Nichole Lee

• Maintained confidentiality of patient data and condition to safeguard health information.
• Upheld confidentiality requirements and regulatory compliance guidelines.
• Worked closely with patients to deliver excellent and direct individualized patient care.
• Acted as main point of contact for patients, doctors, and hospital staff by closely reviewing medical charts and maintaining high levels of communication.
• Delivered excellent patient experiences.
• Communicated with insurance companies to verify coverage and obtain authorizations for medical treatments and procedures.
• Assisted patients with completing necessary paperwork and forms to provide healthcare facilities with essential information to bill for services.
• Worked with patients to schedule tests and procedures.
• Monitored patient health records for accuracy to meet compliance with healthcare guidelines.
• Provided support and guidance to patients and families to navigate healthcare systems.
• Applied administrative knowledge and courtesy to explain procedures and services to patients.
• Answered incoming calls, scheduled appointments and filed medical records.
• Helped address client complaints through timely corrective actions and appropriate referrals.
• Verified patient insurance eligibility and entered patient information into system.
• Provided excellent customer service to patients and medical staff.
• Worked with patients to ascertain issues and make referrals to appropriate specialists.
• Recommended service improvements to minimize recurring patient issues and complaints.
• Greeted and assisted patients with check-in procedures.
• Engaged with patients to provide critical information.
• Followed document protocols to safeguard confidentiality of patient records.
• Compiled and maintained patient medical records to keep information complete and up-to-date.
• Offered simple, clear explanations to help clients and families understand hospital policies and procedures.
• Resolved customer complaints using established follow-up procedures.
• Processed payments using cash and credit cards, maintaining accurate records of transactions.
• Delivered support to medical staff in completion of patient paperwork.
• Responded to inquiries by directing calls to appropriate personnel.
• Trained new staff on filing, phone etiquette and other office duties.
• Facilitated communication between patients and various departments and staff.
• Organized patient records and database to facilitate information storage and retrieval.
• Assessed processes and procedures, complying with OSHA, and HIPAA regulations.
• Implemented onboarding for new employees, which enabled each to effectively learn tasks and job duties.
• Leveraged patient feedback and performed continuous process improvements to streamline day-to-day business operations and patient satisfaction.
• Addressed and remedied all patient or team member issues.
• Assisted with regulatory issues such as compliance.
• Created and implemented organizational policies and procedures.
• Developed policies and procedures for effective practice management.
• Developed close working relationships with front office and back office staff.
• Provided proper scheduling of patients, ensuring timely, and effective allocation of resources and calendars.
• Communicated effectively with staff members, physicians, and patients, employing active listening and interpersonal skills.
• Consulted with healthcare professionals on business decisions.
• Completed administrative patient intakes with case histories, insurance information and mandated forms.
• Assisted with medical coding and billing tasks.
• Obtained payments from patients and scanned identification and insurance cards.
• Placed new supply orders, managed inventory and restocked clerical spaces.
• Scheduled patient appointments in respective doctors' calendars and followed up with reminder phone calls.
• Performed various administrative tasks by filing, copying and faxing documents.
• Conducted patient intake interviews, recording and documenting relevant information.
• Coordinated referrals through insurance and other medical specialists and documented details in patient charts.
• Processed medical insurance claims and payments.
• Managed office bookkeeping with insurance billing and patient payments.
• Conducted primary source verifications such as background checks and board certifications.
• Received and evaluated applications to look for missing and inaccurate information.
• Enrolled providers and Medicaid, Medicare, and private insurance plans.
• Prepared records for site visits and file audits.
• Assisted with writing job postings and job descriptions for boards.
• Completed human resource operational requirements by scheduling and assigning employees.
• Collaborated with managers to identify and address employee relations issues.
• Pre-screened resumes prior to sending to corporate hiring managers for consideration.
• Tracked referral submission during facilitation of prior authorization issuance.
• Researched denied claims and contacted insurance companies to resolve these issues.
• Verified eligibility and compliance with authorization requirements for service providers.
• Prepared and distributed denial letters, detailing reasons for denial and possible appeal measures.
• Input all patient data regarding claims and prior authorizations into system accurately.
• Obtained and logged accurate patient insurance and demographic information for use by insurance providers and medical personnel.
• Reached out to insurance carriers to obtain prior authorization for testing and procedures.
• Fielded telephone inquiries on authorization details from plan members and medical staff.
• Processed patients lacking coverage for planned procedures.
• Provided prior authorization support for physicians, healthcare providers and patients in accordance with payer guidelines.
• Responded to inquiries from healthcare providers regarding prior authorization requests.
• Evaluated clinical criteria for approval or denial of services requiring pre-authorization.
• Analyzed medical records and other documents to determine approval of requests for authorization.
• Reviewed appeals for prior authorization requests and communicated with payers to resolve issues.
• Verified client information by analyzing existing evidence on file.
• Carried out administrative tasks by communicating with clients, distributing mail, and scanning documents.
• Assured timely verification of insurance benefits prior to patient procedures or appointments.
• Made contact with insurance carriers to discuss policies and individual patient benefits.
• Maintained confidentiality of patient finances, records, and health statuses.
• Determined appropriateness of payers to protect organization and minimize risk.
• Prepared insurance claim forms or related documents and reviewed for completeness.
• Modified, updated and processed existing policies.
• Communicated effectively with staff members of operations, finance and clinical departments.
• Maintained strong knowledge of basic medical terminology to better understand services and procedures.
• Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
• Notified insurance agents and accounting departments of policy cancellations and changes.
• Reviewed outstanding requests and redirected workloads to complete projects on time.
• Generated, posted and attached information to claim files.
• Interviewed policyholders to verify information and obtain additional details.
• Maintained accurate and up-to-date records of claim information for future reference.
• Collaborated with internal departments and external vendors to achieve fast resolution of claims.
• Acted as a departmental resource on appeals matters.
• Coordinated with contracting department to resolve payer issues.
• Contacted clients to collect information and communicate disposition of case, documenting interactions regarding eligibility, verification of benefits and claims payment status.
• Identified root cause of denials to provide plans for denial resolution.
• Conducted in-depth analysis of inquiries and complaints to compose appeal letters for clients.
• Documented medical claim actions by completing forms, reports, logs and records.
• Maintained knowledge of insurance coverage benefit levels, eligibility systems and verification processes.

• Receives inbound telephone calls from internal and external customers. ie. Patients, Insurance Representatives.
• Asks appropriate verification questions prior to releasing confidential patient information in accordance to company policy/HIPAA guidelines.
• Reviews explanation of benefits documents with knowledge and ability to explain information to patients/customers.
• Provides financial counseling service/payment arrangements to walk-in patients with outstanding account balances.
• Maintains and follows up on work queue accounts in a timely manner and documents all actions with clear and accurate documentation.
• Receives patient refund request information and forwards to Refunds processing.
• Requests information on patient charges from Clinics and Coding Quality and follows up in a timely manner.
• Returns telephone calls to follow up with patients on status or outcome of their inquiry within the timeframes established by the department.
• Answers patient registration phone calls.
• Obtains all insurance and demographic information from patient necessary to setup accounts.
• Verifies insurance coverage and sets up new members for all insurance contracts.
• Updates insurance and demographic information on existing patients as provided by patient call or additional information received from site resources.
• Runs registration reports and follows up on incomplete or missing account information as indicated to complete registration process.
• Researches member account transactions for eligibility inconsistencies.
• Maintains complete, accessible, dated files and resource materials.
• Provides assistance to coworkers as requested and/or necessary.
• Documents productivity statistics reports to CBO Supervisor.
• Maintains thorough and effective communication with all coworkers.
• Utilizes Payor website systems and tools to accurately complete registration process.
• Adheres to all company policies, including but not limited to, OSHA, HIPAA, compliance and Code of Conduct.
• Regular and dependable attendance.
• Follows the core competencies set forth by the Company, which are available for review on CMSweb.
• Works holiday shift(s) as required by Company policy

Account Transactions/Insurance

• Reviews account transactions for accuracy, and distributes patient credits.
• Uses appropriate transaction and ANSI codes per posting guidelines.
• Reviews and documents patient correspondence. Contacts patients to acknowledge receipts of correspondence in a timely manner, whenever necessary.
• Obtains updated insurance information, verifies and enters coverage and retro-adjudicates claims accordingly.
• Follows up with insurance carriers on payments and adjustments in order to resolve patient issue. Refers accounts to the Appeals department, if applicable.
• Reviews automated claim form and edits as necessary to reflect complete, accurate information.
• Utilize Payor websites efficiently and maintain confidential security passwords.
  Collections

Collections

• Receives credit card payments via telephone processes payments over the secured online portal.
• Establishes payment plans per Payment Agreement guidelines.
• Works closely with Collections department, collecting agencies, and/or directly with patients on payment of balances due.
• Sets up accounts with payment plan information in EPIC and the online bill pay tool, and clearly documents the terms of the agreement in EPIC.
• Consults with CBO Supervisor prior to offering discounts for non-covered services.
• Return telephone calls to follow up with patients on status of their inquiry within timeframes established by department.

• Resolved customer complaints via phone, email, or mail within established time frames.
• Assisted customers with technical problems related to products or services being purchased.
• Verified customer account data by reviewing existing records and confirming accuracy of data entered into system.
• Collected payments from customers over the phone using secure payment methods.
• Responsible for booking patient appointments utilizing an electronic medical record system, Epic.
• Confirms and/or makes any changes to demographic information and notifies patient of account balance.
• Adheres to scheduling protocols for multiple locations and provider restrictions.
• Uses electronic resource material as needed to support efficient appointment scheduling.
• Preforms within department metrics and call standards.
• Screens and directs incoming calls as needed.
• Verifies scheduling accuracy of MyChart appointments.
• Adheres to all company policies, including but not limited to, OSHA, HIPAA, compliance and Code of Conduct.
• Works holiday shift(s) as required by Company policy.
• Follows assigned work schedule, promptly returning from break and lunch periods
• Regular and dependable attendance.

• Books appointments utilizing computer system
• When booking appointments, also confirms and/or makes any changes to demographic information and notifies patient of account balance
• Greets patients and arrives them on computer system
• Verifies insurance eligibility by using online resources, Medifax, etc
• Ensures appropriate paperwork is complete and up-to-date and scans insurance card, if applicable
• Collects payments from patients, posts amounts, and balances drawer for end of day deposit
• Prints face sheets, receipts, and other documents as needed
• Notifies appropriate personnel of emergencies, messages, patient arrivals, etc
• Confirms in advance patient appointments
• Runs reschedule reports and books rescheduled appointments as necessary
• Ensures report is accurate and current
• Verifies Worker’s Compensation claims, ensures that paperwork is complete, and performs follow-up
• Assists patients with setting up payment plans
• Issues receipts for payment
• Books follow-up appointments
• May perform patient registration functions by collecting and entering demographic and insurance related information into computer system in order to set up patient accounts
• Creates master deposit as directed
• Responsible for handling the sort/distribute of Rightfax documents
• Processing onsite release of information requests
• Priority on-sight sorting, scanning, numbering loose papers.

• Receives inbound telephone calls from internal and external customers.
• Greeted and welcomed patients, family members, and visitors to the hospital.
• Assisted in providing a positive patient experience by attending to their needs and inquiries promptly.
• Provided information on medical treatments, procedures, and services available at the hospital.
• Acted as a liaison between patients and healthcare staff to ensure timely communication of information.
• Patients, Insurance Representatives
• Asks appropriate verification questions prior to releasing confidential patient information in accordance to company policy/HIPAA guidelines
• Reviews and documents patient correspondence
• Contacts patients to acknowledge receipts of correspondence in a timely manner, whenever necessary
• Answers patient registration phone calls
• Obtains all insurance and demographic information from patient necessary to setup accounts
• Verifies insurance coverage and sets up new members for all insurance contracts
• Updates insurance and demographic information on existing patients as provided by patient call or additional information received from site resources
• Runs registration reports and follows up on incomplete or missing account information as indicated to complete registration process
• Researches member account transactions for eligibility inconsistencies
• Maintains complete, accessible, dated files and resource materials
• Provides assistance to coworkers as requested and/or necessary
• Documents productivity statistics reports to CBO Supervisor
• Maintains thorough and effective communication with all coworkers
• Utilizes Payor website systems and tools to accurately complete registration process
• Adheres to all company policies, including but not limited to, OSHA, HIPAA, compliance and Code of Conduct
• Regular and dependable attendance
• Follows the core competencies set forth by the Company, which are available for review on CMSweb
• Works holiday shift(s) as required by Company policy.

• Coordinate with physician partner offices on scheduling cases and maintain schedules
• Coordinate with Navigators on introductory communication with new patients
• Responsible for the identification and proper data entry of insurance demographics
• Update patient demographics/information in system as needed
• Interview patients prior to surgery
• Accurately document information taken into Drchrono accounting system accordingly
• Communicate financial responsibility and make financial arrangements with the patient per Muve protocol to determine patient portions due
• Communicates this information with appropriate personnel for preparation of the pre-admission process
• Ensures all patient setup items are completed (i.e
• Patient eligibility, authorizations, benefits, claim information with insurance companies prior to surgery
• Contact patients and provide updates on benefit verification information, manage any requests additional information, insurance cards, and explain to the patient his or her financial responsibility such as copays, coinsurance, deductibles, at the time of service
• Act as a problem solver with patients regarding their insurance coverages by identifying affordable options to address remaining patient financial responsibilities
• Refer cases in which payers require additional clinical review to appropriate parties to ensure all services have necessary approvals before service is rendered
• General
• Greet guests, patients and support persons making them comfortable while onsite at Muve Health
• Register patients and orient support persons prior-to and day-of-surgery; as early as 4:45 AM local time
• Design and provide input on local and national programs and initiatives to improve Muve employees ('Muvers') and Muve patient quality of life
• Be the face of Muve Lakeway - you will be an integral part in creating an amazing employee and patient experience
• Promote a favorable facility image to patients, physicians, and families
• Manage incoming calls - respond promptly and accurately to telephone, written, and electronic inquiries from patients, providers, and others
• Maintains a thorough understanding of all major insurance plans and all ancillary procedures conducted by Muve Health and medical terminology and coding practices
• Ensure compliance with the Joint Commission and all other Federal, State and Regulatory Agencies
• Serve as backup to Business Office Coordinator
• Other duties, responsibilities and activities may change or be assigned at any time with or without notice.

• Obtain Scheduling sheets from Doctors, Hospitals, and Insurance plans via Fax, Email, and or Phone.
• Ensure Scheduled Procedures are covered, Meet Criteria and listed.
• Verify Insurances. Ie: Medicaid, Medicare, Government payors, Commercial and HMO/PPO Payors.
• Calculating Coinsurance per the payor and Self Pay estimates per Medicare guidelines.
• Communicate Insurance benefits and Financial responsibility to each patient prior to the date of service.
• Collect payments and Post the to correct accounts.
• Identify problems and or trends, obtain solutions and communicate during team meeting.
• Create/Update guides for positions within Department.

• Obtain Scheduling sheets from Doctors, Hospitals and Insurance Plans via Fax, Email and / or Requests via the phone
• Ensure Scheduled Procedures are covered, meet criteria and listed
• Verify insurances, ie: Medicaid, Medicare, other government payers, Commercial and HMO/PPO Payers
• Calculating Coinsurance per the payer and Self Pay estimates per medicare guidelines
• Communicate insurance benefits and financial responsibility to each patient prior to the date of service
• Entering the patient insurance information into the accounting system and selecting correct payers
• Collect payments and post them to correct accounts
• Identify problems and or trends, obtain solutions and communicate during team meeting
• Create/ Update guides for positions within Department
• Provider Data Management &, Research, review and make updates to user requests within provider data management system
• Review provider setup and ensure all records are accurate
• Update provider and practitioners status to par by adding claims payment information
• Setup and perform Facility enrollments such as hospital and clinics
• Conduct provisional credentialing checks for expedited and urgent provider enrollment
• Follow up with providers and physicians for missing documentation.

• Complete Police Report requests via the web
• Provide Claim Support for the Claim Handlers via phone queue, Call Center-ACD
• Train new staff of use of systems and phone training.

• Complete Insurance Verifications for Medicare, HMO's and PPO's
• Complete Authorizations and Referrals for Home Health Care
• Update and accept clinical for pending Authorizations for Liability, Workman’s' Comp, Working Aged, No Fault and Secondary Insurance.

• Handle all inbound Provider Calls on an ACD line or all Providers of various hospitals and clinics
• Data Enter Dental Claims
• Train Newly Hired Representatives.