Summary
Overview
Work History
Education
Skills
Timeline
Generic

Tamara L. Lynch

Raleigh,NC

Summary

Experienced and highly organized medical office professional with a proven track record in managing large front office settings. Demonstrated expertise in patient registration and medical record filing, patient account receivables, provider billing and corrections, medical secretary and data entry, medical billing procedures and medical claims, as well as utilization and medical management.

Overview

11
11
years of professional experience

Work History

Revenue Cycle Support Claims Analyst

Aeroflow Inc
08.2023 - Current
  • Monitoring unconverted invoices and converting invoices manually to facilitate claims transmission.
  • Identified and communicated invoice conversion data errors to Business Units, RCS Team and other stakeholders.
  • Monitored payment trends and identifying any discrepancies or payments not being paid at the allowed/contracted rates.
  • Communicated payment trends to Business Units and RCS Team.
  • Monitored and remediated eligibility responses and claim rejections and communicated trends.
  • Monitored credit balances, remediating and communicating trends.
  • Managed revenue cycle tasks when patients return equipment.
  • Identified trends in claim patterns, providing actionable insights for process improvements and risk mitigation strategies.

Billing Specialist II - Revenue Cycle Analyst

American Anesthesiology, NAPA
01.2016 - 06.2023
  • Quality Control Auditor, August 2022 - June 2023
  • Audit medical records and registration documentation to identify possible billing deficiencies.
  • Review and correct time-related conflicts.
  • Review and correct insurance-related payor codes.
  • Send requests for new surgeons to be added to the billing system.
  • Recommend vendor education based on individual audit results.
  • Assist with Quality team to update incorrect provider reports.
  • Work on special projects.
  • Support offshore Registration and Charge Entry teams as needed.
  • Billing Specialist II for Batch Reconciliation, October 2017 - August 2022
  • Coordinated, monitored, and managed the follow-up on unpaid claims.
  • Investigated and responded to errors generated from electronic claims submissions.
  • Assisted in researching eligibility submission problems/new client submissions
  • Interfaced with other departments, external providers, or clients, as may be required, to resolve errors
  • Initiated verbal and written correspondence to internal and external sources to verify patient and claim information
  • Verified patient information using links to hospitals and web-based sites
  • Provided backup support in all areas of the Front-End Department
  • Coordinated activities with other team members to ensure timely distribution of work to outside locations
  • Participated in administrative staff meetings and attended other meetings and seminars
  • Assisted in evaluation of reports, decisions, and results of department in relation to established goals
  • Served as a member of the Front-End Team Accounts Origination January 2016 - October 2017
  • Served as a specialist for MedData and Availity reporting.
  • Proficient computer skills, including excellent knowledge of Microsoft Office Suite, Outlook, Medsuite, Athena, and other web-based programs.
  • Met the current productivity standard which include both quantity and quality metrics.
  • Assisted in creating and maintaining pivot tables that keep track of team productivity and workflow.
  • Ability to make independent decisions and delegate responsibilities and duties.
  • Ability to draft reports and procedure manuals Ability to effectively present information during meetings using Zoom and Microsoft Teams.

UM Specialist

Blue Cross Blue Shield, Apex Systems
04.2022 - 04.2023
  • Conducts non-clinical reviews based on applicable criteria and guidelines on requested services.
  • Communicates decision to provider and/or member, according to department protocols.
  • Documents outcome of reviews and demonstrates ability to interpret and analyze non-clinical information.
  • Completes verbal or non-verbal outreach to providers or members to obtain medical information for review.
  • Identifies and refers organization determinations that require clinical review to nurse or Medical Director
  • Conducts reviews of authorizations entered to ensure accuracy to avoid impacting claims payment.
  • Accurately and efficiently access practice and hospital information systems to secure and assemble all necessary physician and/or physician extender records to accurately code and bill medical services
  • Communicate via phone, Right Fax, or email with providers regarding patient accounts as needed.
  • Maintain patient files while adhering to HIPAA protocols.
  • Respond to requests for medical records for audit and/or claim research
  • Examined medical records to assure specificity of diagnoses, procedures, and appropriate/optimal reimbursement for hospital and/or professional charges.
  • Maintain thorough understanding of medical record practices, standards, regulations, joint commission on Accreditation of Health Organizations (JCAHO), HealthCare/Finance Administration (HCFA), Medical Review of North Carolina (MRNC), etc
  • Assist with special projects as required
  • Proficiency in Microsoft Office, CRM, and risk assessment software.
  • Proven ability to develop and implement creative solutions to complex problems.

Patient Account Representative

Adreima
12.2014 - 12.2016
  • Responsible for making and receiving calls in the name of hospitals to resolve debts
  • Extensive phone contact with patients and other clients
  • Preparing and submitting billing data and medical claims to insurance companies
  • Ensuring the patient’s medical information is accurate and up to date
  • Preparing bills and invoices, and documenting amounts due for medical procedures and services
  • Collecting and reviewing referrals and pre-authorizations
  • Monitoring and recording late payments
  • Following up on missed payments and resolving financial discrepancies
  • Examining patient bills for accuracy and requesting any missing information
  • Investigating and appealing denied claims
  • Helping patients develop patient payment plans
  • Maintaining billing software by updating rate change, cash spreadsheets, and current collection reports
  • Submit clean claim to clearinghouse or insurance company electronically or via paper CMS-1500 form
  • Follow up with insurance company on denials or rejected claims.

Client Account Representative

Southlight Healthcare
02.2015 - 12.2015
  • Verify client benefits according to payer source
  • Explain benefits plans and financial policies to clients
  • Evaluate client financial status upon admission and arrange payment plans
  • Verify research and complete paperwork and forms to bill as types (Medicaid, IPRS, third party) of claims for reimbursement within timely billing guidelines
  • Work denial reports within specific period to ensure reimbursement
  • Participate in treatment team meeting for staying abreast of treatment recommendations as they pertain to billing and insurance coverage
  • Prepare, submit, and monitor appeals to third party payers as needed
  • Utilize manual/electronic systems to track billing, charges, authorizations, etc
  • Provide a wide variety of reports as requested
  • Assist clinicians with the monitoring of visits, discharges, authorizations, changes in financial circumstances, payer sources and financial contacts
  • Assist with preparation of authorization and re-authorization of services, as appropriate
  • Monitor client payments
  • Follow up on all outstanding accounts throughout treatment and post discharge, if necessary
  • Keep up to date regarding rules and regulations for payer sources.

Claims Processor I

Blue Cross Blue Shield of North Carolina, Manpower
07.2014 - 11.2014
  • Federal Employees Plan medical claim processing
  • Provide expertise or general claims support by reviewing, researching, investigating, negotiating, processing, and adjusting claims
  • Authorize appropriate payment or refer claims to investigators for further review
  • Analyze and identifies trends and provides reports as necessary
  • Submits clean claim to clearinghouse or insurance company electronically or via paper CMS-1500 form
  • Follows up on denials or rejected claims
  • Resolves issue and resubmits claim
  • Documents denial and rejections and provides input on procedure changes to ensure accuracy and efficiency
  • Prepares appeal letters and submits appropriate documentation to substantiate appeal
  • Ensures electronic and manual payments are properly posted in medical claim billing software.

Education

Technical Diploma - Medical & Health Office And Technology

Brookstone College
Greensboro, NC
2003

No Degree - Business Administration And Management

North Carolina Central University
Durham, NC

Skills

  • Skills and Training
  • Medical Terminology
  • Medical Transcription
  • ICD-9 and CPT Coding
  • Pharmacology
  • Anatomy and Physiology
  • Medical Law and Ethics
  • Business Communications
  • Medical Billing & Insurance Forms
  • Business English
  • Accounting
  • Business Math
  • Microsoft Outlook
  • Microsoft Office
  • Typing (50 – 60 wpm)
  • Data Entry Alpha Numeric (9,600 kpm)
  • Data Entry 10-Key (6,500 kpm)
  • Internet

Timeline

Revenue Cycle Support Claims Analyst

Aeroflow Inc
08.2023 - Current

UM Specialist

Blue Cross Blue Shield, Apex Systems
04.2022 - 04.2023

Billing Specialist II - Revenue Cycle Analyst

American Anesthesiology, NAPA
01.2016 - 06.2023

Client Account Representative

Southlight Healthcare
02.2015 - 12.2015

Patient Account Representative

Adreima
12.2014 - 12.2016

Claims Processor I

Blue Cross Blue Shield of North Carolina, Manpower
07.2014 - 11.2014

Technical Diploma - Medical & Health Office And Technology

Brookstone College

No Degree - Business Administration And Management

North Carolina Central University

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Tamara L. Lynch