Summary
Overview
Work History
Education
Skills
Timeline
Generic

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
LeChe' Simmons