Shameka Pouncy
Grand Prairie,Texas
Summary
Experienced Professional Medical Authorization Specialist with expertise in HCPCS, ICD-10, & CPT coding seeking a challenging position within Medical Coding/Billing in which my previous work experience can be utilized, offering an extensive career promoting positive customer experiences.
Overview
20
20
years of professional experience
Work History
Authorization Specialist
Children's Medical Center
Dallas, TX
11.2013 - Current
- Ensures maximum reimbursement on all services with timely and accurate verification of coverage, completion of all third-party payer requirements for authorization for high dollar services, estimating and requesting payments making appropriate referrals to financial counseling
- Demonstrate and apply knowledge of medical terminology, including HIPAA regulations
- Request, track, and obtain pre-authorization from insurance carriers for patient's medical services, insurance eligibility, and benefits requirements
- Scheduling and/or pre-register patient admissions and appointments
- Utilization of EPIC for verification for third party coverage to ensure all services are reimbursed
- Responsible for document procurement of FMLA, disability, and
- Facilitates submission of patient claims and reduction in payer denials by adhering to organizational polices and maintaining department productivity goals
- Perform daily auditing and billings of patients accounts
- Documentation of patent and provider claims of medical history
- Establish and monitor daily scheduled processes to ensure accuracy of the correct usage of medical and billing codes (ICD-10, CPT-4, HCPCS)
- Provide efficient customer service to patients and develop/maintain positive working relationships with internal/external customers
- Collaborate with designated clinical personnel for peer-to-peer review of medical claims.
- Assist leadership with various administrative duties, as well as other areas in Patient Access Services
- Entered credit slips and return requests to issue authorizations and process returns documentation.
Insurance Coordinator
Children's Healthcare of Atlanta
Atlanta, GA
02.2006 - 07.2013
- Coordinated and performed verification of insurance benefits by contacting provider and determining eligibility of coverage
- Obtained authorizations for high dollar radiology procedures by providing coding and clinical information to the insurance companies
- Obtained accurate and complete demographic, insurance, and payer information from customers to perform pre-registration on all assigned accounts
- Maintained tracking of patients on schedule, ensuring that eligibility and authorization information has been entered into data entry systems
- Met weekly production numbers of 50 or more for insurance verification and pre-registration
- Followed up on problem accounts via telephone or email, documenting each encounter
- Informed patients of any discrepancies on current insurance policies such as terminations, non-coverage for certain procedures, or non-network provider information
- Exemplified excellent customer service while communicating with patients, physician offices, and internal customers
- Collaborated with other professionals to evaluate patient medical or physical condition and to assess client needs
- Performed daily quality checks on multiple accounts.
Senior Access Specialist
Children's Healthcare of Atlanta
Atlanta, GA
06.2006 - 05.2007
- Interviewed and register patients by obtaining precise and accurate demographic financial data to complete the scheduling and registration process in a timely and efficient manner
- Performed multi-task administrative duties to ensure efficient daily business operations including ordering and restocking front office supplies and receiving and distributing mail
- Acted as liaison between patients, waiting room management, and department staff by informing patients and families of procedures or delays, answering question, offering assistance and other services needed
- Posted, reconciles, and balances charges for the department
- Assist in training staff and serves as a resource for complex issues.
Medical Records Tech
Federal Occupational Health
Atlanta, GA
03.2004 - 02.2006
- Maintained Pre-Placement and Incumbent medical exams consisting of over 500 monthly
- Performed quality assurance checks on all medical exams prior to their data entry
- Performed medical billing in a Merits database
- Transcribed medical documentation from Pre-Placement and Incumbent medical exams
- Collaborated with physicians for documentation requirements.
Skills
- Proficient with Micro-Soft Office Suite (Outlook, Excel, SharePoint)
- Financial and Managerial Accounting practices
- Knowledge of Medicare, Medicaid, HMO, PPO
- Complex problem solving, detail-oriented, strong analytical skills
- Knowledge of HIPAA standards
Timeline
Authorization Specialist
Children's Medical Center
11.2013 - Current
Senior Access Specialist
Children's Healthcare of Atlanta
06.2006 - 05.2007
Insurance Coordinator
Children's Healthcare of Atlanta
02.2006 - 07.2013
Medical Records Tech
Federal Occupational Health
03.2004 - 02.2006
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