Critical thinking professional with talents in validating workflows, maintaining a knowledge of policy changes to insurance plans and sharing best practices with management. A reliable Revenue Cycle Analyst known for successfully handling various tasks in deadline-driven environments.
Overview
12
12
years of professional experience
Work History
Revenue Cycle Analyst
Baylor College Of Medicine
01.2022 - Current
Reached out to insurance companies to verify coverage.
Identified and resolved payment issues between patients and providers.
Created well-researched presentations on revenue cycle data to deliver to upper management and executives.
Developed spreadsheet models for diverse projects and analysis.
Solved financial problems with use of diverse analytical and modeling techniques.
Reviewed monthly requisitions for accuracy and completeness, reconciled transactions and determined payment approval statuses.
Assured timely verification of insurance benefits prior to patient procedures or appointments.
Made contact with insurance carriers to discuss policies and individual patient benefits.
Maintained strong knowledge of basic medical terminology to better understand services and procedures.
Communicated verification and authorization status updates with scheduling department to facilitate decision-making for patient admissions and insurance coverage.
Scheduled patient appointments in respective doctors' calendars and followed up with reminder phone calls.
Frequently double-checked patient histories and current information while scheduling follow-ups and other appointments.
Coordinated referrals through insurance and other medical specialists and documented details in patient charts.
Contacted hospitals to confirm patients medical histories and prevent inaccurate diagnoses and treatments.
Correctly coded and billed medical claims for various hospital and nursing facilities.
Performed billing and coding procedures for ambulance, emergency room, impatient and outpatient services.
Scanned and filed medical records in alphabetical order to maintain organized and up-to-date filing system.
Processed insurance company denials by auditing patient files, researching procedures and diagnostic codes to determine proper reimbursement.
Reviewed, analyzed and managed coding of diagnostic and treatment procedures contained in outpatient medical records.
Medical Billing Specialist | Insurance Verificatio
CHI Baylor St Luke's Hospital
02.2020 - 01.2022
Reviewed outpatient records and interpreted documentation to identify diagnoses and procedures.
Interacted with physicians and other healthcare staff to ask questions regarding patient services.
Reviewed patient charts to better understand health histories, diagnoses and treatments.
Used Epic to input information into computerized patient record system.
Performed billing and coding procedures for ambulance, emergency room, impatient and outpatient services.
Processed insurance company denials by auditing patient files, researching procedures and diagnostic codes to determine proper reimbursement.
Reviewed 40-60 medical records to select appropriate coding sequences.
Examined patients' insurance coverage, deductibles, insurance carrier payments and remaining balances not covered under policies when applicable.
Researched CPT and ICD-9 coding discrepancies for compliance and reimbursement accuracy.
Determined prior authorizations for medication and outpatient procedures.
Posted payments and collections on regular basis.
Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers.
Prevented financial delinquencies by working closely with managers to resolve billing issues before becoming unmanageable.
Processed eligibility and benefits verification and authorization requests.
Followed up on denials, late payments, extensions and other special circumstances.
Utilized Epic to document and track customer account details.
Tracked pending authorizations to resolve discrepancies and avoid revenue loss.
Medical Records Coordinator| Insurance Specialist
South Central Houston Action Council
08.2018 - 12.2019
Processed medical records requests from outside providers according to facility, state and federal law.
Obtained necessary signatures on information release forms to obtain medical and treatment records from other service providers.
Maintained accuracy, completeness and security for medical records and health information.
Recorded patients' medical history, status, services provided and other information necessary for compliance with reporting requirements.
Maintained historical reference by abstracting and coding clinical data such as diseases, operations, procedures and therapies with standard classification systems.
Maintained knowledge of benefits claim processing, claims principles, medical terminology and procedures and HIPAA regulations.
Used administrative guidelines as resource or to answer questions when processing medical claims.
Calculated premiums and established payment methods for sales.
Made contact with insurance carriers to discuss policies and individual patient benefits.
Assured timely verification of insurance benefits prior to patient procedures or appointments.
Coordinated referrals through insurance and other medical specialists and documented details in patient charts.
Workers' Compensation Billing Specialist
Toyota Financial Services
09.2017 - 08.2018
Attained up-to-date knowledge of coding requirements through continuing education courses and certification renewal.
Reviewed, analyzed and managed coding of diagnostic and treatment procedures contained in outpatient medical records.
Performed billing and coding procedures for ambulance, emergency room, impatient and outpatient services.
Used Epic to input information into computerized patient record system.
Applied official coding conventions and rules from American Medical Association and Centers for Medicare and Medicaid Services to assign diagnostic codes.
Communicated with insurance providers to resolve denied claims and resubmitted.
Reviewed patient records, identified medical codes and created invoices for billing purposes.
Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers.
Translated and interpreted medical billing codes with strong accuracy to enable swift payment from insurance agencies.
Researched claims and incident information to deliver solutions and resolve problems.
Worked effectively with medical payers such as Medicare, Medicaid, commercial insurances to obtain timely and accurate payments.
Generated and submitted invoices based upon established accounts receivable schedules and terms.
Finance Manager/ Sr. Loan Processing Specialist
Cottonwood Financial
11.2014 - 08.2017
Consulted with representatives of regulatory agencies to complete accurate filings and uphold strict compliance
Executed core financial processes, including vendor setup and payment, operational expenses, administration of bank accounts and account reconciliations
Supported CSRs with special projects and additional job duties
Interviewed clients regarding loan needs and financial histories and conveyed information regarding application processes
Worked with customers in person and via telephone to answer questions, process transactions and resolve issues
Prepared documents for underwriting by verifying client income, credit reports and other information
Processed loans with various departments to ensure timely, accurate and fair proceedings
Reviewed loan files for completeness, identified missing documentation and generated condition lists for applicants
Lead Teller Operations Specialist
Wells Fargo
04.2013 - 09.2014
Assisted customers with setting up or closing accounts, completing loan applications and signing up for new services
Completed highly accurate, high-volume money counts via both manual and machine-driven approaches
Checked amount details and fraud markers for transaction papers such as checks and money orders
Assisted estimated 20 customers each hour and remained poised and professional even in high-stress situations and when dealing with irate individuals
Enthusiastically greeted customers and offered dedicated service during entire transaction, improving bank satisfaction ratings by 30% quarterly
Completed highly accurate, high-volume money counts via both manual and machine-driven approaches.
Learned about customer's financial needs, established trust and optimized sales opportunities resulting in quality customer service.
Assisted customers with setting up or closing accounts, completing loan applications and signing up for new services.
Counted, verified and handled bank deposits and armored car transactions.
Devoted special emphasis to punctuality and worked to maintain outstanding attendance record, consistently arriving to work ready to start immediately.
Education
GED -
GED.com
Skills
Medical Billing
CPT Coding
HIPAA Compliance
Payment Processing
Insurance Knowledge
Medical Records Management
Medical Coding
Billing Systems
Claims Adjustments
Proficient in EPIC, EClinicals and other EMR Systems
Insurance coverage verification
Organization and Time Management
Data Entry
Timeline
Revenue Cycle Analyst
Baylor College Of Medicine
01.2022 - Current
Medical Billing Specialist | Insurance Verificatio
CHI Baylor St Luke's Hospital
02.2020 - 01.2022
Medical Records Coordinator| Insurance Specialist
South Central Houston Action Council
08.2018 - 12.2019
Workers' Compensation Billing Specialist
Toyota Financial Services
09.2017 - 08.2018
Finance Manager/ Sr. Loan Processing Specialist
Cottonwood Financial
11.2014 - 08.2017
Lead Teller Operations Specialist
Wells Fargo
04.2013 - 09.2014
GED -
GED.com
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