Roslyn Williams
Dallas,TX
Summary
Accomplished Denial Management Specialist with a proven track record at Texas Oncology, enhancing claim adjudication processes and reducing account receivables. Expert in strategic planning and root cause analysis. Excel in staff management and problem-solving, significantly improving department performance and customer satisfaction. Skilled in data analysis and conflict resolution, consistently achieving and surpassing business goals.
Overview
16
16
years of professional experience
Work History
Denial Management Specialist
Texas Oncology
Richardson, TX
09.2016 - Current
- Reviews and resolves accounts assigned via work lists daily as directed by management. Focus on working complex denials across multiple payers and/or regions. Conducts account history research as required, including navigating patient encounters and charts, researching charge and payment histories, determining historical account and claim status changes, researching payer remittance advice. Considered SME (Subject Matter Expert) by achieving high rates of revenue recovery within department by increasing expected reimbursement by 80%.
- Conduct follow-up research on claims to review contract discrepancies also account balances. This may include 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 Payor to obtain claims status for denied claims
- Work independently and collaboratively within team to achieve production goals and deadlines. Strong commitment to productivity by staying focused and on task without constant supervision. Effectively communicate with colleagues, supervisors, and managers to ensure clarity, alignment, and successful outcomes. Taking ownership of assigned tasks and projects, demonstrating accountability and reliability in meeting expectations.
Adapt to changing priorities and work demands, maintaining high levels of quality and efficiency. Proactively identify opportunities for process improvement and contribute innovative solutions to enhance overall productivity and teamwork.
Insurance Reimbursement Specialist II
Christus Health
Irving, TX
03.2013 - 09.2016
- Handles special projects as assigned by leadership, including escalations from management. Work follow-up report daily, maintain established goals, notify Manager of issues preventing achievement of department goals. Met exceeded department productivity of 150 accounts worked per week, maximized processes within department by increasing revenue each month. Follow up on daily correspondence (denials, underpayments) to work patient accounts appropriately. Negotiate with insurance to resolve any known problems to help reduce AR by making phone calls, sending disputes, appeals to help get claims paid. Researched, analyzed claim denials by contracts with hospitals also various insurance companies. Tracking, analyzing trends that are causing denials. Work with insurance payers to ensure proper reimbursement of patient accounts. Participated in conference calls, created accounts receivable reports, compiled issue reports to expedite resolution of accounts.
- Monitored team members regularly, provided feedback,trained new staff, performed audits of work performed, communicated progress to appropriate Supervisor. Provided continuing education of all team members on process and A/R requirements. Collaborated with healthcare providers to obtain necessary medical records for prompt claim adjudication. Streamlined department communication to facilitate accurate information exchange and improve case management efficiency.
- Evaluated complex cases requiring specialized expertise, making informed recommendations to improve outcomes for clients and insurance carriers. Optimized claim submission procedures by regularly reviewing payer requirements and updating internal documentation. Reduced outstanding account receivables by proactively identifying and resolving billing discrepancies. Supported cross-functional teams in contract negotiations, providing critical insights into reimbursement rates and trends. Improved claim processing efficiency by streamlining workflows and implementing best practices. Reduced outstanding account receivables by proactively identifying and resolving billing discrepancies.
Medical Claims Processor
Aetna, A CVS Health
Arlington, TX
11.2008 - 03.2013
- Paid or denied medical claims based upon established claims processing criteria. Assessed medical claims for compliance with regulations and corrected discrepancies. Ensured compliance with all applicable regulations by strictly adhering to HIPAA guidelines and company protocols when handling sensitive patient information. Utilized analytical skills to identify patterns and trends in claim submissions, leading to development of targeted strategies for reducing errors and improving overall department performance.
- Consistently ensure high levels of customer satisfaction by promptly addressing inquiries and resolving issues related to medical claims. Also, identify and resolve discrepancies between patient information and claims data. Through meticulous attention to detail and thorough review of claims processing, reduced errors in claims submissions. Additionally, improved efficiency by implementing new software and streamlining workflows. Processed insurance payments and maintained accurate documentation of payments.
- Managed portfolio of at least 30 complex cases requiring extensive research, coordination with multiple parties, and diligent follow-ups to secure client reimbursement. Processed high volumes of medical claims accurately and efficiently under tight deadlines, ensuring prompt payment for services rendered. Evaluated medical claims for accuracy and completeness and researched missing data. Paid or denied medical claims based upon established claims processing criteria. Streamlined communication between departments by developing efficient methods for sharing claim status updates and relevant documentation. Provided exceptional support during audits by supplying detailed records of claim transactions as needed, ensuring full transparency in department operations
Education
Bachelor of Science - Health Administration
Western Governors University
Salt Lake City, UT03.2026
GED -
Texas Education Agency
Austin, United States01.2004
Skills
- Detail-oriented
- Expert Problem Solving
- Root Cause Analysis
- Attention to Detail
- Decision-Making
- Analytical Skills
- Medical Records
- Reconsiderations
- NCCI edits
- LCD/NCD
- Remittance/EOBs
- Epic
- Payer Portals
Timeline
Denial Management Specialist
Texas Oncology
09.2016 - Current
Insurance Reimbursement Specialist II
Christus Health
03.2013 - 09.2016
Medical Claims Processor
Aetna, A CVS Health
11.2008 - 03.2013
Bachelor of Science - Health Administration
Western Governors University
GED -
Texas Education Agency
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