SABRINA SWAZY
Arlington,TX
Summary
Qualified and hardworking Insurance Reimbursement Specialist with expertise in policy research and customers service. Offering 15 plus years of experience in analyzing coverage and securing collection for claims. Excellent written and verbal communication skills. Operate databases and medical billing software and answer inquiries from facilities, patients and insurance companies.
Well versed in using Epic, Flowcast, Meditech, Centricity, Ewms, Tiers, EMR database for billing and client data input.
Overview
25
25
years of professional experience
Work History
SR COLLECTOR
Parkland Hospital
12.2021 - Current
- Reviews hospital and professional claims to resolve outstanding balances and secure accurate and timely payments from third party payors.
- Work credit balances, update patient demographics, update current insurance registration.
- Access to FSS/DDE(Medicare) to review claims.
UBER DRIVER
Uber Eats
03.2020 - 07.2020
- Skilled at working independently and collaboratively in a team environment.
- Self-motivated, with a strong sense of personal responsibility.
- Proven ability to learn quickly and adapt to new situations.
- Followed all relevant traffic laws and safety regulations.
- Kept detailed mileage and fuel reports to track overall fuel costs.
- Complete routine pre- and post-trip inspections to evaluate vehicles and assess maintenance needs.
Reimbursement Specialist
JDA Parathon
04.2019 - 07.2020
- Contact Insurance companies to gather information on denied claims and submitted appeals and obtain retro authorizations, via telephone and/or internet.
- Demonstrate a sense of urgency when communicating with the insurance company to get a claim resolved quickly, while remaining calm, professional and courteous.
- Review and interpret third party contracts with clients for use in supporting denial resolution.
- Review and interpret Payer/Provider contracts with clients for use in supporting expected reimbursement calculations for system resolution.
- Review Payer remittance advices to determine correct payment amounts and patient responsibilities
- Work closely with physician office to obtain authorization and coding information and medical documentation for appeal.
Instacart Shopper
Instacart
10.2019 - 01.2020
- Increased customer satisfaction by providing timely and efficient grocery shopping services.
- Maintained high levels of accuracy in fulfilling orders, ensuring a positive customer experience.
- Assisted customers with special requests by locating hard-to-find items or making appropriate substitutions.
- Adhered to strict quality standards, carefully selecting fresh produce and checking expiration dates on perishable items.
Medical Eligibility Specialist
Texas Health and Human Services Commission
02.2018 - 03.2019
- Reviewing the criteria for different aid programs to determine eligibility for various applicants.
- Inputted all communication with applicants into the computer system in case future clarification or responses were needed.
- Conducts interviews with applicants, explaining the benefits process and which programs were available.
- Processed benefits applications, which included documents for Medicare Savings Program, Nursing Home Programs, and Waivers for Medicaid and Medicare Recipients.
- Calling applicants so that details regarding the benefits process could be explained and verify information on application submitted.
- Utilizing EWMS, TIERS, DATA BROKER, SOLQ, when inputting applicant information into the agency's computer system to verify information to complete cases and avoid pending cases.
Medical Collector
MedSynergies/Optum
06.2017 - 09.2017
- Ensure all claims are billed and received by the payers for proper adjudication. This includes timely processing of allocated volume of accounts, based on established production guidelines and time parameters provided for workflow.
- Responsible for outbound calls and / or status inquiries via payers website validating receipt of medical claims and adjudication status within established timeframes.
- Work any edits and denials in allocated workflow to achieve proper adjudication to payment. This includes, but is not limited to: verify insurance is correct, update insurance demographics, rebill claims not received, document the status of work performed, follow-up on outstanding adjudication items according to departmental guidelines, and is also responsible for billing secondary / tertiary claims along with providing supporting documentation to payers for additional payment.
- Perform scheduled follow up on accounts to include calls to payers and/or patients, as well as accessing payer websites, and resolving complex accounts with minimal or no assistance necessary.
- Document all work and calls performed, in accordance to policy. This includes complete contact information, good grammar, and expected outcomes.
- Obtain primary and / or secondary EOB and claims to bill next responsible payer, along with utilizing various internal resources to obtain medical records to respond to requests from payers upon request.
Reimbursement Specialist
Evolution Healthcare
01.2017 - 05.2017
- Conducted appropriate account activity on final billed claims by contacting government agencies, third party payers, and patients/guarantors via phone, email, or online.
- Generated an appeal based on the dispute reason and contract terms specific to the payer.
- This includes online reconsideration.
- Ensured proper account documentation which is clear, concise and includes all pertinent information.
- Daily calls to payers to obtain payment resolution and account status information.
- Validated denial reasons and ensures coding is accurate ad reflect denial reasons.
- Ensured professional verbal and written communication with facilities clients, and co-worker following established guidelines.
- Worked with wide range of specialty billing and collections; to include Home Health and Episodic and Medicare Secondary.
Commercial Biller
Christus Healthcare
12.2015 - 03.2016
- Performed billing, collections and reimbursement supported for all regions for Christus Health Hospitals by RCBS.
- Ensured claims are entered and submitted with 48-hours of receipt.
- Sent secondary claim upon processing of primary insurance including re-bill claim upon correction review.
- Followed up on Error, Valid, and Hold queues on billing issues.
- Resubmit insurance claims as necessary.
- Ensured all ICD-9 and CPT coding was correct and forwarded any errors to the appropriate departments to correct.
- Verified insurance coverage, type of coverage and using that information to determine the payment rate for services rendered for physician and hospital billing.
Claims Analyst/Reimbursement Specialist
UT Southwestern Medical
04.2008 - 07.2015
- Contacted payers, via website, phone and/or correspondence, regarding reimbursement of unpaid accounts over thirty (30) days or more.
- Entered data of information received to resolve edits and processes claims.
- Identified and resolved discrepancies and claims delay issues that impact billing and collections.
- Researched, analysed, reviewed and appealed denied claims and requests for additional information.
- Performed follow up on all claims submitted in timely intervals established by CBO.
PROOF OPERATOR
JPMorgan Chase
02.1999 - 12.2011
- Operated proof machine to list, sort and prove credits, debits and deposits.
- Processed financial transactions of deposits, payments, checks and withdrawals by encoding numerical data.
- Detected out of balance transactions and followed implemented handling procedures.
- Prepared, sent and received image cash letters and processed all transit bags.
Education
High School Diploma -
Alcee Fortier Senior High School
New Orleans, LA06.1987
Some College (No Degree) - Health Information Technology
DeVry University
Irving, TXCertificate of Completion Medical Coding - MEDICAL CODING
ABSOLUTE MEDICAL CODING INSTITUE
Raleigh, NC12.2020
Skills
- Exceptional interpersonal, communications, and leadership skills, able to promote teamwork in a fast-paced environment while interfacing with several departments
- Maintain patient records/HIPPA
- Medical terminology
- UB04/1500 claims
- Medical coding capability
- Proficient in Microsoft Office Suite
- Sound decision-making
- Data Entry 10 key Alpha/Numeric
- Route logs
- GPS and route planning
- Transportation
- Order picking and processing
Timeline
SR COLLECTOR
Parkland Hospital
12.2021 - Current
UBER DRIVER
Uber Eats
03.2020 - 07.2020
Instacart Shopper
Instacart
10.2019 - 01.2020
Reimbursement Specialist
JDA Parathon
04.2019 - 07.2020
Medical Eligibility Specialist
Texas Health and Human Services Commission
02.2018 - 03.2019
Medical Collector
MedSynergies/Optum
06.2017 - 09.2017
Reimbursement Specialist
Evolution Healthcare
01.2017 - 05.2017
Commercial Biller
Christus Healthcare
12.2015 - 03.2016
Claims Analyst/Reimbursement Specialist
UT Southwestern Medical
04.2008 - 07.2015
PROOF OPERATOR
JPMorgan Chase
02.1999 - 12.2011
High School Diploma -
Alcee Fortier Senior High School
Some College (No Degree) - Health Information Technology
DeVry University
Certificate of Completion Medical Coding - MEDICAL CODING
ABSOLUTE MEDICAL CODING INSTITUE
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