Ta Kisha Murphy
Madison,TN
Summary
Seeking a fully remote contract or direct hire role with opportunity to grow and career advancement. Methodical Revenue Cycle Specialist with strong attention to detail and in-depth understanding of billing procedures. Excellent planning and problem-solving abilities. Prepared to bring 17 years of related experience to a dynamic position with room for career growth. Well-qualified Medical Billing Specialist proficient in ICD-10 coding and Epic. Demonstrated success analyzing existing systems and providing recommendations for improvement. Forward-thinking and hardworking with flexible and diligent approach. Analytical professional with strong background in financial modeling and risk management. Skilled in providing financial consultations and solutions for businesses of all sizes. Astute candidate develops new strategies and processes to optimize financial operations.
Overview
9
9
years of professional experience
1
1
Certification
Work History
Contract Definition Analyst
Experian
04.2023 - 07.2023
- Defining and maintaining over 22 payer contracts in Experian Health’s proprietary physician and hospital contract manager software
- Extensive understanding of reimbursement methodologies in order to be able to accurately model payer contracts in order to value physician and hospital claims and estimates.
- Audit implementations to ensure clients have provided necessary information needed to initiate implementation.
- Answering valuation-related support cases from clients within Experian Health’s Service Level Agreement turnaround time period
- Other duties, such as special projects, as assigned.
- Warehousing documents and Setting naming conventions)
- Interacted with clients and employees, which helped cultivate positive working relationships.
- Viewed reports regularly to make sure processing was conducted efficiently.
- Identified key areas not performing well and implemented effective, new processes.
AR Collection Specialist
Envision Healthcare Inc
02.2022 - 03.2023
- Excellent communication skills and strong customer service skills
- Followed all company policies and procedures to deliver quality work.
- Interpreted clients' needs and introduced services to fit specific requirements.
- Evaluated diverse organizational systems to identify workflow, communication, and resource utilization issues.
- Extensive working knowledge of managed care networks and insurance carriers Extensive working knowledge of accounts receivable functions, including CPT and ICD-10 coding.
- Working in Vision, NextGen, and Athena systems
- Contacted clients with past-due accounts to formulate payment plans and discuss restructuring options
- Identified, researched, and resolved billing variances to maintain system accuracy and currency
- Reviewed accounts on monthly basis to assess aging and pursue collection of funds
- Identified, researched, and resolved billing variances to maintain system accuracy and currency
- Contacted clients with past-due accounts to formulate payment plans and discuss restructuring options.
- Managed monthly reconciliation schedules for assigned accounts
- Listened and responded to customer requests and forwarded necessary information to superiors.
- Maintained accurate records of customer accounts, payments and payment plans.
Contract Management Specialist
Medhost
11.2020 - 01.2022
- Maintaining reimbursement rules and supporting data tables for use in hospital contract management software through research and defining methods of revenue recovery
- Developing methods for critical access facilities for accurately valuing inpatient & outpatient claims with a focus on Developed and followed processes to manage contracts and remain in compliance with company commitments and regulatory obligations using Salesforce.
- Verified submitted documents for completeness and compliance with company policies, addressing discrepancies.
- And collaborating to troubleshoot where necessary.
- Collected, organized, and modeled data using Salesforce Helped leaders understand how to effectively manage.
- Answering valuation-related support tickets from clients’ Analytical skills, Focus, Accuracy, and Timelines are paramount qualities Research and define evaluation logic primarily for Medicare hospital claims valuation, with commercial payer websites for adjudication rules Downland provider manuals, reimbursement policies, and medical policies for use in hospital and applicable commercial payer valuations.
- Provide internal consulting for enhancement of Hospital Claims Scrubbing Application Conducted research and investigations into Covid-19 related diagnoses.
- Evaluated diverse organizational systems to identify workflow, communication, and resource utilization issues.
- Gathered, documented, and modeled data to assess business trends.
- Developed and followed processes to manage contracts and remain in compliance with company commitments and regulatory obligations
- Worked collaboratively with administrative staff in negotiation, correspondence, documentation, and compliance checks for service contracts.
- Conducted thorough reviews of operations to devise and deploy improvement strategies.
Account Management Specialist
Convergent USA
02.2019 - 08.2020
- Think critically through implementation of plans to identify gaps and make necessary changes and adjustments 45 daily accounts worked to resolution in efforts to recover facility unresolved balances surrounding all denial types from all payers.
- Investigated and resolved claim variances Resolves client and audit issues to completion with attention to detail and high levels of professionalism.
- Completed in-depth research to investigate claims and resolve problems.
- Assessed individual situations and developed effective and appropriate resolutions.
- Monitored aging accounts and reached out to customers to discuss payments.
- Rounding each service center to learn processes (Billing AR follow-up, Denials, Cash Posting) to assist with determining process improvement.
Medical Insurance Collector
Navient Solutions
08.2018 - 01.2019
- Claim denial review and corrections.
- Requesting Retro authorizations for services rendered requiring authorization Appeals for not medically necessary, not classified, or experimental procedures Claim review for coding denial for diagnosis, modifier use, and inappropriate procedure code due to payer-specific guidelines Contract coherence per contract review per capitation health versus medical plans for correct billing based on levels of responsibility surrounding yearly Dophers.
- Entered client details and notes into system for interdepartmental access and review.
- Processed debtor payments and updated accounts to reflect new balances.
- Worked with customers to create debt repayment plans based on current financial conditions
- Used Excel to create Pivot tables and spreadsheets
- Worked with customer to create debt repayment plan based on current financial conditions Listened to customers and negotiated solutions that met creditor and debtor needs.
ACCOUNT REIMBURSEMENT SPECIALIST
02.2017 - 04.2018
- Coding, Authorizations, Appeals Provides feedback to physicians and providers based on documentation reviewed Offers suggestions for improvements based on coding/billing requirements and coding policies (CMS VS AMA)
- Demonstrates knowledge to work coding denials, received from third-party payers including
- MCO, Medicaid, & Medicare High-Volume of over 50 calls per day
- Third-party billing, claim to correct, addressing daily correspondence directly related to workers' compensations and auto accidents inquiries, billing, and lawsuits for reimbursement and collection efforts
- Followed up on denied and unpaid claims to resolve problems and obtain payments
- Guided office staff on how to effectively complete prior authorization forms and appeals documentation to achieve positive results.
Account Reimbursement Specialist II
Vanderbilt Medical Group
10.2015 - 03.2017
- Maintain follow-up on patient accounts to include unapplied payments within established guidelines
- Pharmacy billing, collecting, and editing of CMS 1500 claims through conversion on HCPCS codes to NDC units for reimbursement
- Telephones or sends formal letters in the initial stages of the collection process to the delinquent account
- Analyzes each payor and patient’s outstanding accounts receivable, re-bills, refunds, and denials to obtain maximum reimbursement
- Re-bill patient insurance and other third-party carriers for charges per company/division per company and customary charges special contract or letter agreement pricing
- Managed collection claims for unpaid bills against the estates of debtors; evaluated and verified benefits and eligibility; posted and adjusted payments from insurance companies; identified and resolved patient billing and payment issues.
Recovery Analyst Consultant II
04.2014 - 10.2015
- Manage 45-60 aged accounts per day from 2012 to resolve all recovery issues and request pre-authorization, retro authorization, and extended authorization to extend in-patient stays
- Handle claim corrections, edits, audits, and claim resubmission and work closely with subrogation accounts, third-party liability, pre-existing conditions, and worker compensation
- Complete thorough follow-up on claim denials and submit claim appeals for denied claims for timely filing, investigational, experimental, and splitting claims when necessary
- Work with claims that deny a total number of hours versus the procedure on facility claims to create a corrected claim per billing guidelines, allowing recovery on services excluding room and board
- Utilize Epic, Medipac, Star Panel, and Hyperspace as resources for necessary documents needed to attach to appeals
- Referenc
Education
Technical Certificate - Medical Insurance Billing
Nashville College of Medical Careers
Madison, TN05.2012
Skills
- Claims
- Reconciliation
- Excel
- Pivot Tables
- Accounts Receivable
- Contract Management
- Analytical Skills
- Salesforcecom
- Microsoft Office
- Verbal and Written Communication
- Contractual Compliance
- Account Planning and Management
- Account Reconciliation
- Improvement Recommendations
- Medical Terminology Knowledge
- Workers' Compensation Authorization
- Billing and Budgeting Reviews
- Operations Advisory
- Authorization Procedure Implementation
- Revenue Cycle Process Improvements
- Debt Restructuring and Refinancing
- Debt Collection Procedures
- Invoice and Payment Tracking
- Claims Review
- HCPCS Coding Guidelines
- Outpatient Procedures
- Correspondence Writing
- Account and Revenue Tracking
- Patient Reimbursements
- Workflow Processes
- Clerical Support
- Insurance Benefits Understanding
- Procedural Codes
Certification
- Management training - May 2012
- Certified Medical Coding Specialist , Nashville Medical Careers- May 2011- May 2012
- Quality Assurance Certificate, Ford Motor Company - September 2006
Timeline
Contract Definition Analyst
Experian
04.2023 - 07.2023
AR Collection Specialist
Envision Healthcare Inc
02.2022 - 03.2023
Contract Management Specialist
Medhost
11.2020 - 01.2022
Account Management Specialist
Convergent USA
02.2019 - 08.2020
Medical Insurance Collector
Navient Solutions
08.2018 - 01.2019
ACCOUNT REIMBURSEMENT SPECIALIST
02.2017 - 04.2018
Account Reimbursement Specialist II
Vanderbilt Medical Group
10.2015 - 03.2017
Recovery Analyst Consultant II
04.2014 - 10.2015
Technical Certificate - Medical Insurance Billing
Nashville College of Medical Careers
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