Nykia Cooper-Williams
Houston,TX
Overview
4
4
years of professional experience
1
1
Certification
Work History
Claims Billing Specialist
OrthoLoneStar
Houston, TX
10.2023 - Current
- Audits claims for billing errors and finding common denial trends
- Collecting patient payments
- DME AR reports for outgoing claims or claims appeals (old and new) DOS
- Reviewing Surgery reports for missing documentation
- Inbound / Outbound calls for patients and insurance carriers ( BCBS, Aetna, Cigna, Humana, USDOL..
- ECT )
- Submissions of Appeals, Adjustments, and Reconsiderations
- Patient / Insurance refunds when qualified
Patient Access Specialist
CHRISTUS Health
Houston, TX
10.2022 - 10.2023
- Provides effective collection services, ensuring the successful recovery of accounts in accordance with client and state guidelines
- Documents and updates patient account information in collection software system timely and accurately to include appropriate account status
- Handles inbound patient and/or carrier calls promptly and professionally, providing assistance and resolution to account inquiries, issues, and requests
- Uses collection tools effectively to ensure quality recovery services and meet or exceed established goals and work standards
- Performs research and analysis of account, and claim issues and strives to resolve problems timely and accurately
- Ensure daily productivity standards are met
Claims Verification Specialist
Center For Advanced Sinuses
Houston, TX
02.2021 - 10.2022
- Confirms the need for an authorization and takes the appropriate actions to ensure the verification is obtained
- Verifies the basic patient/service information is available - the minimum data set for scheduling a service
- If not present, initiates appropriate activity to obtain the required data set, such as insurance
- Prioritizes the urgency of the authorization by anticipating the approximate time it may take obtain the authorization from the insurance company, the complexity of the procedure and the scheduled date of service; follows up with insurance company to accelerate responses and expedite authorizations
- Evaluates or assists with the evaluation of cases when the insurance company has denied payment to determine next steps
- Interacted with medical and professional staff to obtain appropriate clinical documentation for review
- Takes the appropriate actions when it appears that the authorization will not be provided on a timely basis; to include escalation
- Advises and coordinates with the authorizations team regarding problematic transports
- Support co-workers and engage in positive interactions
- Communicate professionally and timely with internal and external customers
- Demonstrate friendliness by smiling while speaking to customers
- Provide helpful assistance in anticipating and responding to the needs of our customers
- Collaborate with customers in planning and decision making to result in optimal solutions
- Ability to stay calm under pressure and deal effectively with difficult situations
Education
Diploma -
Pima Medical Institute
11.2014
Skills
- Phlebotomy
- Vital Signs
- MDS
- Infection Control Training
- ICD coding
- ICD-10
- CPT Coding
- Medical Records
- Insurance Verification
- Patient Care
- Medical Scheduling
- Phone Etiquette
- Quality Assurance
- Medical Office Experience
- Supervising Experience
- Anatomy Knowledge
- Medical Billing
- Epic
- Documentation Review
- Case Management
- Medical Coding
- Medical Terminology
- Transcription
- Meditech
- Athenahealth
Certification
Certified Phlebotomy Technician (CPT), 11/01/14, Present
Willing To Relocate
Houston, TX
Timeline
Claims Billing Specialist
OrthoLoneStar
10.2023 - Current
Patient Access Specialist
CHRISTUS Health
10.2022 - 10.2023
Claims Verification Specialist
Center For Advanced Sinuses
02.2021 - 10.2022
Diploma -
Pima Medical Institute