Petric V. Crockett
Missouri City
Summary
Detail-oriented Medical Billing Specialist with expertise in healthcare revenue cycle management and billing operations. Skilled in analyzing billing discrepancies, optimizing reimbursement processes, and enhancing revenue cycle efficiency. Proficient in claims processing, account reconciliation, and denial resolution, ensuring accuracy and regulatory compliance while driving organizational performance.
Overview
27
27
years of professional experience
Work History
Sr. Billing Specialist
Memorial Hermann Healthcare Systems
Houston, TX
02.2018 - Current
- Detail-oriented with extensive experience in insurance claims processing, and account resolution.
- Analyze and resolve complex billing issues while identifying trends to improve claim accuracy and reimbursement.
- Review medical claims prior to submission to ensure completeness, accuracy, and compliance with payer requirements.
- Investigate and correct invalid or inaccurate claims information to reduce denials and payments delays.
- Research, review, and resolve electronic claim and payment rejections in a timely manner.
- Analyze and resolve government billing issues in accordance with federal and payer regulations.
Billing Specialist
Globonics LLC
Sugar Land, TX
08.2016 - 01.2018
- Resolve complex billing issues and process medical claims for multiple physician and hospital systems.
- Research and resolve outstanding accounts appearing on 120+ days aging report to improve timely reimbursement.
- Analyze billing and payments trends to identify recurring issues and implement appropriate corrective actions.
- Conduct insurance follow-up to ensure accurate claim adjudication and maximize reimbursement.
- Manage and resolve self-pay accounts by reviewing balances, coordinating account resolution , and facilitating appropriate payment or adjustment process.
- Collaborate with internal departments and insurance payers to expedite claim resolution and maintain compliance with billing guidelines.
Sr. Billing Specialist
Memorial Hermann TIRR
Houston, TX
11.2004 - 06.2016
- Resolved complex billing issues by researching discrepancies and implementing timely, accurate solutions.
- Negotiated out of network payment agreements and financial arrangements on behalf of patients to facilitate claim resolution and reduce financial barriers.
- Performed follow-up on outstanding claims and reconciled billing rejections to ensure accurate claim processing and timely reimbursement.
Billing Lead/Coord
The Institute of Rehabilitation and Research (TIRR)
Houston, TX
07.2002 - 08.2004
- Supervised and delegated daily responsibilities to billing and government collections staff to ensure efficient workflow and timely account resolution.
- Resolved complex government billing and collections issues while ensuring compliance with Medicare, Medicaid, and payer guidelines.
- Investigated and resolved billing and collection discrepancies to improve reimbursement and reduce outstanding accounts.
- Processed daily electronic claim downloads and submitted claims accurately and efficiently through electronic billing systems.
- Performed manual Medicare and Medicaid claim entry, ensuring accuracy, completeness, and compliance with government billing requirements.
Managed Care Analyst
Memorial Hermann Healthcare Systems
Houston, TX
08.2000 - 11.2002
- Reviewed and analyzed managed care underpayments using contract terms, fee schedules, online resources, and automated billing systems to identify reimbursement discrepancies.
- Performed daily follow-up on outstanding claims to ensure accurate reimbursement in accordance with DRG methodologies, managed care contracts, and payer fee schedules.
- Collaborated with payer representation to research and resolve complex managed care reimbursement and contract-related issues.
- Reviewed medical records, Explanation of Remittance (EOR) documentation, and Chargemaster information to determine appropriate and accurate reimbursement.
- Researched payer policies and reimbursement guidelines to identify root cause of underpayments and recommend appropriate resolution.
Insurance Specialist
TIRR _ The Institute of Research and Rehabilitation
Houston, TX
02.1999 - 07.2000
- Reviewed and resolved electronic insurance claim rejections to ensure accurate and timely claim processing.
- Provided exceptional customer service by assisting patients with billing inquiries, account resolution, and payment options.
- Managed account follow-up, and collections to promote timely reimbursement and reduce outstanding balances.
- Prepared and reconciled weekly accounts receivable reports to monitor account status and identify collection opportunities.
- Prepared and submitted verbal appeals to resolve denied or underpaid insurance claims.
- Conduct insurance follow-up to ensure accurate claim adjudication and maximize reimbursement.
Education
Associate of Arts -
Houston Community College
Houston05-2021
No Degree - General Studies
Our Lady of the Lake College
Baton Rouge12-1998
Skills
- Expert billing knowledge
- Billing reconciliation
- HIPAA compliance
- Process improvement
- Billing expertise
- Solid organizational skills
- Efficient time management
- Insurance verification
- Customer Service
- Team collaboration aptitude
- Adaptability to change
- Professional ethics
Timeline
Sr. Billing Specialist
Memorial Hermann Healthcare Systems
02.2018 - Current
Billing Specialist
Globonics LLC
08.2016 - 01.2018
Sr. Billing Specialist
Memorial Hermann TIRR
11.2004 - 06.2016
Billing Lead/Coord
The Institute of Rehabilitation and Research (TIRR)
07.2002 - 08.2004
Managed Care Analyst
Memorial Hermann Healthcare Systems
08.2000 - 11.2002
Insurance Specialist
TIRR _ The Institute of Research and Rehabilitation
02.1999 - 07.2000
No Degree - General Studies
Our Lady of the Lake College
Associate of Arts -
Houston Community College