LeChe' Simmons
9988 Windmill Lakes Blvd #318,TX
Summary
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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