Nyree Barefield Ross
Humble,Texas
Summary
Dedicated Reimbursement Specialist with strong analyzation and negotiation abilities. Highly skilled in reviewing and processing analytical data to identify payer trends and related issues. Adept at providing exceptional customer service and conducting thorough coverage evaluations. Possesses expertise and in-depth knowledge of the operational characteristics and procedural requirements of Medicare/Medicaid.
Overview
28
28
years of professional experience
Work History
Senior Reimbursement Specialist
Texas Children’s Hospital
10.2023 - 10.2024
- Export EPIC reports from EPIC to identify and track trends
- Validate third party portal for accuracy
- Provide quarterly audit reports for payment variances with EPIC and third party vendor
- Assist with resolving reimbursement issues with managed care and commercial
- Provide weekly payment variance reports to management team
- Actively participates in the account/ payer resolution process and planning.
Senior Account Representative Out-of-State/Government Physician Billing
Texas Children’s Hospital
09.2021 - 10.2023
- Provide supplemental training to employees on collection procedures, workflows, policies, and procedures
- Perform quality review of accounts on team members
- Work escalated high dollar invoices
- Actively participate and lead special projects as assigned
- Export and provide weekly work queue analysis for team members
- Identify processing and payor issues
- Timely follow up on outstanding insurance accounts
- Participated in various special projects that recovered $500K in outstanding revenue
- Ensure that each completed account is documented with clear and concise notes
- Collaborate with management or other departments for claims resolution
- Recovered $260,000 in outstanding revenue in first 60 days
- Weekly check-in meetings with team members via Teams
- Verify payment discrepancies.
Account Representative Government Physician Billing
Texas Children’s Hospital
08.2019 - 09.2021
- Provide supplemental training to employees on collection procedures, workflows, policies, and procedures
- Perform quality review of accounts on team members
- Work escalated high dollar invoices
- Actively participate and lead special projects as assigned
- Export and provide weekly work queue analysis for team members
- Identify processing and payor issues
- Timely follow up on outstanding insurance accounts
- Participated in various special projects that recovered $500K in outstanding revenue
- Ensure that each completed account is documented with clear and concise notes
- Collaborate with management or other departments for claims resolution
- Recovered $260,000 in outstanding revenue in first 60 days
- Weekly check-in meetings with team members via Teams
- Verify payment discrepancies.
Accounts Representative II
Houston Methodist Hospital
11.2016 - 07.2019
- Recovered $300,000 in self-pay claim payments
- Research CPT and ICD-9/ICD-10 coding discrepancies
- Collaborate with management team to reduce aging accounts
- Provide follow up on outstanding accounts in a timely manner
- Ensure that accounts are completed and worked at a high level of quality
- Ensure that each completed account is documented with clear and concise notes
- Provide training to new employees on billing software and processes
- Meetings with physicians regarding outstanding AR.
Senior Billing Specialist I/ II
Houston Methodist Hospital
04.1997 - 11.2016
- Recovered $300,000 in self-pay claim payments
- Research CPT and ICD-9/ICD-10 coding discrepancies
- Collaborate with management team to reduce aging accounts
- Provide follow up on outstanding accounts in a timely manner
- Ensure that accounts are completed and worked at a high level of quality
- Ensure that each completed account is documented with clear and concise notes
- Provide training to new employees on billing software and processes
- Meetings with physicians regarding outstanding AR.
Office Supervisor/Medical Coder
Houston Digestive Diseases Consultants
07.2004 - 10.2006
- Coding and billing of in-patient/out-patient services from provider documents and operative reports
- Research CPT and ICD-9 coding discrepancies
- Actively maintained current working knowledge of CPT and ICD-9 coding principles
- Examine diagnosis codes for accuracy, completeness, specificity, and appropriateness
- Accurately enter procedure/diagnosis codes into billing software
- Communicate with providers regarding coding discrepancies or changes
- Assist in training new employees with software and office processes
- Establish and maintain a positive work environment that supports high morale
- Approve and manage timecards, schedules, vacation requests, and payroll submission
- Responsible for cash handling procedures
- Manage and order office supplies
- Provide conflict resolution
- Delegate work duties to staff
- Provide and review evaluations for employee performance
- Insurance verification and precertification for hospital and in-office procedures.
Office Supervisor/ Medical Coder
Houston Digestive Diseases Consultants
01.1999 - 07.2004
- Coding of in-patient/ out-patient services from provider documents and operative reports
- Research charges for CPT/ICD-9 discrepancies
- Accurately enter procedure/diagnosis codes into billing software
- Assist with training of new employees on billing software and office processes
- Approve and manage timecards and schedules
- Manage inventory and order office supplies as needed
- Provide and review evaluations for employee performance
- Follow up on outstanding insurance balances
- Notify patients of deductibles/ co-insurance prior to out-patient services
- Obtain authorization for in-patient/out-patient services.
Medical Coder/Precertification Specialist
Houston Digestive Diseases Consultants
01.1999 - 07.2004
- Coding and billing of in-patient/out-patient services from provider documents and operative reports
- Research CPT and ICD-9 coding discrepancies
- Actively maintained current working knowledge of CPT and ICD-9 coding principles
- Examine diagnosis codes for accuracy, completeness, specificity, and appropriateness
- Accurately enter procedure/diagnosis codes into billing software
- Communicate with providers regarding coding discrepancies or changes
- Assist in training new employees with software and office processes
- Establish and maintain a positive work environment that supports high morale
- Approve and manage timecards, schedules, vacation requests, and payroll submission
- Responsible for cash handling procedures
- Manage and order office supplies
- Provide conflict resolution
- Delegate work duties to staff
- Provide and review evaluations for employee performance
- Insurance verification and precertification for hospital and in-office procedures.
Education
Bachelor of Business -
University Of Houston Downtown
08.2024
Certificate: Outpatient Coder -
AAPC
01.2020
Associate of Arts in Multidisciplinary Studies -
Houston Community College
01.2019
Skills
- Proficient in using EPIC and Microsoft Office
- Ability to analyze complex data and provide insights
- Remote work experience
- Knowledge of billing systems
- Data Analytics
- Strong Customer Service Skills
- Medical terminology
- Team player
- Excellent time management skills
- Conflict Management
- Knowledge of ICD-10-CM/CPT and HCPCS codes
- Knowledge of Managed Care Plans/Medicare and Medicaid (Out-of-State Medicaid Plans)
- Strong communication and interpersonal skills
- Microsoft Office
- Excel
- Appeals processing
- Medical Billing
- HIPAA Compliance
- Medicare Compliance
- Claims Management
- Provider Relations
- Medicaid knowledge
- Financial Accounting
- Accounts receivable management
Timeline
Senior Reimbursement Specialist
Texas Children’s Hospital
10.2023 - 10.2024
Senior Account Representative Out-of-State/Government Physician Billing
Texas Children’s Hospital
09.2021 - 10.2023
Account Representative Government Physician Billing
Texas Children’s Hospital
08.2019 - 09.2021
Accounts Representative II
Houston Methodist Hospital
11.2016 - 07.2019
Office Supervisor/Medical Coder
Houston Digestive Diseases Consultants
07.2004 - 10.2006
Office Supervisor/ Medical Coder
Houston Digestive Diseases Consultants
01.1999 - 07.2004
Medical Coder/Precertification Specialist
Houston Digestive Diseases Consultants
01.1999 - 07.2004
Senior Billing Specialist I/ II
Houston Methodist Hospital
04.1997 - 11.2016
Bachelor of Business -
University Of Houston Downtown
Certificate: Outpatient Coder -
AAPC
Associate of Arts in Multidisciplinary Studies -
Houston Community College
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