Sasha Rees
Houston,TX
Summary
Highly motivated, dedicated healthcare administrator and Enrollment Analyst II. with 6 +years of Healthcare administration experience, who understands the necessity of providing unrivaled patient care. Equally capable of working alone or as a member of a team, and highly skilled at exercising initiative and problem-solving. Eager to prove my leadership skills in assisting and providing mentorship to other analysts
Overview
8
8
years of professional experience
1
1
Certification
Work History
Enrollment Analyst II
Kelsey-Seybold
08.2022 - Current
- Receiving and processing of enrollment applications analyzing eligibility media
- Utilized various databases and systems (CMS, Gentran, Epic...)
- Processing incoming and outgoing Files working edits for 100,000(+) managed care members
- Responsible for maintaining the enrollment integrity of the EPIC and Health Plan Enrollment systems
- Responding to incoming calls from Medicare members or other health plan representatives and initiating outgoing calls to Members regarding billing and collections and enrollment statuses
- Actively participated in training sessions to stay abreast of changes in healthcare legislation.
- Maintained high levels of accuracy when entering data into computer systems.
- Verifying eligibility, and enrollment statuses of members through various insurance portals (UHC, Cigna, Availity, WellCare Ect..
- Review escalation emails from other departments in regards to members accounts and files
- Provide escalation assistance to other teams members and departments when needed
- Upload insurance coverages for patients into all organizations systems
- Verifying eligibility coverage dates in question
- Review past due balances on Plan premiums and Late enrollment penalties
Out of Network Supervisor
Altus Biologics
05.2018 - 07.2022
- Verifying eligibility & obtain Benefits coverages for CPT & HCPCS coding
- Keep accurate records and reporting on collection activity
- Retrieve data for each outstanding invoices
- Contact clients to notify them of their overdue payments
- Process payments and refunds
- Update account status records and collection efforts
- Assisted with budgetary development by providing in-depth analysis of current and potential future expenses
- Established solid record of maintaining consistent performance and quality levels
- Led and motivated my team of employees through supervision, training and coaching on duties and daily operational activities
- Resolved conflicts between physicians, nurses and administrative staff to maintain optimal workflows
- Managed operations in accordance with budget requirements
- Facilitated peer-to-peer conflict resolution
- Implemented new hire training to further develop skills and initiate discussions on task prioritization
- Participated in meetings with department heads to discuss clients disputes as well as revenue cycle review
- Analyzed and reported on billing cycle data to inform management
- Contact patients to go over benefits and patient cost share
- Reviewing patient clinical & lab documentation, to confirm is patient meets Insurance payor polices
- Obtain prior authorization or Pre determination with payor to insure proper processing of claims
- Enroll patients in Drug Co-Pay assistance Programs (EX: Janssen Carepath, Pfizer encpompass, Cimzia, Orencia, ect
- Ect.)
- Ensure all privacy, third party permission & assignment of benefit forms are signed by both patient and provided at time of service
- Bill insurance companies for services provided
- Obtain reimbursement for assistance program claims, as well as co-pay cards and checks that have been reimbursed to the patients
Collections Account Manager
Archer R.V's
11.2015 - 04.2018
- Maintain and secure customer financial information
- Enter client financial history and demographics in loan contracts
- Supervise and train staff
- Responsible for high risk clients
- Maintain collection debt pickups on delinquent accounts
- Developed and implemented strategies to identify, contact, and negotiate payment plans with delinquent customers.
- Analyzed customer accounts for delinquency trends and developed solutions to address them.
- Conducted skip tracing activities to locate missing or unresponsive customers.
Medical Coding Billing Specialist
Kinghaven Counseling Group
06.2017 - 07.2017
- Prepared claim documents for refunds
- Entering data to generate invoices
- Generated direct billing reports
- Generate reports for charge review, claim submission and payment posting
- Obtained necessary notes from physicians for coding
- Entering patients' insurance/demographics data into the systems
Education
Bachelor of Science Healthcare - Management
The College of Health Care Professions
Houston, TX10.2018
Skills
- Healthcare Administration Skills
- Maintaining and exceeding quality and production standards
- Team Building
- Critical Thinking
- Data Management
- Reviewing and auditing CMS Databases and reporting
- Medicare Communication Skills Both verbal and written
- Benefits Verifications
- Prior Authorizations
- Insurance payor policies
- Medical records reviewer
- Proficient in ICD 10, CPT & HCPCS codes
- Insurance claims billing & collections
- Revenue Cycle
- Strong Communication Skills
- Medical Data Entry
- Insurance portals
- Electronic Health Records
- Proficient with Microsoft Word, Excel
- Proficient with Google Docs, Google Sheets, & PDF
- Organized, Multi-Tasker
- Regulatory Compliance
- Performance Monitoring
- Coaching and Mentoring
- Analytical Thinking
- Eligibility Determination
Certification
Certified Billing & Coding Specialist (NRCCS)- 2017 HIPPA Certified- August 2021 - renewed 2023
HIPPA Certified- August 2021
Timeline
Enrollment Analyst II
Kelsey-Seybold
08.2022 - Current
Out of Network Supervisor
Altus Biologics
05.2018 - 07.2022
Medical Coding Billing Specialist
Kinghaven Counseling Group
06.2017 - 07.2017
Collections Account Manager
Archer R.V's
11.2015 - 04.2018
Bachelor of Science Healthcare - Management
The College of Health Care Professions
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