Shauna Rice
Lucedale,MS
Summary
Responsible and motivated student ready to apply education in the workplace. Offers excellent technical abilities with software and applications, ability to handle challenging work, and excellent time management skills. Organized and motivated employee eager to apply time management and organizational skills in various environments. Seeking entry-level opportunities to expand skills while facilitating company growth. Compassionate Patient Access Representative well-versed in performing diverse administrative functions for patient care with high degree of diplomacy and problem-solving acumen. Positive and upbeat team player with good communication and time management abilities. Demonstrated extreme attention to detail with accuracy of medical records. Dedicated employee known for punctuality, pursuing employment options where good customer service and positive attitude will make a difference. Motivated professional offering an associates degree in billing and coding. Adds value to any organization in need of great collaboration, interpersonal and multitasking abilities.
Overview
1
1
year of professional experience
1
1
Certification
Work History
Patient Access Representative
Singing River Hospital
Pascagoula, MS
01.2023 - Current
- Communicated financial obligations to patients and collected fees at time of service.
- Reviewed prior authorization requests for completeness and accuracy.
- Researched medical policies to ensure appropriate coverage of services.
- Assessed insurance benefits and determined eligibility criteria.
- Submitted prior authorization requests electronically or by phone to payers.
- Maintained accurate records on all prior authorizations requested, received, and denied.
- Processed appeals for denials in accordance with established procedures.
- Responded promptly to inquiries from providers, members, and other departments within the organization.
- Evaluated clinical information provided by providers against specific criteria set forth by health plans.
- Ensured compliance with state regulations related to utilization management activities.
- Notified ordering providers of denied authorizations.
- Performed detailed medical reviews of prior authorization request, following established criteria and protocols.
- Applied knowledge of Medicare, Medicaid and third-party payer requirements utilizing on-line eligibility systems to verify patient coverage and policy limitations.
- Maintained files for referral and insurance information, entering referrals into system.
- Maintained high level of professionalism when speaking to doctors and insurance companies.
- Contacted insurance carriers to obtain authorizations, notifications and pre-certifications for patients.
- Made outbound calls to insurance companies, patients and physicians to perform eligibility checks for patients.
- Followed all Medicare, Medicaid, HIPAA and private insurance regulations and requirements.
- Contacted insurance companies to obtain necessary preauthorizations needed for upcoming tests and procedures.
- Actively participated in team meetings and training sessions.
- Kept patient appointments on schedule by notifying providers of patients' arrival and reviewing service delivery compared to schedule.
- Verified patients' insurance and payment methods during admissions or check-in processes.
- Accessed programs and set up correct payment strategies based on patient means and needs.
- Performed pre-registration functions such as verifying demographic information, obtaining authorizations, and collecting deposits and co-payments.
- Managed incoming faxes related to patient registration processes.
- Instructed patients on policies and required actions for different types of appointments and procedures.
- Responded to patient inquiries regarding billing or financial matters.
- Verified documentation methodically to avoid critical errors impacting care delivery and payments for services.
- Verified insurance coverage for services provided by the facility.
- Scanned documents into electronic medical records system.
- Ensured accuracy of all data entered into computer system.
- Applied knowledge of payer requirements and utilized on-line eligibility systems to verify patient coverage and policy limitations.
- Applied HIPAA privacy and security regulations while handling patient information.
- Obtained informed consent and payment documentation from patients and filed in system.
- Explained policies, procedures and services to patients.
- Processed patient responsibility estimate determined by insurance at pre-registration.
- Counseled patients on potential financial liabilities and payment requirements.
- Created new patient accounts in EMR system as needed.
- Verified demographics and insurance information to register patients in computer system.
- Maintained confidentiality of all patient information in accordance with HIPAA regulations.
- Answered phones promptly in a professional manner.
- Collected co-pays and other payments from patients at time of service.
- Assisted with scheduling outpatient appointments.
- Organized and maintained records by updating and obtaining both personal and financial information from patients.
Education
Associates - Medical Billing And Coding With Honors
DeVry University
Downers Grove, IL02-2023
Skills
- EPIC EMR
- CHAA Certification
- Database Management
- Electronic Health Records Management
- Office Administration
- Account Management
- Medical Records Maintenance
- Document Scanning
- Information Verification
- HIPAA Compliance
- Medical Terminology
- Records Organization
- Health Information Systems
- Positive Interactions
- Telephone Etiquette
- Insurance Verification
- Payment Collection
- Insurance Company Knowledgeable
- Multitasking and Organization
- Registration and Admissions
- Pre-Admission Requests
- Patient Education
- Appointment Scheduling
- Customer Service
- Scheduling Diagnostic Procedures
- Problem-Solving
- Financial Procedures Adherence
- Training Coordination
- Information Collection
- Patient Registration
- Payment Processing
- Insurance Billing
- EMR Updating
- Phone and Email Etiquette
- Fee Collection
- Insurance authorization for medical procedures
- Updating patient insurance and verifying current enrollment
- Verifying patient insurance policy details for copays, deductibles, co-insurance, and out of pocket cost
- Verifying patient insurance policy for detailed coverage for inpatient/outpatient procedures
Certification
- CHAA-Certified Healthcare Access Associate
Accomplishments
- Deans List for each semester during full enrollment period
Timeline
Patient Access Representative
Singing River Hospital
01.2023 - Current
Associates - Medical Billing And Coding With Honors
DeVry University
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