Racheal Dorsey

• Prepared and processed provider enrollments with Medicare JK providers.
• Used IBM Case Manager to enter provider effective dates into enrollment database.
• Input gathered information and researched data on applicants into computer system using PECOS (Provider Enrollment, Chain & Ownership System).

• Managed Prior Authorization submissions for 3 outpatient clinics, totaling over 60 authorizations daily.
• Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
• Reviewed outstanding requests and redirected workloads to complete projects on time.
• Determined appropriateness of payers to protect organization and minimize risk.
• Coordinated with contracting department to resolve payer issues.
• Made contact with insurance carriers to discuss policies and individual patient benefits.
• Communicated verification and authorization status updates with outpatient financial counselors to facilitate decision-making for patient admissions and insurance coverage.

Followed guidelines when reviewing applicant data to determine eligibility for economic assistance.

• Interviewed applicants and explained scope of different available benefits.
• Maintained records of transactions in dashboard and shared reports with team members and management.
• Attended weekly facility meetings to discuss logistical issues and obtain updated procedural and insurance-related instructions.
• Contributed to reduction of accounts receivables by adhering to predetermined policies and procedures to recover amounts due from patients.
• Helped address client complaints through timely corrective actions and appropriate referrals.
• Facilitated communication between patients and various departments and staff.
• Trained and mentored new employees in registration department, answered questions and provided insight on patient services.
• Researched and implemented new Medicaid plans, which helped to reduce number of denials by 25%.
• Observed all facility rules and regulations regarding patient data to promote confidentiality and integrity.

• 90% enrollment rate for current uninsured or under insured patients.
• Identified healthcare resources and programs for patients unable to meet financial obligations.
• Contacted insurance providers to obtain key information regarding patient benefits and to submit documentation for accounts.
• Conducted interviews with patients and family members and answered questions regarding insurance benefits.
• Determined patient financial needs and referred eligible patients to proper county, state or federal agencies to obtain financial assistance.

• Facilitated client satisfaction and renewed customer relations to drive growth.
• Addressed problems with accounting, billing and service delivery to maintain and enhance client satisfaction.
• Liaised with external customers and internal departments to provide and gather information enabling customer requirements to be met.
• Utilized appropriate cost containment techniques to reduce overall claim costs.
• Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
• Coordinated with contracting department to resolve payer issues.