Monica Bedonie
Phoenix,AZ
Summary
Dynamic administrative professional and case manager with over 20 years of experience delivering exceptional customer service in the hospital industry. Recognized for strong analytical, communication, and problem-solving skills, along with a proven ability to adapt quickly to new challenges and environments. Committed to fostering team success while continuously enhancing professional skills, with a proactive approach to optimizing processes and achieving organizational goals. Eager to leverage a detail-oriented mindset and effective time management in a full-time role that presents meaningful challenges and opportunities for growth.
Overview
12
12
years of professional experience
Work History
Patient Access Registration
Optum 360
01.2019 - Current
- Maintains up-to-date knowledge of specific admission, registration, and pre-registration requirements for all areas.
- Ensures the pre-registration process is complete for all assigned accounts at least 5-days prior to the scheduled date of service whenever possible.
- Verifies insurance eligibility and benefits on all assigned accounts using electronic verification systems or by contacting payers directly to determine level of insurance coverage. When contacting payers directly, utilizes approved scripting.
- Obtains referral, authorization and pre-certification information and documents this information in the ADT system.
- When appropriate, ensure the payer receives a Notice of Admission on all admissions, scheduled and non-scheduled, within 24-hours or the next business day.
- Meets CMS billing requirements for the completion of the MSP, issuance of the Important Message from Medicare, issuance of the Observation Notice, and other requirements applicable and documenting completion within the hospital’s information system for regulatory compliance and audit purposes.
- Follow up on missing authorizations. If authorization is not obtained within 48-hours prior to service, contact the patient to advise them of their financial responsibility.
- Thoroughly and accurately documents insurance verification and authorization information in the ADT system, identifying outstanding deductibles, copayments, coinsurance, and policy limitations, and advises patients and collects amounts due at or before the time of service.
- Identifies any outstanding balance due from previous visits, notifies patients during the financial clearance process and requests patient payment.
- Sets up payment plans for patients who cannot pay their entire current copayment and/or past balance in one payment.
- Explains the Payment and Billing Assistance Program to all patients regardless of financial concerns or limitations.
- Interviews self-pay patients to identify potential eligibility for government aid and/or other payer sources, including Medicaid presumptive eligibility. Follows appropriate policy and/or refers to eligibility vendor.
- Understands and follows the “Delay/Defer” policy and escalates accounts that do not meet financial clearance requirements to Patient Registration leadership immediately.
- For patients who qualify, offers a flat rate discount based on estimated charges, percent of reimbursement, and/or hospital specific policy and procedure.
- Thoroughly and accurately documents the conversation with the patient regarding financial liabilities, agreement to pay and/or payment assistance.
- Clarifies division of financial responsibility if payment for services is split between a medical group and an insurance company. Ensures this information is clearly documented in the ADT system.
- Verifies medical necessity check has been completed for outpatient services. If not completed and only when appropriate, uses technology tools to complete medical necessity checks and/or notifies patients that an ABN will need to be signed.
- Responsible for reviewing assigned accounts to ensure accuracy, and to ensure required documentation is obtained and complete.
Collection Specialist
Optum 360/Avella Specialty Pharmacy
05.2016 - 01.2019
- Worked claims that are in Overpayment. Researched claims using Absolute (AR), Emdeon, and Elevate Provider Network.
- Utilized Microsoft Word, Excel, Database Access, Office Ally and Nitro Pro. Collections for Pharmacy & Medical Claims, Review explanation of benefits for payment accuracy, Review of aging accounts, Familiarity with coding methods, Review all payer correspondence, Collect on private HMO, PPO and government payers, Extensive contact with insurance carriers of all types, Identification of overpayments, issuing refunds to the insurance carrier or the patient and identifying balances for write off.
Fiscal Service Specialist II
AZ Dept Health Services
08.2013 - 04.2016
- Contracted out with different companies to provide clerical assistance by assignment. Used AHCCCS, Medware and Neomatrix.
- Did charge entry, payment posting, EOB posting, printing and mailing patient statements. Answered/Returned Phone calls.
Education
Associate of Science - Social Service, Minor in Psychology
University of Arizona
Tucson, AZ01.1997
Associate Degree - Science
Dine’ College
Tsaile, AZ01.1995
Skills
- Proficient in data entry
- Friendly, positive attitude
- Collaborative teamwork
- Customer service
- Problem-solving
- Teamwork and collaboration
Timeline
Patient Access Registration
Optum 360
01.2019 - Current
Collection Specialist
Optum 360/Avella Specialty Pharmacy
05.2016 - 01.2019
Fiscal Service Specialist II
AZ Dept Health Services
08.2013 - 04.2016
Associate Degree - Science
Dine’ College
Associate of Science - Social Service, Minor in Psychology
University of Arizona