient insurance eligibility and entered patient information into system.
- Followed document protocols to safeguard confidentiality of patient records.
- Applied administrative knowledge and courtesy to explain procedures and services to patients.
- Compiled and maintained patient medical records to keep information complete and up-to-date.
- Engaged with patients to provide critical information.
- Recommended service improvements to minimize recurring patient issues and complaints.
Project Billing Specialist Rejections/Denial Specialist
Oklahoma Sleep Institute Clinic
05.2010 - 12.2012
- Enhanced billing efficiency by streamlining invoice processing and implementing automated systems.
- Reduced invoicing errors by closely monitoring project budgets and tracking expenses accurately.
- Collaborated with project managers to ensure timely billing and accurate financial reporting for all projects.
- Improved cash flow by consistently meeting deadlines for invoice submission and collection.
- Negotiated favorable payment terms with clients, resulting in stronger business relationships and increased client satisfaction.
- Increased revenue recognition by diligently reviewing contracts to ensure accurate billing of time, materials, and expenses.
- Assisted in the development of a comprehensive project billing training program for new team members, improving departmental onboarding processes.
- Contributed to successful audits by maintaining meticulous records of invoices, payments, and supporting documentation.
- Resolved customer disputes promptly and professionally, resulting in improved client relations and faster invoice resolution times.
- Optimized workload distribution among team members by creating an effective project assignment system based on priority level and due date.
- Evaluated financial risks associated with each project by conducting thorough assessments of contract terms.
- Developed customized reports for management that provided valuable insights into key performance indicators related to project billing.
- Trained junior staff on proper invoicing procedures, ensuring consistent quality standards across the entire team.
- Maintained strong relationships with external vendors through regular communication regarding payment status updates or pending disputes.
- Participated in various process improvement initiatives aimed at increasing overall accuracy levels within the department.
- Conducted periodic reviews of existing policies and procedures to identify areas needing improvement or adjustment.
- Managed a high volume of complex, multi-faceted projects with strict deadlines while maintaining consistent attention to detail and accuracy.
- Supported ongoing departmental growth by participating in the hiring process for new Project Billing Specialists and providing mentorship to new team members.
- Researched and resolved billing discrepancies to enable accurate billing.
- Assisted with billing inquiries and provided timely responses to enhance customer satisfaction.
- Provided excellent customer service, developing and maintaining client relationships.
- Monitored customer accounts to identify and rectify billing issues.
- Processed and verified invoices to secure accuracy of billing information.
- Identified, researched, and resolved billing variances to maintain system accuracy and currency.
- Worked effectively with medical payers such as Medicare, Medicaid, commercial insurances to obtain timely and accurate payments.
- Developed and maintained billing procedures to make timely payments.
- Contacted clients with past due accounts to formulate payment plans and discuss restructuring options.
- Reviewed and reconciled customer accounts to manage accuracy of payments.
- Identified payment trends and adjusted billing processes accordingly to retain customers.
- Used data entry skills to accurately document and input statements.
- Responded to customer concerns and questions on daily basis.
- Audited and corrected billing and posting documents for accuracy.
- Collaborated with customers to resolve disputes.
- Maintained accurate records of customer payments.
- Utilized various software programs to process customer payments.
- Processed payment via telephone and in person with focus on accuracy and efficiency.
- Produced and mailed monthly statements to customers and assisted with related requests for information and clarification.
- Generated accounts payable reports for management review to aid in financial and business decision making.
- Created improved filing system to maintain secure client data.
- Improved claim denial resolution by thoroughly researching and identifying root causes of denials.
- Increased overall productivity by implementing efficient denial tracking and follow-up processes.
- Reduced aging accounts receivable balance with timely appeal submissions for denied claims.
- Enhanced payer relationships by maintaining professional and effective interactions during the denial resolution process.
- Analyzed denial trends to proactively address recurring issues and improve clean claim submission rates.
- Educated healthcare providers on proper documentation practices, reducing clinical-related denials significantly.
- Conducted regular audits of denied claims, identifying areas for improvement in the revenue cycle process.
- Optimized workflows within the team by assigning tasks based on individual strengths and expertise in particular payers or denial reasons.
- Ensured compliance with industry regulations and guidelines during denial management activities, avoiding potential legal issues or penalties.
- Trained new employees on denial management best practices, fostering a knowledgeable and efficient workforce.
- Contributed to company-wide initiatives aimed at improving overall revenue cycle performance through targeted interventions addressing claim denials specifically.
- Assisted patients in understanding their coverage limitations or non-covered services, promoting transparency and patient satisfaction during the billing process.
- Recommended policy changes to reduce administrative burdens associated with managing denied claims, streamlining operations.
- Participated in cross-functional projects focused on improving end-to-end revenue cycle performance, leveraging expertise in denial management as a key contributor.
- Served as a subject matter expert on denial-related issues within the organization, providing guidance and support to colleagues when needed.
- Maintained knowledge of insurance coverage benefit levels, eligibility systems and verification processes.
- Documented medical claim actions by completing forms, reports, logs and records.
- Adjusted client accounts by entering discretionary billing items, requesting rebills and updating billing entity records.
- Resolved medical claims by approving or denying documentation, calculating benefit due and initiating payment or composing denial letter.
- Conducted in-depth analysis of inquiries and complaints to compose appeal letters for clients.
- Examined medical treatment records and medical bills to gauge overall extent of liability.
- Identified root cause of denials to provide plans for denial resolution.
- Contacted clients to collect information and communicate disposition of case, documenting interactions regarding eligibility, verification of benefits and claims payment status.
- Reviewed provisions of certificates or policies to determine patient's medical coverage losses.
- Generated, posted and attached information to claim files.
- Checked documentation for accuracy and validity on updated systems.
- Carried out administrative tasks by communicating with clients, distributing mail, and scanning documents.
- Maintained confidentiality of patient finances, records, and health statuses.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Verified client information by analyzing existing evidence on file.
- Prepared insurance claim forms or related documents and reviewed for completeness.
- Posted payments to accounts and maintained records.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
- Processed and recorded new policies and claims.
- Calculated adjustments, premiums and refunds.
- Assured timely verification of insurance benefits prior to patient procedures or appointments.
- Communicated effectively with staff members of operations, finance and clinical departments.
- Reviewed outstanding requests and redirected workloads to complete projects on time.
Education
High School Diploma -
John Marshall High School
Oklahoma City, OKSkills
- Commercial and Private Insurance
- Denial Management
- CPT Knowledge
- Software Proficiency
- HIPAA Compliance
- Account Management
- Medical Billing
- Insurance Verification
- Medicaid and Medicare Knowledge
- Claims Review
- Electronic Claims
- Medical Claims Submission
Timeline
Patient Financial Navigator
OU Health Sciences Center
11.2019 - 03.2022
Patient Account Specialist III
Integris Central Business Office
03.2017 - 09.2019
Senior Patient Account Representative
Legacy Medical Management
11.2014 - 03.2017
Project Billing Specialist Rejections/Denial Specialist
Oklahoma Sleep Institute Clinic
05.2010 - 12.2012
Medical Biller
Family Care Home Health Agency
10.2004 - Current
High School Diploma -
John Marshall High School
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