MiMi Bishopton
Irving,TX
Summary
Dedicated and detail-oriented Revenue Cycle Specialist with years of experience in managing the end-to-end revenue cycle for healthcare services. Proficient in insurance verification, claims processing, denials management, and patient billing. Strong analytical skills with a focus on optimizing financial processes and ensuring compliance with industry regulations.
Adept at minimizing financial losses and enhancing revenue integrity, I leveraged investigative techniques and critical thinking at Bank of America to significantly reduce fraudulent transactions. My expertise in revenue cycle management, combined with exceptional communication skills, drove a 98% first-pass acceptance rate in insurance claims, Demonstrating a profound impact on operational efficiency and customer satisfaction.
Overview
5
5
years of professional experience
Work History
Client Fraud Representative
Bank of America
09.2022 - Current
- Investigate and analyze suspicious transactions to detect and prevent fraud, minimizing financial losses for both clients and the bank.
- Handle incoming calls and inquiries from clients regarding potential fraud, providing clear and empathetic communication to ensure customer satisfaction.
- Collaborate with fraud analysts and the security team to escalate and resolve complex cases, ensuring swift and effective action.
- Educate clients on fraud prevention techniques, including recognizing phishing attempts and safeguarding personal information.
- Maintain detailed records of fraud cases, including documentation of actions taken and resolutions achieved.
- Monitor account activity for unusual patterns and proactively reach out to clients to confirm or deny suspicious transactions.
- Achieved a [percentage]% reduction in fraudulent transactions through vigilant monitoring and prompt intervention.
Revenue Cycle Specialist
Accuity Delivery Systems
05.2020 - 08.2022
- Managed the submission and follow-up of over 500 insurance claims per month, achieving a 98% first-pass acceptance rate.
- Identified and corrected claim errors, reducing the claim denial rate by 15%.
- Verified patient insurance coverage and benefits for an average of 200 patients weekly, ensuring accurate billing and reducing delays in reimbursement.
- Collaborated with front-end staff to streamline the insurance verification process, decreasing verification time by 20%.
- Resolved denied claims through resubmission and appeals, recovering an additional $250,000 in Prepared monthly reports on key performance indicators (KPIs) such as days in accounts receivable (A/R) and collection rates.
Conducted data analysis to identify areas for revenue cycle improvement, resulting in a 12% reduction in A/R days. over two years.
Developed a tracking system for denial trends, leading to process improvements and a 10% reduction in future denials.
- Generated and sent out patient bills, resulting in a 15% increase in on-time payments.
- Worked with patients to establish payment plans and provided clear explanations of their financial responsibilities.
- Ensured all billing practices complied with HIPAA and other regulatory requirements.
- Stayed updated on changes in insurance policies and coding regulations, providing training to team members.
Revenue Cycle Specialist
Bilh Pharmacy
03.2019 - 01.2020
- Increased revenue by identifying and resolving billing errors in a timely manner.
- Trained new team members on revenue cycle best practices, contributing to a more knowledgeable workforce.
- Served as a liaison between clinical departments, finance, and administration, ensuring smooth communication for proper revenue cycle management.
- Ensured accurate billing with thorough audits of patient accounts and insurance claims.
- Coordinated patient payment plans, balancing compassion with firmness to ensure timely payments while preserving positive patient relationships.
- Maintained clear documentation of all activities related to unpaid claims or denied services.
Education
Bachelor of Science - Marketing
Tallinn University Of Technology
Tallinn, Estonia 06.2018
Skills
- insurance Verification & Claims Processing
- Denials Management & Appeals
- Patient Billing & Collections
- Revenue Cycle Analysis & Reporting
- Compliance & Regulatory Knowledge (HIPAA, ICD-10)
- Excellent Communication & Customer Service
- Proficient in [Relevant Software/Tools: eg, Epic, Cerner, Meditech, Excel]
- Risk Analysis
- Customer Service & Communication
- Investigative Techniques
- Account Monitoring & Reporting
- Financial Transactions Management
- Problem-Solving & Critical Thinking
- Data Analysis
- Conflict Resolution
- Team Collaboration
Timeline
Client Fraud Representative
Bank of America
09.2022 - Current
Revenue Cycle Specialist
Accuity Delivery Systems
05.2020 - 08.2022
Revenue Cycle Specialist
Bilh Pharmacy
03.2019 - 01.2020
Bachelor of Science - Marketing
Tallinn University Of Technology