Nicole Austin
Corpus Christi,TX
Overview
26
26
years of professional experience
Work History
Lead - Insurance Billing and Follow Up
Vail Health Hospital
08.2016 - Current
- Manage daily accounts receivable tasks, assign claim worklists, and monitor productivity metrics to ensure maximum cash flow and rapid resolution of claims.
- Re-bill, and appeal denied and complex claims.
- Provide training to billing and follow-up representatives. Assist them with complex billing situations and different payer policies.
- Identify systemic billing issues, or payer delay trends, and make proactive recommendations to resolve.
- Perform quality audits on accounts and review claim edit lists to ensure team adherence to HIPAA, payer contracts, and internal compliance guidelines.
Regulatory Billing Specialist
Vail Health Hospital
08.2016 - Current
- Maintain the HRSA COVID-19 Uninsured Program.
- Process and bill facility UB and professional 1500 claims based on regulatory guidelines.
- Prepare redeterminations and clerical error reopening’s for claims reprocessing for Medicare claims.
- Led employee training for the Nthrive claims management system.
- Partner with internal departments to answer billing questions resolve medical denials.
Account Specialist Regulatory Audits
Centura Health
12.2011 - 07.2016
- Track the audit process of non-regulatory DRG changes for Medicare Advantage commercial insurances for multiple facilities.
- Process and track part B billing for Medicare claims.
- Track and oversee Medicaid audits from HMS to determine if Medicaid is primary and was billed correctly.
- Process and reconcile balances and overpayment recoveries from Medicare.
- Communicate with case managers from different facilities to ensure that the appeal process for different audits is documented and followed through successfully.
Application System Analyst Supervisor/Cash Control
Centura Health
12.2011 - 07.2016
- Led 11 employees through monthly one-on-ones and performance reviews.
- Analyze, design, and make recommendations to improve existing systems/or methods, and provide written, detailed reports of such.
- Assess assigned user areas for efficiencies and effectiveness. Evaluate alternative and technology solution on an ongoing basis and assures cost-effectiveness.
- Coordinate the preparation of departmental and interdepartmental policies and procedures, job functions, operating procedures, manuals, and system documentation.
- Preform quality audits of 835/ electronic files to insure accuracy of payments posting to patient accounts.
- Maintain and enroll EFT/ERA for all payers.
- Resolve escalated posting issues by researching the root cause and correct or change programming in systems as necessary.
- Participated in the Epic build in regard to cash posting.
- Updated electronic posting tables as needed to ensure accuracy in posting.
Chiropractic Assistance
Shuemake Family Chiropractic
09.2010 - 11.2011
- Facilitated the tracking of intern doctor’s progress as they were assigned to the office by different colleges.
- In-processed all patients.
- Prepared financial reports for doctor.
- Billed and handled all Medicare and Auto claims.
- Coordinated talks/seminars for the doctor to speak at on a monthly and quarterly basis.
Business Wireless Care Specialist
Sprint Nextel Corporation Inc.
10.2000 - 08.2010
- Provided facilitative leadership to a diverse team responsible for the design, engineering and implementation of highly complex integrated product/network solutions.
- Worked directly with customers, outside vendors, sales, network and operations to create solutions for the customer's changing demands.
- Assisted in the management of the customer lifecycle, from customer acquisition through billing activation across the product portfolio.
- Performed some administrative duties related to follow-up on customer orders, order monitoring, billing reconciliations, and equipment tracking.
Quality Assurance Analyst
Sprint Nextel Corporation Inc.
10.2000 - 08.2010
- Audited cash receipts; audit the cash posting team to insure Nextel payments are applied correctly, audit the processing team to ensure that charge backs, recurring credit card, and recurring direct debit enrollments were properly set up, and audit the cash research team insuring disputes are closed in the customer’s best interest.
- Prepared monthly, quarterly and yearly reports for the cash quality assurance team to send to management.
- Developed and documented the quality assurance process for cash applications using the Six Sigma equation.
- Monitored inbound regional collection calls to ensure quality assurance. Provide feedback to collection representatives regarding quality assurance and how it applies to their job.
- Schedule and conduct QA calibrations for first party agencies.
Cash Research Representative
Sprint Nextel Corporation Inc.
10.2000 - 08.2010
- Researched and resolved misapplied and lost payments in a timely manner.
- Reconciled the non-AR entries for the cash research team and forwarded the documentation to the reconciliation team.
- Communicated and supported the collections department and customers to help resolve collection issues on customer accounts.
- Posted credit card fallout payments for the cash research team.
Timeline
Lead - Insurance Billing and Follow Up
Vail Health Hospital
08.2016 - Current
Regulatory Billing Specialist
Vail Health Hospital
08.2016 - Current
Account Specialist Regulatory Audits
Centura Health
12.2011 - 07.2016
Application System Analyst Supervisor/Cash Control
Centura Health
12.2011 - 07.2016
Chiropractic Assistance
Shuemake Family Chiropractic
09.2010 - 11.2011
Business Wireless Care Specialist
Sprint Nextel Corporation Inc.
10.2000 - 08.2010
Quality Assurance Analyst
Sprint Nextel Corporation Inc.
10.2000 - 08.2010
Cash Research Representative
Sprint Nextel Corporation Inc.
10.2000 - 08.2010