Peggy Powell
Edmond,OK
Overview
24
24
years of professional experience
Summary
Dedicated Healthcare Professional experienced in managing reimbursement processes and resolving billing issues. Achieved process efficiency and compliance through strong analytical skills and attention to detail. Committed to contributing to team success while adapting to the dynamic challenges of the healthcare industry.
Work History
REIMBURSEMENT SPECIALIST
Carter Professional Care
Edmond, OK
06.2020 - Current
- Identified and resolved payment issues between patients and providers.
- Balanced and reconciled accounts to ensure accuracy and resolve discrepancies.
- Performed prior authorizations and denials
- Contacted responsible parties to facilitate collection of past due debts and improve account recovery.
- Balanced and reconciled accounts.
- Managed prior authorizations and denials to streamline patient access to necessary services.
- Linked covering physicians to payors
- Revised and maintained Chargemaster to ensure accurate billing practices.
- Updated Chargemaster
REVENUE CYCLE MANAGER/BUSINESS OFFICE MANAGER
US Oncology/TX Center For Proton Therapy
Irving, TX
05.2015 - 02.2020
- Supported clinical team members in optimizing revenue cycle procedures and resolving issues.
- Completed financial reporting and analysis for billing revenue cycle.
- Responsible for insurance verifications, prior authorizations and appeals for all services performed in facility
- Executed financial reporting and analysis to enhance billing revenue cycle accuracy.
- Verified insurance, processed prior authorizations, and handled appeals for all services performed in the facility.
- Developed image verification and scheduling department for MRI/PET/CT diagnostic procedures
- Interviewed, hired, conducted performance reviews, and managed payroll for the Business Office.
- Worked in unison with the Intake Department, Nursing Department and Front Office Staff coordinating patient care and streamlining office processes
FINANCIAL SERVICES MANAGER
ProCure Proton Therapy
Oklahoma City, OK
03.2009 - 05.2015
- Managed Financial Services Department and ensured accuracy of demographics in Siemens/Mosaiq system.
- Verify patient insurance benefits, submit prior authorizations and obtain referrals, research clinical study information for submissions to insurance carriers for treatment approval
- Handled treatment denials and appeals, coordinating peer-to-peer discussions for physicians
- Delivered self-pay quotes and established payment arrangements for patients
- Meet with patients and go over benefits
- Prepared weekly reports for physicians on the status of patient approvals for treatment.
- Interface with billing company and physician group
PRACTICE MANAGER
HR&P Solutions/Philip A Waller, MD
Houston, TX
04.2005 - 11.2008
- Supported entire staff to enhance process flow and increase overall efficiency
- Developed close working relationships with front office and back office staff
- Enhanced staff morale through constructive feedback and clear direction
- Managed all aspects of daily operations for the clinic, personnel, and budget.
- Developed and implemented office policy and procedures
- Performed coding and entry for clinic office visits, infusion treatments and MRI charges
- Processed claims through clearing house
- Posted payments from patients, explanation of benefits, worked/researched discrepancies
- Managed Accounts Receivable functions and ensured timely processing of transactions.
- Compile monthly reports and generate client statements
COLLECTION MANAGER
Genezen Healthcare
Dallas, TX
03.2003 - 04.2005
- Developed appeal letters and processes resulting in payment recovery of thousands from unpaid claims
- Monitored insurance payments for contracted practices to ensure accurate reimbursement per payer contract
- Interfaced with billing company and physician groups on claim denials, reimbursement, and patient account status
- Provide monthly reports to physician practice regarding A/R status and monthly collections
- Performed referrals, authorizations and collections for multiple rheumatology physician practices across the State of Texas
Education
CPC - Certified Professional Coder
AAPC
UTAHOSU-OKC 2 years - Health Care Administration
OSU-OKC
Oklahoma CitySkills
- HCPCS codes
- Accounts payable management
- Diagnostic Codes
- Procedural Codes
- Claims management
- Insurance Benefits Understanding
- Extensive knowledge of Medicaid, commercial insurance, third party payers and Marketplace plans
- Extensive knowledge of referrals, prior authorizations, appeals
- Accounts payable management
- Financial Records and Processing
- Healthcare software proficiency
- Microsoft Office skills
- Insurance and Medicaid expertise
- Referral and authorization management
- CMS Guidelines
- HIPAA Regulations
- Siemens, Mosaiq, Athena, iKM, Centricity, some Epic, MISYS
- Microsoft Word, Outlook and Excel
- Data Entry
- Benefit Plan Analysis
- Verbal and Written Communication
- Appeals management
- ICD-10 coding
- Claims management
Timeline
REIMBURSEMENT SPECIALIST
Carter Professional Care
06.2020 - Current
REVENUE CYCLE MANAGER/BUSINESS OFFICE MANAGER
US Oncology/TX Center For Proton Therapy
05.2015 - 02.2020
FINANCIAL SERVICES MANAGER
ProCure Proton Therapy
03.2009 - 05.2015
PRACTICE MANAGER
HR&P Solutions/Philip A Waller, MD
04.2005 - 11.2008
COLLECTION MANAGER
Genezen Healthcare
03.2003 - 04.2005
CPC - Certified Professional Coder
AAPC
OSU-OKC 2 years - Health Care Administration
OSU-OKC