Summary
Overview
Work History
Education
Skills
Timeline
Generic

Quiniesha MCCLENDON

McDonough,GA

Summary

REVENUE CYCLE PROFESSIONAL with 5 years progressive experience in healthcare environment. Expert level of Managed Care, payor contracts, regulations, policies handling various tasks in deadline-driven environments. Offering high-level of analytical and problem-solving skills with the ability think critically in validating workflows, maintaining a knowledge of policy changes to insurance plans and sharing best practices with management. Specializing in troubleshooting system errors, pinpointing risk areas, identifying trends to help decrease denials and recognize revenue saving opportunities.

Overview

8
8
years of professional experience

Work History

PATIENT ACCESS REPRESENTATIVE-PRN

NORTHSIDE HOSPITAL
04.2022 - Current
  • Collected and entered patient demographic data into computer database to establish patient's medical record.
  • Obtained patient's insurance information and determined eligibility for benefits for specific services rendered.
  • Received patient deductibles and co-pay amounts and discussed options to satisfy remainder of patient financial obligations.
  • Offered simple, clear explanations to help clients and families understand hospital policies and procedures.
  • Anticipate and respond promptly to questions and concerns surrounding patient registration
  • Followed document protocols to safeguard confidentiality of patient records.

EDI ANALYST

GO HEALTH URGENT CARE
02.2020 - 05.2022
  • Responsible for claim edits and clearinghouse troubleshooting to maximize cash flow while maintaining and improving internal and external customer relations
  • Ensure all intended outbound and expected inbound EDI documents are successfully sent and received including reconciliations on a daily, weekly, and monthly basis.
  • Document all EDI solutions for system development life cycle and maintain all document specifications and develop various transaction specifications as per requirement
  • Investigate all routine processes of EDI, administer all system performance and data mapping processes, and prepare routine reports to management
  • Posting payments to individual accounts, distribute contractual payments, identify secondary insurances and self-pay responsibilities
  • Report and document any critical system issues or barriers to upper management via e-mail correspondence
  • Assists with tracking and trending CPT-4 Coding and ICD-10 coding errors to accurately optimize all professional services documented for billing purposes
  • Answer EDI inquiries from internal and external parties utilizing the EDI support team’s ticketing system
  • Training end-users and data partners on the proper use of the EPIC system and how to define requirements and develop EDI mappings
  • Responsible for management of payor EDI enrollments. Including, 837 (claim submission), 835(ERA), 270/271 (Eligibility), and 276/277(Claims Statuses).

REVENUE CYCLE SPECIALIST

UF HEALTH PHYSICIANS
11.2018 - 12.2019
  • Responsible for performing insurance liability collection and accounts receivable activities for commercial accounts (PPO, HMO, POS, Managed Medicare/Medicaid, etc.) to ensure the timely receipt of insurance liabilities for physician services
  • Analyzed and followed up on accounts via phone calls regularly to verify timely receipt of claim, check claim status, submit required medical documentation
  • Ability to determine Coordination of Benefits through insurance verification for Third Party Liability coverages, government and commercial insurances
  • Document follow-up activity or pertinent notes (e.g., date of receipt, reference number) within the system of record to track and record overall claim process history
  • Daily focus on attaining productivity standards in a fast-paced production-based environment, recommending new approaches for enhancing performance and productivity when appropriate
  • Act as a knowledgeable resource on commercial collections functions for department staff
  • Ability to adapt and manage time while providing support to essential staff answering account questions and assisting with new staff training, etc.)
  • Proficient in generating patient statements per request; Performed billing and clerical duties including mail sorting, incoming calls and Appeal preparations
  • Monitor accounts receivable daily through worklists and check claim status through payor claims department or online to ensure proper claims processing
  • Verified coverage for patient and guarantor accounts; researched and resolved claim status issues involving credit balances, claim status and real time eligibility using various computer systems applications and websites
  • Corresponds with payors to obtain and submit any necessary documentation to support claim processing by accessing Electronic Health Records system if required by the contractual agreement, payor guidelines, or state or federal law
  • Ensured financial integrity of UFHP B/AR by performing established financial processes to expedite the billing and collection of professional services rendered

RECORDS TECHNICIAN

ALACHUA COUNTY COURT SERVICES
03.2016 - 11.2018
  • First point of contact for all patrons presenting to the misdemeanor probation office ensuring professional customer service and positive customer experience
  • Responds to customer request and answers questions regarding general Cost of Supervision, general information while maintaining lobby control
  • Collected appropriate identification from clients and confirmed all patron demographics to validate identity
  • Followed established procedures for processing receipts and payments etc
  • Organized and filed various documents such as legal court documents, violation and arrest reports, warrants and affidavits for Compliance Officers
  • Scheduled intake appointments highlighting Court ordered sanctions, Assigned individuals appropriate Probation Officer
  • Participated in weekly First Appearance rotation-retrieving Florida Criminal History, National
  • Criminal History, Hotfiles and FBI Reports
  • Responds to customer requests and answers questions regarding various service and account information with a positive attitude
  • Engaged in active listening with callers to confirm or clarify information and diffuse upset callers.

Education

Bachelor of Science - YOUTH & COMMUNITY SCIENCES

UNIVERSITY OF FLORIDA
Gainesville, FL
12.2015

Skills

  • Knowledge of ICD-10, CPT & medical terminology
  • Excellent strong written & verbal communication skills
  • Demonstrated knowledge of CMS & HIPPA regulations
  • Proficient in analyzing claims working knowledge of UB04 or CMS-1500 claim forms
  • Knowledge of Microsoft Office software, including strong knowledge of Excel
  • Ability to manage, organize, prioritize, multi-task and adapt to changing priorities
  • Knowledge of third-party insurance plan types: HMO, PPO, POS, & Indemnity
  • EHR experience with eClinicalWorks, ChiroTouch & Epic
  • Ability to work independently & as a team
  • Account and revenue tracking

Timeline

PATIENT ACCESS REPRESENTATIVE-PRN

NORTHSIDE HOSPITAL
04.2022 - Current

EDI ANALYST

GO HEALTH URGENT CARE
02.2020 - 05.2022

REVENUE CYCLE SPECIALIST

UF HEALTH PHYSICIANS
11.2018 - 12.2019

RECORDS TECHNICIAN

ALACHUA COUNTY COURT SERVICES
03.2016 - 11.2018

Bachelor of Science - YOUTH & COMMUNITY SCIENCES

UNIVERSITY OF FLORIDA

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Quiniesha MCCLENDON