Tametria Chavers

1. Contacts payors to follow-up on outstanding claims for assigned accounts to verify reason for non-payment and corrects account, re-bills claim, and/or performs adjustments.

2. Responds to routine denials from payors such as inability to identify the patient, coordination of benefits, non-covered services, past filing deadlines to ensure information is transmitted that is required to process payments. Performs required actions in order to resolve the account balance promptly by submitting appeals, correcting account information, coordinating requests for medical records, and posting account adjustments.

3. Documents all actions taken on accounts in the system account notes to ensure all prior actions are noted and understandable by others.

4. Performs routine audits of individual accounts to resolve all discrepancies in account balances.

5. Informs the Supervisor of any problems or changes in payor requirements and exercises independent judgment to analyze and report repetitive denials so that corrective actions can be taken.

6. Tracks productivity and provides cumulative reports on a daily, weekly or monthly basis, as required by supervisor and/or manager.

7. Maintains a positive working relationship with contacts at all agencies, patients, insurance companies, government entities, clinical personnel, other Parkland staff and management, to promote teamwork, cooperation, and a positive public image for Parkland. Serves as a positive role model for staff and patients and demonstrates strong interpersonal skills. Accepts constructive criticism and integrates suggestions in effective ways

• Streamlined billing processes for improved efficiency and reduced errors.
• Monitored delinquent accounts and initiated collections actions when necessary, recovering outstanding balances while maintaining positive customer relationships.
• Supported cross-functional projects focused on process improvements within the Billing Department, leading to increased operational efficiency.
• Developed personalized payment plans for customers experiencing financial difficulties, resulting in increased customer retention.
• Maintained a strong knowledge of industry regulations and best practices relating to billing procedures, providing expert guidance when needed.
• Enhanced customer satisfaction by promptly addressing billing inquiries and resolving disputes.
• Collaborated with team members to achieve monthly service targets and maintain high-quality standards.
• Updated customer records with accurate billing information, preventing future disputes and delays in payment processing.

• Collect balances due from payors ensuring proper reimbursement for all services.
• Identifies and forwards proper account denial information to the designated departmental liaison. Dedicates efforts to ensure a proper denial resolution and timely turnaround.
• Maintain an active knowledge of all collection requirements by payors.
• Works collector queue daily utilizing appropriate collection system and reports.
• Demonstrates knowledge of standard bill forms and filing requirements.
• Identify and resolve underpayments with the appropriate follow up activities within payor timely guidelines.
• Identify and resolve credit balances with the appropriate follow up activities within payor timely guidelines.
• Identify and communicate trends impacting account resolution.
• Performs Revenue Cycle functions in a manner that meets or exceeds CHRISTUS Health key performance metrics.
• Ensures PFS departmental quality and productivity standards are met.
• Collects and provides patient and payor information to facilitate account resolution.
• Responds to all types of account inquires through written, verbal or electronic correspondence.
• Maintains payor specific knowledge of insurance and self-pay billing and follow up guidelines and regulations for third-party payers. Maintains working knowledge of all functions within Revenue Cycle.
• Responsible for professional and effective written and verbal communication with both internal and external customers in order to resolve outstanding questions for account resolution.
• Meets or exceeds customer expectations and requirements, and gains customer trust and respect.
• Compliant with all CHRISTUS Health, payer and government regulations.
• Exhibits a strong working knowledge of CPT, HCPCS and ICD-10 coding regulations and guidelines.
• Appropriately documents patient accounting host system or other systems utilized by PFS in accordance with policy and procedures. Provides continuous updates and information to PFS Leadership Team regarding errors, issues, and trends related to activities affecting productivity, reimbursement, payment delays, and/or patient experience.

• Implemented process improvements within the department, leading to reduced turnaround times for claims processing.
• Assisted customers with complex coverage needs, identifying suitable products and explaining their benefits.
• Conducted thorough risk assessments for potential clients, reducing potential losses for the company.
• Participated in ongoing professional development opportunities to stay current with industry advancements.
• Modified, updated and processed existing beneficiary, amount of coverage and type of insurance.
• Obtained and verify patient insurance benefits coverage by use of insurance websites or by reaching out to the insurance carriers prior to patient appointments/procedures.

Applied basic insurance underwriting knowledge to evaluate and analyze information.

● Navigated computer system to look up customer information and update policies.

● Itemized Bill Review - scrub charges and claims. itemized charges and scrub them.

● client reimbursement policies

● Take inbound calls and makes outbound calls as needed. Analyzes client and provider inquiries to determine appropriate steps for resolution.

● most of work comes through e-mail. 90-95%.

● Communicated with insurance carrier, patient and third party or employer to verify patient insurance benefits.

● Drafted reports and presentations to illustrate research findings.

● Outlined research findings in detailed documentation to support decision making by project managers,clients and other marketing team members.

Prepared insurance claim forms or related documents and reviewed for completeness.

● Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.

● Made contact with insurance carriers to discuss policies and individual patient benefits.

● Reviewed police reports, medical treatment records, medical bills and physical property damage to determine extent of liability.

● Determined insurance coverage levels and restrictions by thoroughly examining claims forms and associated records.

● Maintained knowledge of benefits claim processing, claims principles, medical terminology and procedures and HIPAA regulations.

● Supported efficient handling of complex claims and followed up on open, denied or suspended claims to complete required line items.

● Determined liability, compensability and benefits due on each claim.

● Coordinated benefits while applying applicable deductibles, co-insurance and out-of-pocket costs.

● Claims on HCFA 1500 forms.

● Based payment or denials of medical claims upon well-established criteria for claims processing.

● Persuade patients to pay amounts due on medical accounts, non-payable claims, or balances left from patient responsibility. i.e. deductible, coinsurance and /or co-pays

● Produced and mailed monthly statements to customers and assisted with related requests for information and clarification.

● Partnered with cash application team and credit manager on timely and accurate posting of remittances.

● Evaluated pending claims to identify and resolve problems blocking auto-adjudication.

● Audits patient's accounts to ensure procedures and charges are coded accurate and corrected billing errors.

● Generated financial statements and reports detailing accounts receivable status.

● Logged charges and payments within Centricity.

● Compiled and tracked outstanding balances owed to medical facilities.

● Processed online and paper appeal submissions and refund requests.

● Contact insurance companies to check on status of claims payments and write appeal letters for denial claims.