MONICA WHEATLEY
Emory University Hospital
Tucker,GA
37
years of professional experience
Results-oriented Payor Response Analyst with expertise in optimizing business operations. Specializes in account reconciliations that enhance profitability and reduce costs. Efficient in processing payments to minimize debt and avoid fees, while ensuring accuracy in ledger information.
Work History
Revenue Cycle Specialist II
4 Years- Led cross-functional teams to implement system upgrades for revenue management.
- Developed training materials for staff on compliance regulations
- Developed training materials for staff on compliance regulations and best practices.
- Increased revenue by identifying and resolving billing errors in a timely manner.
- Reached out to insurance companies to verify coverage.
- Collaborated with clinical departments to resolve discrepancies in charge capture.
- Enhanced customer satisfaction by promptly addressing and resolving billing disputes.
- Balanced and reconciled accounts.
Patient Representative 2
4 Months- Identified issues, analyzed information, and provided solutions to enhance patient satisfaction.
- Completed all paperwork and addressed discrepancies promptly to ensure compliance and accuracy.
- Performed duties in accordance with all applicable standards, policies and regulatory guidelines to promote safe working environment.
- Reviewed credit accounts to ensure accuracy in financial records.
- Prepared account documentation for approval to facilitate refund processing.
- Located Explanation of Benefits and payment receipt to confirm patient liability.
- Retrieved patient information from Medicaid website to assist with claims.
- Processed refunds to designated carriers to resolve billing issues.
Billing Specialist/Payer Response Anaylist, Remote
12 Years 9 Months- Worked effectively with medical payers such as Medicare, Medicaid, commercial insurance to obtain timely and accurate payments.
- Identified, researched and resolved billing variances to maintain system accuracy and currency.
- Analyzed complex Explanation of Benefits forms to verify correct billing for insurance carriers.
- Contacted clients with past due accounts to establish payment plans and negotiate restructuring options.
- Processed insurance company denials by auditing patient files, researching procedures and diagnostic codes to determine proper reimbursement.
- Performed various billing tasks to ensure accurate and timely invoicing of services. . recorded information in company databases.
- Performed targeted collections on past due accounts aged over 15 days.
- Checked insurance eligibility by making appropriate phone calls and verifying on the website.
- Contacted clients with past due accounts to formulate payment plans and discuss restructuring options.
- Executed billing tasks and recorded information in company databases.
- Checked insurance eligibility by making appropriate phone calls and verifying on the website.
- Determined proper codes for medical records and patient services.
- Verified all patient demographic information when registering for services.
- Established contact with ordering physician's office to resolve any issues or to collect missing vital information.
- Documented patient medical information, case histories and insurance details to facilitate smooth appointments and payment processing.
- Analyzed complex Explanation of Benefits forms to ensure accurate billing and resolve discrepancies with insurance carriers.
- Reviewed outgoing bills for eligibility and accuracy.
- Reviewed outgoing bills for eligibility and accuracy.
- Collected necessary information from clients and databases to streamline billing processes. from multiple sources to simplify billing and organize accounts.
- Moved outstanding balances to appropriate accounts for accurate financial tracking. to correct payers.
- Checked ICD-9 coding on claims to ensure accuracy.
- Utilized talents and expertise to complete on-time and accurate monthly closing processes, journal entries and accruals.
- Processed insurance company denials by auditing patient files and researching procedures and diagnostic codes to secure appropriate reimbursement.
Insurance Verification Specialist
1 Year- Verified insurance coverage prior to all procedures or appointment scheduling.
- Verified that patient had proper insurance coverage prior to any procedures or appointment scheduling.
- Contacted insurance companies to obtain and clarify patient benefit information for accurate processing.
- Instructed clients on amounts covered under benefits plans
- Updated patient financial information to promote accurate record keeping
- Verified patient insurance coverage prior to procedures or appointment scheduling to prevent delays and ensure compliance.
- Accurately inputted all patient and insurance information into company's computer system using Horizon,Meditech,Eagle Etc.
- Accurately input all patient and insurance information into company's computer system using Horizon,Meditech,Eagle Etc.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Contracted other medical facilities to confirm medical histories and prevent inaccurate diagnosis.
MEDICAID APPLICATION REPRESENTATIVE
6 Years 1 Month- Delivered prompt, accurate services leveraging knowledge of government regulations, health benefits, and healthcare terminology to facilitate Medicaid access.
- Processed Medicaid applications thoroughly by gathering and organizing essential documents from patients and family members to ensure compliance and efficiency.
- Conduct face to face interviews with patients and family members to obtain documents for Medicaid applications.
- Conducted bedside interviews to gather necessary information for Medicaid applications.
- Verified insurance information to support timely processing of applications for nursing homes, rehab, and home care agencies.
Insurance Follow Up/Collector Agent
12 Years 6 Months- Reviewed collection reports to determine status of collections and amounts of outstanding balances.
- Used skip tracing resources to locate debtors and updated information in company system.
- Counseled debtors on payment options, arranging installment agreements to facilitate repayment.
- Responded to correspondence from insurance companies.
- Followed up on potentially fraudulent claims initiated by claims representatives.
- Evaluated accuracy and quality of data entered into agency management system.
- Performed targeted collections on past due accounts aged over 60 days.
- Contacted clients with past due accounts to develop payment plans and explore restructuring options.
- Processed over 50 payments weekly in the accounting system.
- Enforced scheduled collection campaigns to prevent loss and achieve targeted recovery rates.
Education
Certificate Program: Medical Terminology/ICD9/CPT4 - Medical Billing
Certificate Program: MEDICAL BILLING AND CODING - Medical Coding
Skills
Claims processing
MEDICAL TERMINOLOGY
Judgment skills
Data analysis
Auditing proficiency
Conflict resolution
Customer engagement
Insurance
Analytical skills
Invoice processing
Decision-making
Debt management
Basic math
Math
Basic Computer
Microsoft Office
Medical billing
Medical terminology
WebMed
Patcom
Eagle
MDX
SSI
Clients
Medical coding
Reconciling
Database management
Microsoft Office
HIPAA compliance
Timeline
Revenue Cycle Specialist II
Emory University Hospital
08.2021 - 08.2025Read More
Patient Representative 2
Emory Health Care
04.2021 - 08.2021Read More
Billing Specialist/Payer Response Anaylist, Remote
HCA/Parallon
07.2008 - 04.2021Read More
Insurance Verification Specialist
Northside Hospital Atlanta
07.2007 - 07.2008Read More
MEDICAID APPLICATION REPRESENTATIVE
FRR RECOVERY INC
02.2001 - 03.2007Read More
Insurance Follow Up/Collector Agent
Northshore/LIJ
08.1988 - 02.2001Read More
York College Of The City University Of New York
Certificate Program: MEDICAL BILLING AND CODING from Medical Coding
Read More
Queens College Of The City University Of New York
Certificate Program: Medical Terminology/ICD9/CPT4 from Medical Billing
Read More