Nefertiti Francis
Summary
A professional, competent, and motivated team player, with the ability to multitask, prioritize, and meet deadlines, possessing high-stress tolerance, strong communication and organizational skills, attention to detail and accuracy in documentation, a thorough knowledge of medical terminology and medical procedures (CPT), and diagnosis codes (ICD-9 ), and compliant with HIPPA regulations, proficient in ability to navigate insurance payor websites.
Efficient medical professional with 20+ years of experience. Productive and diligent with passion for resolving discrepancies through attention to detail and creative problem-solving.
Passionate about perpetuating company values through impeccable work ethic and drive. Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy.
Overview
28
28
years of professional experience
1
1
Certification
Work History
Professional Medical Biller/Precertification Coord
Mass Eye And Ear Infirmary
Boston, MA
01.2014 - Current
- Review all inpt/outpt functions of billing and update database as required
- Respond to high volume calls in a timely manner including any follow up billing correspondence, inquiries, and complaints received via email, fax, mail or telephone call by patients/inter-office depts
- Outside medical facilities, lawyers, and insurance companies
- Process lawyer, insurance and patient requests for itemized billing statements, which may include corresponding to MVA or WC cases
- Verify/Update insurance information and demographics, as needed
- Analyze and reconcile customer accounts
- Process patient/insurance payments
- Responsible for daily ledger reports for patient payments
- Initiate collection of delinquent accounts as well as offer payment resolution plans
- Maintain and update billing account records, as well as monitor account irregularities.
- Reduced claim denials by meticulously reviewing patient insurance information and coding practices.
- Managed appeals process for denied claims, resulting in successful reimbursements from insurance companies.
- Filed and updated patient information and medical records.
OR Scheduler
Mass Eye and Ear Infirmary
01.2008 - 01.2014
- Schedule surgical procedures and complete surgeon's orders, answer and return telephone calls in a timely, professional manner, enter patient demographics
- Maintain accurate and current records of physician's privileges/credentials, communicate with credentialing specialist, physicians' secretaries, and other corresponding departments and/or outside practices
- Schedule MRI/CT/Laser procedures according to protocol/procedure policies
- Prepare associated reports as directed by manager
- Print and edit daily/weekly schedules of surgeries, deliver to appropriate departments
- Provide staff support as needed.
Pre-Certification Screener
Mass Eye and Ear Infirmary
01.2009 - 01.2010
- Verified demographics and insurance benefits and eligibility
- Interacted with patients, insurance companies, internal and external physicians and offices
- Navigated insurance payor websites and educated patients on financial responsibility
- Obtained patient authorizations and referrals, as required by insurance guidelines/policies
- Addressed and resolved any managed-care concerns.
Patient Services Representative
Aspen Dental
01.2006 - 01.2007
- Provided quality customer service, data entry, filing, record keeping, mail processing, management of multi-lined telephone, insurance verification/billing, and payment collection.
CNA /HHA
Amazing Grace Private Nursing Care Facility
01.2005 - 01.2006
- Delivered direct patient care, accompanied patients to physician appointments, grocery shopping, etc.
Certified Nursing Assistant
Hebrew Rehabilitation Center
01.2003 - 01.2006
- Delivered highest quality of patient care assisting with ADL's, taking vital signs, heights, weights, and I/O's, and assisting with feeding, transporting, and preparation.
Unit Coordinator
New England Medical Center
01.2001 - 01.2002
- Scheduled patient admissions and discharges, diagnostic/tests and appointments in IDX system, served as contact for internal/external affiliates, patients, doctors, and all other staff
Clinical Assistant/Patient Coordinator
Advanced Spine Center
01.2001 - 01.2002
- Prepared attorney statements and maintain ongoing communication with various attorneys, insurance companies and medical personnel to ensure that patients received quality coordinated care and were properly billed
- Maintained patient records, process new referrals & discharges, as well as scheduled weekly appointments
Unit Coordinator
Boston Medical Center, Boston
Boston, MA
01.1996 - 12.2000
- Handled confidential patient information with discretion, adhering to HIPAA regulations to protect privacy rights.
- Trained new Unit Coordinators on unit-specific protocols, contributing to overall team proficiency in delivering exceptional patient care experiences.
- Achieved appropriate patient flow by admitting, transferring and discharging patients in computer system and notifying appropriate personnel of patient status verbally and through signage.
- Managed medical emergencies calmly and effectively while activating appropriate codes according to hospital policy; ensuring prompt response from specialized personnel.
- Answered telephone calls to offer office information, answer questions, and direct calls to staff.
- Assisted with processing patient admissions, transfers and discharges.
- Developed strong working relationships with ancillary departments, facilitating timely completion of diagnostic tests and treatments for patients.
- Reduced errors in medication administration through meticulous verification of physician orders and close monitoring of potential interactions or allergies.
- Received physicians and visitors on unit, identifying, acknowledging and responding to patient, physician and staff needs to meet operational and care needs of parties.
- Coordinated seamless transportation arrangements for patients requiring off-site diagnostic testing or specialty consultations.
- Coordinated and maintained referral sources related to admissions, discharges, and follow up services to sustain daily census requirements.
- Enhanced unit efficiency by maintaining up-to-date patient information and coordinating interdisciplinary care.
Education
Nursing
Quincy Community College
01.2005
Certified Nursing Assistant / Home Health Aide
Dimmock Community Health Center for Workforce Development
01.2003
Psychology
University of Massachusetts Boston
01.1999
High School Diploma
Multicultural Middle College High School
01.1998
Skills
- Knowledge of office equipment and proficiency with computers and window-based products, dental and medical terminology and medical procedures (CPT), and diagnosis codes (ICD-9), and compliant with HIPPA regulations
- Word Perfect
- Microsoft Outlook
- Clinic Works
- Windows
- ESI
- Epic
- MASERVE
- IDX
- MDS
- Paragon
- MA21
- MMIS
- Microsoft Office
- PowerPoint
- Microsoft Word
- Excel
- Access
- Patient Gateway
- Insurance Billing
- Insurance Verification
- Customer Service
- CPT Knowledge
- Medicaid and Medicare Knowledge
- Data Entry
- Medicare and Medicaid process
- Denial Management
- ICD-10
- Worker's Compensation Knowledge
- Multitasking and Organization
- Critical Thinking
- Teamwork and Collaboration
- Work Prioritization
- Payer Contracts
- Medical Terminology
- Commercial and Private Insurance
- Error Revision
- Deadline Adherence
- Decision-Making
- EPIC
Certification
- Certified Nursing Assistant / Home Health Aide 2003
- CPR/First Aid 2003
Timeline
Professional Medical Biller/Precertification Coord
Mass Eye And Ear Infirmary
01.2014 - Current
Pre-Certification Screener
Mass Eye and Ear Infirmary
01.2009 - 01.2010
OR Scheduler
Mass Eye and Ear Infirmary
01.2008 - 01.2014
Patient Services Representative
Aspen Dental
01.2006 - 01.2007
CNA /HHA
Amazing Grace Private Nursing Care Facility
01.2005 - 01.2006
Certified Nursing Assistant
Hebrew Rehabilitation Center
01.2003 - 01.2006
Unit Coordinator
New England Medical Center
01.2001 - 01.2002
Clinical Assistant/Patient Coordinator
Advanced Spine Center
01.2001 - 01.2002
Unit Coordinator
Boston Medical Center, Boston
01.1996 - 12.2000
Nursing
Quincy Community College
Certified Nursing Assistant / Home Health Aide
Dimmock Community Health Center for Workforce Development
Psychology
University of Massachusetts Boston
High School Diploma
Multicultural Middle College High School