Morgana Hall
Los Angeles,CA
Summary
To obtain a position in the medical field where I can apply my knowledge, skills, and abilities to advocate for the organization, patients, and providers alike.
Overview
13
13
years of professional experience
Work History
IHSS Care Provider
County Of Los Angeles, Contactor
05.2016 - Current
- Prepared nutritious meals according to dietary restrictions and preferences for better overall health and after meal clean-up.
- Provided transportation for clients to medical appointments, social events, and other necessary outings.
- Ensured a safe and comfortable environment by maintaining a clean and well organized living space.
- Maintained strict confidentiality regarding all aspects of client personal information and medical history.
- Traveled to clients' homes to complete healthcare services and promote continuity of care.
- Managed challenging behaviors effectively through de-escalation techniques and clear communication strategies.
Financial Counselor/Clearance Specialist
Providence Health Systems Heme/Onc Clinic
05.2019 - 07.2021
- Verified patient’s demographics and other information is up to date.
- Conducted interviews with patients and family members and answered questions regarding insurance benefits.
- Safeguarded client confidentiality while maintaining accurate records and documentation of counseling sessions.
- Conducted detailed financial reviews of clients’ eligibility for services or benefits to assess compliance and ensured adherence to regulatory guidelines and policies for clients’ eligibility criteria.
- Completed or assisted patients in the completion of benefit forms for third party resources; contacts private insurance companies to verify coverage and to obtain authorization for services; verifies existing governmental coverage for health care services.
- Examined details in the patient medical records and H&P to communicate in an educated manner with medical directors, physicians, or other clinical staff regarding codes for regimens.
- Organized communication between medical director and physician on denied services to smooth claims processes.
- Identified healthcare resources and programs for patients unable to meet financial obligations.
- Documented details regarding contact with patients, providers and other individuals in system.
Claims Examiner
Golden State Health
11.2017 - 11.2020
- Reviewed and interpreted provider contracts to properly adjudicate claims.
- Reviewed and interpreted Division of Financial Responsibility (DOFR) for claims processing.
- Verified eligibility and benefits as necessary to properly apply co-pays.
- Researched authorizations and properly selected appropriate authorization for services billed.
- Completed basic validation prior to offset to include, but not limited to, eligibility, COB, SOC, and DRG requests.
- Followed department processing policies and correctness in performing departmental duties, including but not limited to, claim processing (claim reversals and adjustments), claim recovery (refund request letter, refund checks, claim reversals), reporting and documentation of recovery as explained in departmental Standard Operating Procedures.
- Responded to provider correspondence related to recovery requests and provider remittances where recovery has occurred
- Worked with Finance to complete accurate and timely posting of provider and vendor refund checks and manual check requests to reimburse providers.
Outpatient U.M. Coordinator
MedPoint Management
01.2017 - 05.2019
- Distinguished urgent, routine, and unplanned complex referrals and TAR authorizations requests
- Solely responsible for retro referral processing and ensured referrals are handled within compliance and timely guidelines
- Worked with Medical Directors and other clinical staff to facilitate medical directors and peer to peer communications
- Researched payments and claims
- Knowledge of medical terminology, CPT/HCPCS codes and of health networks, IPA’s, HMO’s, PPO’s, PCPs, and contract affiliations.
Customer Quality Specialist
Apria Healthcare
05.2011 - 05.2013
- Verified insurance benefits and eligibility prior to processing patient DME orders.
- Informed patients of their financial responsibility and collected outstanding payments.
- Obtained needed medical documents from prescribing physicians to ensure correct and timely reimbursement.
- Ensured consistent adherence to company policies, procedures, and work instructions relating to quality management practices across all organizational levels.
- Served as a liaison between customers and internal departments, effectively communicating expectations and requirements pertaining to product specifications and performance criteria.
- Streamlined complaint resolution process for faster response times and increased customer loyalty.
Education
Health Information Management -
Eastern Gateway Community College
Steubenville, OH01.2022
Skills
- Authorizations submission for all service scopes performed in both a hospital and professional setting; HCPCS; claims payment mythologies; claims adjudication, cycle; admitting; coding, collections; and payment posting
- Proficient in several EMR systems including EPIC, EZ-Cap and several other systems
- Working knowledge of contract calculation engines, demonstrated knowledge medical terminology
- Practice management scheduling systems
- Proficiency of all lines of business including state and federal
- Proficient in facility and professional contracted versus non-contract payers including interpretation of language specific to covered services
- Conducted interviews with patients and family members to determine financial status, counseled and assisted in obtaining foundation assistance sponsored
- Patients or direct billing: Informed patients of potential out of pocket expenses Supports patients’ billing inquires related to explanation of benefits, self-pay billing questions, patient disputes, verifications, and other billing inquiries
- Supports and performs account reconciliation for both internal billing and for third-party physicians upon completion of care, as needed Produces and requests patient refunds Provides patient statements upon request
- Researched tracers, adjustments, and re-submissions
Timeline
Financial Counselor/Clearance Specialist
Providence Health Systems Heme/Onc Clinic
05.2019 - 07.2021
Claims Examiner
Golden State Health
11.2017 - 11.2020
Outpatient U.M. Coordinator
MedPoint Management
01.2017 - 05.2019
IHSS Care Provider
County Of Los Angeles, Contactor
05.2016 - Current
Customer Quality Specialist
Apria Healthcare
05.2011 - 05.2013
Health Information Management -
Eastern Gateway Community College