Laura Houston
Coral Springs,FL
Summary
Self-motivated Revenue Cycle Advisor with significant years of relevant experience, related proficiencies and a background in automated collection system design, implementation, and operation. Detail-oriented individual who exemplifies professionalism, and an ability to manage multiple projects and tasks at any given moment. Strong understanding of various insurances. Demonstrate history of successful administration and effective issue resolution, while providing high-quality reporting to management as well as facilitating efficient network and software operations. Highlighted leadership qualities and the ability to work with and manage individuals from varying backgrounds, while promoting team values. Driven partner eager for professional growth, increased responsibility, and the opportunity to leverage extensive technical knowledge with client building skills
Overview
22
22
years of professional experience
Work History
RCM-Client Advisor
Modernizing Medicine
Boca Raton, FL
06.2020 - Current
- Manage overall medical billing operations including create and actively manage Practice Performance plans to ensure client health, ensure an effective flow of demographic charge and payment information, oversee aggressive follow-ups with accounts receivable (A/R), monitor fee schedules and insurance payments in order to ensure fully allowed reimbursement, identify and implement strategies to improve internal and customer processes, conduct weekly meetings with the RCM team to provide guidance and feedback regarding claims processing.
- Leverage deep knowledge and understanding of clients’ key practice revenue performance metrics to consult and advise our clients on a monthly basis, denials trend management, office workflow efficiency opportunities, payer related trend analysis and education related to policies and procedures for payers, payer online portal & gaining access, and ERA enrollments.
- Review and analyze customer accounts; identify trends and issues, recommend and implement solutions and see through to a successful resolution.
- Provide a high level of value and customer service to both our client practices and their patients by identifying and efficiently resolving insurance and other billing-related issues.
- Incorporate and execute quality assurance processes related to ensuring accurate customer billing activity.
- Collaborate with geographically dispersed team members to improve overall client metrics.
- Establish, implement and manage Practice Performance Plans that identify, quantify and resolve issues that are impacting service levels and/or delivery of contractual obligations, as needed.
- Conduct routine audits and client meetings to review business metrics, progress, and other proactive topics to ensure high-quality delivery of contracted services.
- Manage and monitor the end-to-end RCM process for assigned clients.
- Collaborate with the internal RCM operations team to ensure seamless service delivery.
- Maintain knowledge of current healthcare industry and specialty-related changes and keep abreast with ModMed software enhancements and releases.
- Perform additional projects and job duties as assigned.
Revenue Cycle Specialist/ASM
Central Reach
Pompano Beach, FL
09.2019 - 06.2020
- Evaluates patient accounts and takes appreciate action pertaining to compliant billing and collections as necessary to assure timely payments or other disposition of patient’s accounts.
- Ensure all A/R inquires are responded to timely and appropriately. This includes inquiries on denials and other “zero pay” posted or not posted to A/R.
- Understand and follow processes needed to ensure clean claims are submitted timely using a third party claim editor system.
- Perform consistent, assertive, efficient and timely follow-up on accounts as determined by Management
- Identify payor issues or trends and update Management in a timely manner , providing concrete examples for management to review.
- Able to understand and effectively interpret payer contracts, remittances advice, and explanation of benefits statements
- Demonstrate a working knowledge of the medical health/behavioral health benefits provided by assigned payer and accurately explain to clients of Applied Behavior Analysis organizations
- Graph and analyze data in real-time as it’s being collected for ABA organizations-physician based therapy management practice software
- Prepared financial statements for management review.
- Researched discrepancies on unpaid invoices and reconciled them.
- Audited payments from third-party payers to ensure accuracy of reimbursement amounts.
- Collaborated with other departments to resolve customer inquiries regarding billing issues.
- Maintained current knowledge of insurance policies, procedures, regulations, and guidelines.
- Built and strengthened client relationships to form long-lasting, profitable bonds.
Reimbursement Specialist
Promise Healthcare, Inc
Boca Raton, FL
06.2017 - 09.2019
- Performed monthly audits for accuracy of claims submitted for payment.
- Resolved discrepancies between provider documentation and insurance plan requirements.
- Provided training to new staff on the proper submission process for reimbursement requests.
- Generated reports summarizing daily activity related to reimbursements and payments.
- Investigated complex cases involving multiple providers or incorrect coding issues.
- Verified that all necessary documents were included in each request before submitting it for payment.
- Monitored changes in industry standards related to reimbursements and updated internal policies accordingly.
- Developed relationships with insurance companies to facilitate timely payments.
- Determined medical necessity, using individual insurance carrier regulations.
- Evaluated existing systems used for tracking reimbursements and proposed improvements as needed..
- Researched rejections, investigating problems to appeal claims.
- Attended seminars to remain up-to-date with coding guidelines and reimbursement requirements.
- Manage and maintain desk inventory, complete reports, and resolve high priority and aged inventory.
- Communicate issues to management, including payer, system or escalated account issues.
- Accurately and thoroughly documents the pertinent collection activity performed
- Review the account information and necessary system applications to determine the next appropriate work activity.
- Responsible for all aspects of follow up and collections, including making telephone calls, accessing payer websites.
- Proficient knowledge of receivables process
- Other assign task to assist the team
Reimbursement Analyst/Collector
Urgent Medical Billing, LLC
Boca Raton, Florida
12.2015 - 06.2017
- Monitor all facility trends and find solutions to dilemmas
- Facilitate reports to team members
- Provide monthly reports for revenue status
- Strong ability to negotiate with insurance carriers
- Expertise in deciphering Explanation of Benefits
- Knowledgeable of substance abuse related ICD_9 and Cpt codes
- Strong background in medical billing submission and collections
- Strong attention to detail
- Proficient knowledge of receivables process
- Coordinated communications with payors to ensured accurate billing practices, enhanced reimbursement opportunities, achievedcash collections targets and reduced or maintained a/r over 120 days at and below targeted level
- Corresponded with providers regarding payment disputes and other issues related to reimbursements.
- Reviewed patient account balances to ensure that payments are properly applied against outstanding debts.
- Reviewed uninsured accounts, verifying medical assistance application process, charity care application and drug replacement program availability.
- Negotiated payment arrangements with customers who were past due on their accounts.
- Processed refunds, chargebacks, or other forms of compensation for dissatisfied customers.
Patient Account Rep (National Medicare & Medicaid Center)
Conifer Health Solutions
Boca Raton, Florida
03.2015 - 12.2015
- Researches each account using company patient accounting applications and internet resources that are made available. Conducts appropriate account activity on uncollected account balances with contacting third party payors and/or patients via phone, e-mail, or online. Problem solves issues and creates resolution that will bring in revenue eliminating re-work. Updates plan IDs, adjusts patient or payor demographic/insurance information, notates account in detail, identifies payor issues and trends and solves re-coup issues. Requests additional information from patients, medical records, and other needed documentation upon request from payors. Reviews contracts and identify billing or coding issues and request re-bills, secondary billing, or corrected bills as needed. Takes appropriate action to bring about account resolution timely or opens a dispute record to have the account further researched and substantiated for continued collection. Maintains desk inventory to remain current without backlog while achieving productivity and quality standards.
• Perform special projects and other duties as needed. Assists with special projects as assigned, documents, findings, and communicates results.
• Recognizes potential delays and trends with payors such as corrective actions and responds to avoid A/R aging. Escalates payment delays/ problem aged account timely to Supervisor.
• Participate and attend meetings, training seminars and in-services to develop job knowledge.
• Respond timely to emails and telephone messages as appropriate.
• Ensures compliance with State and Federal Laws Regulations for Managed Care and other Third Party Payors.
Collections Lead
Transformations Treatment Center (Substance Abuse Facility)
Delray Beach, Florida
09.2014 - 03.2015
- Monitor all facility trends and find solutions to dilemmas.
- Facilitate reports to team members
- Provide monthly reports for revenue status
- Developed and implemented a collections strategy to ensure timely payments from customers.
- Monitored customer account activities to identify delinquent accounts and initiate collection efforts.
- Negotiated repayment plans with customers that were mutually beneficial for both parties.
- Provided guidance to collections staff on complex cases and escalated unresolved disputes to senior management as necessary.
- Ensured compliance with all applicable laws, regulations and company policies related to collections activity.
- Drafted monthly reports summarizing key performance metrics such as number of accounts in arrears, amounts collected.
- Maintained open communication channels between the organization's legal department, external attorneys and third party agencies when pursuing litigation against delinquent customers.
- Strong ability to negotiate with insurance carriers
- Processes claim corrections identified from the reconciliation
- Experience with coding, CPT/HCPC, Revenue, and Diagnosis codes
- Preparing, reviewing, and transmitting claims using billing software, including electronic and paper claim processing
- Through billing software, review claim rejections and correct errors, and rebill claims
- Following up on unpaid claims within the standard collection cycle timeframe
- Checking each insurance payment for accuracy and compliance with contract and usual and customary charges
- Reviewing accounts with balances to identify next steps, including balances needing to be set as “collections” for balance due patient
- Researching and appealing denied claims
Account Manager/Collector
Medivance Billing Service, LLC (Mental Health and Substance Abuse)
Sunrise, Florida
05.2012 - 09.2014
- Contact payers to check claim status and reimbursement for both Florida and California facilities
- Enabled excellent customer service in a medical institution and made sure that all the patients are well attended
- Assist supervise operations and workflow, office staff, including performance management and training/development of a specialty practice.
- Provides support and performs regular QA reviews for client intake, registration and scheduling functions.
- Conducted patient follow-up and assisted with patient evaluation clinic programs as directed
- Coordinated communications with payors to ensured accurate billing practices, enhanced reimbursement opportunities, achieved cashcollections targets and reduced or maintained a/r over 120 days at and below targeted level
- Coordinated scheduling of practitioner schedules to ensure proper coverage of patient appointments and out-of-office calls
- Ensured the privacy and security of protected health information per hipaa requirements, reviewed clinician documentation to ensure that patient charts are completed
- Followed up on all opened accounts, maintaining thorough chronological financial records on each patient account
- Maintained accurate and completed patient files, ensuring that they are in compliance with the hanger compliance policies
- Compiled and coded a/p invoices per guidelines for approval and reported pcc employee hours to payroll department
- Obtained accurate insurance information, verification and pre-authorization and completed special projects as assigned
- Processed all billing daily, ensuring that claims are accurate, timely and fully documented
- Provided counseling to patients advising them of their financial responsibility and obtained credit agreements for outstanding balances
- Provided the highest level of customer service is provided to patients, fellow employees and referral sources
- Received, sorted and distributed mail appropriately and in a timely manner
- Operated the electronic health records and billing system.
- Managed client reception and client services coordination.
- Provided the required leadership, support and direction for office initiatives and special projects.
- Managed insurance and billing related procedures of the facility and solved queries of the patients regarding their insurance renewal and expire
- Facilitated in completing general formalities related to the patients, like insurance and medical reports
- Send appropriate letters and consistent follow-up on outstanding accounts by working collection report and correspondence.
- Performs audits on accounts when required
- Managed multiple accounts simultaneously while meeting deadlines
Third Party Analyst/Lead
H.F.S.
Hollywood, Florida
04.2011 - 05.2012
- In-house collection consultant for case management department for University Of Miami to complete audit for transplant cases
- Conducted patient follow-up and assisted with patient evaluation clinic programs
- Coordinated communications with payors to ensured accurate billing practices, enhanced reimbursement opportunities, achieved cash collections targets and reduced or maintained a/r over 120 days at and below targeted level
- Coordinated scheduling of practitioner schedules to ensure proper coverage of patient appointments and out-of-office calls
- Ensured the privacy and security of protected health information per hipaa requirements, reviewed clinician documentation toensure that patient charts are completed
- Followed up on all opened accounts, maintaining thorough chronological financial records on each patient account
- Maintained accurate and completed patient files, ensuring that they are in compliance with the hanger compliance policies
- Compiled and coded a/p invoices per guidelines for approval and reported pcc employee hours to payroll department
- Obtained accurate insurance information, verification and pre-authorization and completed special projects as assigned
- Processed all billing daily, ensuring that claims are accurate, timely and fully documented
- Provided counseling to patients advising them of their financial responsibility and obtained credit agreements for outstanding balances
- Provided the highest level of customer service is provided to patients, fellow employees and referral sources
- Received, sorted and distributed mail appropriately and in a timely manner
- Reported timely key statistics to marketed and corporate management for sales, revenue, cash and patient flow
Claims Examiner
Health Systems One
Hallandale, Florida
03.2009 - 04.2011
- Determines covered medical insurance losses by studying provisions of policy or certificate.
- Establishes proof of loss by studying medical documentation; assembling additional information as required from outsidesources, including claimant, physician, employer, hospital, and other insurance companies; initiating or conducting investigationof questionable claims.
- Documents medical claims actions by completing forms, reports, logs, and records.
- Resolves medical claims by approving or denying documentation; calculating benefit due; initiating payment or composing denialletter
- Ensures legal compliance by following company policies, procedures, guidelines, as well as state and federal insurance regulations.
- Maintains quality customer services by following customer service practices; responding to customer inquiries.
- Provides legal support by assembling documentation for settlement action.
- Protects operations by keeping claims information confidential.
- Prepares reports by collecting, analyzing, and summarizing information.
Medical Collector
Boca Raton Community Hospital
Boca Raton, Florida
03.2006 - 03.2009
- Contact patients with medical accounts by telephone and/or a predictive dialer system to obtain payment in full or negotiate payment. Follow all documented processes and scripts while working calling campaigns or handling inbound calls.
- Read account notes while simultaneously talking with patients, verifying stored information and updating information like demographics, attorney information, and insurance on each account.
- Actively listen to patients informing them of balances or correcting insurance information while being professional at all times, maintaining control of the conversation, tone and displaying a courteous and empathetic attitude at all times.
- Document accounts correctly, accurately and timely noting right party verified, disputes, HIPAA release forms sent/received, etc.
- Work in an expeditious manner while thoroughly documenting the account as it is worked minimizing “wrap up" time betweencalls.
- Correct broken promises and payment arrangements by actively working one’s “que" daily following all work schedules forcampaigns.
- Meet and exceed goals set which are the threshold for earning commission on a monthly basis while following all policies andprocedures and in compliance with all laws and regulations.
- Direct formal and informal complaints outside/inside to a member of management.
- Will be proactive in finding solutions in an ever-changing regulatory and healthcare collections environment.
- Utilizes PC and applications relevant to job assignment and tasks involved.
Medical Biller
Tenet RBO FL
Boca Raton, Florida
09.2004 - 03.2006
- In depth understanding of medical billing processes, CPT, ICD-9, and revenue codes
- Experience with Electronic medical records and medical billing systems
- Recover delinquent accounts for emergency room physician services
- Achieve minimum requirements on all key performance indicators
- Possess working knowledge of and compliance with federal laws HIPPA and FDCPA
- Familiar with payment vendors
- Familiarity with PAS website and all forms of electronic payment options
- Ability to navigate company website
- Refer patients to payment vendors to facilitate problem solving process
- Problem solving and basic skip tracing skills
- Goal oriented, persuasive and personable
- Comply with company policies and established procedures
- Document accounts thoroughly
Medical Collector
Broward Adjustments
Fort Lauderdale, Florida
01.2002 - 08.2004
- Reviewed and analyzed customer-billing inquiries submitted by call center and field service representatives.
- Maintained metrics to determine revenue impacts. Elevated accurate billing of installation charges, equipment changes, and order processing procedures through identification and proactive feedback to call center, service center, and field service &support management teams.
- Guaranteed the accurate recording of customer payments by researching misapplied inquiries. Facilitated improved customer relations by quickly discerning needs and resolving issues according to customer expectations.
- Verified insurance coverage for patients and obtained authorizations as necessary.
- Submitted claims electronically, via mail or fax, to third-party payers.
- Resolved rejected claims by researching errors and submitting corrections.
- Answered incoming calls from patients regarding billing inquiries.
- Generated correspondence to patients regarding outstanding balances due.
- Assisted with coding issues when needed to ensure accurate reimbursement from insurance companies.
- Attended meetings regularly with management team regarding performance metrics and goals set forth by the organization.
- Took billing calls, questions and concerns from patients and third party carriers.
- Attended provider meetings and workshops when appropriate.
- Accepted and processed customer payments and applied toward account balances.
- Received payments and posted amounts to customer accounts.
Education
Insurance Billing and Coding Specialist -
Concorde Career Institute
Lauderdale Lakes, FL08.2002
Graduated -
Boyd Anderson High
Lauderdale Lakes, FL06-2000
Some College (No Degree) - Public Health
Broward Community College
Coconut Creek, FLSkills
- Offers unparalleled integrity, initiative, resourcefulness, consistency, and diligence in achieving business objectives and both short and long term goals
- Excels in reporting, assistance, and customer service Results-oriented, able to balance multiple responsibilities, consistently delivering results on time
- Adept at leading by example, marshaling resources and creating professional atmosphere to accomplish objectives
- Natural communicator with strong motivational skills and the ability to support operational goals and meet business objectives
- Highly adaptable, rapidly learn new procedures and processes, and quickly adjust to changes in schedule, team structure, assignment parameters, and organizational objectives
- Client Engagement
- Progress Reporting
- Teamwork and Collaboration
- Relationship Building
- Team Collaboration
- Problem-Solving
- Data Interpretation
Timeline
RCM-Client Advisor
Modernizing Medicine
06.2020 - Current
Revenue Cycle Specialist/ASM
Central Reach
09.2019 - 06.2020
Reimbursement Specialist
Promise Healthcare, Inc
06.2017 - 09.2019
Reimbursement Analyst/Collector
Urgent Medical Billing, LLC
12.2015 - 06.2017
Patient Account Rep (National Medicare & Medicaid Center)
Conifer Health Solutions
03.2015 - 12.2015
Collections Lead
Transformations Treatment Center (Substance Abuse Facility)
09.2014 - 03.2015
Account Manager/Collector
Medivance Billing Service, LLC (Mental Health and Substance Abuse)
05.2012 - 09.2014
Third Party Analyst/Lead
H.F.S.
04.2011 - 05.2012
Claims Examiner
Health Systems One
03.2009 - 04.2011
Medical Collector
Boca Raton Community Hospital
03.2006 - 03.2009
Medical Biller
Tenet RBO FL
09.2004 - 03.2006
Medical Collector
Broward Adjustments
01.2002 - 08.2004
Insurance Billing and Coding Specialist -
Concorde Career Institute
Graduated -
Boyd Anderson High
Some College (No Degree) - Public Health
Broward Community College