Pauline Breaton
Grayson,GA
Summary
Dynamic Revenue Cycle Specialist with strong attention to detail and excellent communication skills. Proven ability to resolve billing inquiries and analyze financial data to minimize denials, ensuring a seamless customer experience.
Detail-oriented Revenue Cycle Specialist with over 9 years of experience in medical billing and coding. Expertise in analyzing denied claims and resolving discrepancies, driving improvements in claim processing efficiency and enhancing revenue performance.
Overview
9
9
years of professional experience
Work History
Revenue Cycle Specialist
Metroderm PC/UDP
2017.03 - Current
- Process and submit insurance claims to various payers, ensuring accuracy in coding and billing information minimize denials and delays.
- Review patients accounts to verify correct insurance billing information, update records as necessary, and resolve any discrepancies in patient account balances.
- Analyze denied claims to identify denials reasons and perform the necessary follow-up actions including appealing denied claims with appropriate documentation and justification.
- Coordinate with healthcare providers to obtain necessary medical documentation, referrals, or authorization required for claim processing and reimbursement.
- Engage directly with patients to explain their bills, resolve billing inquiries, and set up payment plans for outstanding balances, ensuring a positive customer service experience.
- Monitor and report on key performance indicators related to revenue cycle activities, such as claims denial rates, time to payment, and outstanding accounts receivable, to identify areas for improvement.
- Implement and adhere to compliance standards and regulations related to medical billing and coding, maintaining confidentiality of patient information in accordance with HIPPA guidelines.
- Participate in the development and testing of new billing software and systems to improve revenue cycle efficiency, including providing feedback on software performance and suggesting enhancements.
- Analyze financial data to identify trends and improve revenue performance.
- Follow up on denied and rejected claims to ensure timely resolution.
- Participate in revenue cycle audits and compliance reviews
Education
Medial Terminology & Anatomy & Physical Certificat
Midland Technical College
Columbia, SC2008-06
Paralegal Certificate
York College
New York, NY2000-05
Skills
Customer Service, MS Word, MS Excel
Ability to Multitask, Strong Knowledge of DME Revenue Cycle
Knowledge of 1500 forms, ICD 10, HCPC
Knowledge of Medicare and Commercial claim filing procedures and regulations
Strong attention to details and ability to work independently and as part of team
Excellent communication and problems-solving skills
Time Management
Adaptability and Flexibility
Critical Thinking
Timeline
Revenue Cycle Specialist
Metroderm PC/UDP
2017.03 - Current
Medial Terminology & Anatomy & Physical Certificat
Midland Technical College
Paralegal Certificate
York College