Shakira Hills
Marrero,LA
Summary
Seasoned Lead Patient Access Representative with a proven track record at LCMC Health, adept in insurance verification and maximizing collections, achieving established goals. Skilled in Epic and Microsoft Excel, coupled with exceptional problem-solving abilities. Demonstrates a strong grasp of medical terminology and coding, ensuring accurate and efficient patient service coordination.
Overview
18
18
years of professional experience
Work History
Lead Patient Access Representative
LCMC Health
New Orleans, LA
11.2022 - 12.2024
- Performed insurance verification task, including running automated eligibility response to ensure active coverage
- Verified with insurance companies that services are covered benefits
- Determined if authorization is required for service, if authorization is required than initiate/obtain authorization
- Document initiation authorization requirements and subsequent follow up
- Scanned all documents in Media accurately and timely resolve work queues including scanning medical documents into patient accounts
- Informed patient/guarantor of liability due, including prior balances and estimates for scheduled service
- Maximized collections, meeting established collection goals
- Communicated with physicians and physician office staff when peer to peer reviews are needed to complete the authorization
- Knowledgeable on all payer (governmental and private) pre-certification requirements
Benefits Specialist
AmerisouceBergen
New Orleans, LA
10.2019 - 10.2022
- Verified and reports general patient information in facilitation billing and collections activities
- Under general supervision, analyze and resolve benefits and insurance information ensuring reconciliation of data within company-defined deadlines, and in compliance with company policies and procedures
- Reviewed referral information in CIS supplied by Care Center for accuracy
- Verify patients Medicaid, private insurance, and self-pay payor sources via Telephone , or online systems
- Obtained authorization from private insurance and all other payer sources requiring authorization via
- Telephone , facsimile, or online systems while maintaining compliance to medical record confidentiality regulations
- Obtained information from agencies when necessary to assist with receiving authorizations and reauthorizations from private insurance and all other payer sources
- Maintained strong knowledge of basic medical terminology to better understand services and procedures
Medical Insurance Verification Specialist
St. Thomas Healthcare
New Orleans, LA
10.2006 - 08.2019
- Contacted insurance companies to confirm a patient's coverage, policy details, and benefits
- Ensure that the procedures or treatments are covered under the patient's plan
- Secured pre-approvals or authorizations for specific medical procedures, tests, or hospital admissions, as required by the insurance provider
- Accurately entering patient and insurance information into Epic healthcare system
- Maintained detailed records of communications with insurance providers
- Informed patients about their coverage, out-of-pocket costs, co-pays, and deductibles
- Assisted patients with understanding their insurance benefits and resolving any coverage issues
- Coordinated with billing departments and medical staff to ensure smooth claims processing
- Addressed and resolved denied claims or discrepancies in coverage
- Working with insurance companies on appeals for denied services
Education
Associate's degree - Medical Office Administration
Herzing University
Kenner, LA09.2016
Skills
- Strong leadership
- Medical terminology proficiency
- Adaptable to change
- Effective problem solving
- Insurance verification expertise
- Payment processing
- Referral coordination
- Health insurance knowledge
- Electronic health records
- Problem-solving
- Medical coding
- EMR
- Multitasking and organization
Timeline
Lead Patient Access Representative
LCMC Health
11.2022 - 12.2024
Benefits Specialist
AmerisouceBergen
10.2019 - 10.2022
Medical Insurance Verification Specialist
St. Thomas Healthcare
10.2006 - 08.2019
Associate's degree - Medical Office Administration
Herzing University
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