Rachel Hardin
Inman,South Carolina
Summary
Highly-motivated employee with desire to take on new challenges. Strong worth ethic, adaptability and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills. Familiar with processing online appeals, refund requests and billing audit information. Uses strong customer service skills to communicate with patients and third-party carriers. Meticulous worker identifies discrepancies and issues related to billing and reimbursements and implements corrective actions and adjustments. Maintains patient confidence by keeping important information confidential.
Overview
14
14
years of professional experience
1
1
Certification
Work History
Patient Account Associate II
VBOA
Remote
04.2021 - Current
- Review claims data and supporting documentation to identify coding and / or billing concerns
- Ability to interpret payer contracts and identify contract variances affecting reimbursement
- Utilize knowledge of the cash posting processing to obtain the necessary information to resolve misapplied payments
- Demonstrate clear proficiency in third-party billing requirements to include: federal, state, and commercial / managed care payers
- Prepare appeal letters for technical denials by accessing specific payer appeal forms, submitting appropriate medical documentation, and tracking appeal resolution
- Assist with identifying A / R and denials trends
- Reviews and resolves accounts assigned via work lists daily as directed by management
- Focus on working complex denials across multiple payers and/or regions
- Conduct account history research as required, including navigating patient encounters and charts, researching charge and payment histories, determining historic account and claim status changes, and researching the payer remittance advice
- Conduct follow up research on claims to review contract discrepancy and account balances
- Including attaching documentation, amending coverage/patient/encounter/provider/facility data, gathering additional information requests, and resubmitting corrected claims to ensure accurate and timely claim adjudication
- Review explanation of benefits (EOB) or, if not present, call the Payor to obtain claims status for denied claims
- Defend and appeal denied claims, including researching underlying root cause, collecting required information or documents, adjusting the account as necessary, resubmitting claims, and all appropriate follow up activities thereafter to ensure adjudication of the claim
- Identify coding discrepancies based on the Center for Medicare and Medicaid NCD/LCD requirements.
Crowd sourcing data analyst
Appen
Remote/Work at Home
06.2019 - 04.2021
- Search Media Evaluation, Translation, Transcription, Survey and Data Collection
Data Entry Specialist
Omnicare
Spartanburg, SC
10.2018 - 04.2019
- Ensure that census paperwork is received from the SNF
- Ensure that the census is entered into the operating system accurately and is valid coverage
- Review paperwork and verify completeness and of intake process focusing on payer verification and selection
- Ensure effective coordination and communication between the local pharmacy and the Central Billing Center
- Ensure the smooth dissemination of information relative to Revenue Management to the pharmacy/site and Omnicare customers
- Work Medicaid Pending reports from i-Astral and the operating system to ensure timely application of Medicaid coverage
- Improve account identification on Medicaid Application Pending (MAP)
- Work and partner with other internal departments to resolve issues
- Participate in training session or conference calls to further C2W ADT management knowledge
- C2W ADT Workflow grid is cleared daily for all assigned facilities
- Follow all applicable government regulations including HIPAA
- Participate in projects and/or meeting as designated by management.
Internet Assessor
Lionbridge
Remote/Work at Home
03.2018 - 07.2018
- Analyze internet search results for relevancy and quality
- Evaluate advertisements for relevancy and appropriateness
- Evaluate internet user interest
- Check video for quality and content.
Information Processing Specialist/ Enrollment Services
Pellissippi State Community College
Knoxville, TN
10.2010 - 01.2018
- Answer in-bound calls to the college in a timely manner
- Answer questions on all subjects pertaining to the Pellissippi State enrollment process
- Schedule advising appointments for students
- Assist students with entrance testing appointments
- Schedule New Student Orientation appointments
- Assist with the Admissions processes/questions
- Assist with Financial Aid processes/questions
- Assist with other general questions about college departments and processes
- Provide contact information for Instructors and Administrators
- Assist visitors coming to Info Center (including drive through) with information and directions
- Assist callers with information about the community and college events
- Answer e-mails from students pertaining to Admissions and Financial Aid.
Education
Completion of CPC Certification program -
CareerStep CPC Program
Course work toward an Associates of Arts degree -
Pellissippi Sate Technical CC
Skills
- CPC-A certification through AAPC, with experience in insurance billing, diagnosis and procedure coding, and medical terminology
- Exceptional customer service and troubleshooting skills Excellent computer skills
- Ability to work both in a team environment and independently
- Strong, detail-oriented organizational skills coupled with the ability to effectively communicate with others at all levels
- Possession of excellent listening skills and the ability to be flexible with job duties, excelling in time management and multi-tasking
- 3-plus years experience with Epic, OneContent and FinThrive
- HIPAA Compliance
- Microsoft Office
Certification
- CPC A
Timeline
Patient Account Associate II
VBOA
04.2021 - Current
Crowd sourcing data analyst
Appen
06.2019 - 04.2021
Data Entry Specialist
Omnicare
10.2018 - 04.2019
Internet Assessor
Lionbridge
03.2018 - 07.2018
Information Processing Specialist/ Enrollment Services
Pellissippi State Community College
10.2010 - 01.2018
Completion of CPC Certification program -
CareerStep CPC Program
Course work toward an Associates of Arts degree -
Pellissippi Sate Technical CC
Similar Profiles
Maranda BengstonMaranda Bengston
Medical Biller at VBOAMedical Biller at VBOA
Hope HutchinsonHope Hutchinson
Medical Billing Specialist at VBOAMedical Billing Specialist at VBOA
Margo McNealMargo McNeal
Patient Accounting Associate II at VBOA - Virtual Business OfficePatient Accounting Associate II at VBOA - Virtual Business Office
Shanna KammererShanna Kammerer
Store Merchandiser at Dollar GeneralStore Merchandiser at Dollar General
Fernando CastroFernando Castro
Landscaper at Fernando Garcia Outdoor ServicesLandscaper at Fernando Garcia Outdoor Services