Tamyra Hargro
Jacksonville,FL
Summary
Detail-oriented worker with knowledge of account management and collaborating with other departments. Talented at data entry and analysis with exceptional knowledge of obtaining authorizations for high tech radiology. Medical Billing and Coding Specialist with 10 years providing administrative and patient support in hospital and medical office settings. Advanced knowledge of private insurance processes and codes.
Overview
25
25
years of professional experience
Work History
Insurance Authorization Specialist
Grady Memorial Hospital
11.2008 - Current
- Denial resolution.
- Maintained consistent follow-up on status of prior authorization requests.
- Submitted for prior authorization with required documentation to appropriate funding source.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- Communicated verification and authorization status updates with MRI Imaging department to facilitate decision-making for patient admissions and insurance coverage.
- Notified insurance companies and of procedure cancellations and changes.
- Reviewed 100 patient cases per week and verified insurance coverage information.
- Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
- Coordinated with contracting department to resolve payer issues.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Assured timely verification of insurance benefits prior to patient procedures or appointments.
- Communicated effectively with staff members of operations, finance and clinical departments.
- Maintained confidentiality of patient finances, records and health statuses.
Insurance Verification Specialist
Emory Hospital
01.2006 - 10.2008
- Communicated verification and authorization status updates with Third Party department to facilitate decision-making for patient admissions and insurance coverage.
- Reviewed 100 patient cases per week and verified insurance coverage information.
- Determined appropriateness of payers to protect organization and minimize risk.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- Assured timely verification of insurance benefits prior to patient procedures or appointments.
- Generated reports to track insurance verifications and claim progress.
- Complied with HIPAA guidelines and regulations for confidential patient data.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Updated patient records with accurate, current insurance policy information.
- Achieved insurance pre-authorizations to enable timely patient procedures.
- Increased accuracy of insurance verification, ensuring compliance with both provider and insurer requirements.
- Assisted patients with understanding personalized insurance coverage and benefits.
- Developed strong relationships with insurance representatives, facilitating smooth communication channels for resolving inquiries or disputes.
Payment Poster
Piedmont Hospital
05.2003 - 06.2006
- Accurately posted payments and adjustments both electronically and manually.
- Managed monthly reconciliation schedules for assigned accounts.
- Payment posted for Aetna & Medicaid.
- Daily balancing.
- Increase Revenue by 20%.
- Identified overpayments and processed refunds for insurance carriers and patients.
- Processed payments that had been received from insurance companies and Medicare.
- Accurately posted payments and adjustments both electronically and manually.
- Managed large volumes of data efficiently and with great care on daily basis.
Medical Billing Specialist
Papp Clinic
02.2000 - 04.2003
- Researched CPT and ICD-9 coding discrepancies for compliance and reimbursement accuracy.
- Follow up.
- A/R reports.
- Examined patients' insurance coverage, deductibles, insurance carrier payments and remaining balances not covered under policies when applicable.
- Communicated with insurance providers to resolve denied claims and resubmitted.
- Posted and adjusted payments from insurance companies.
- Pre-certified medical and radiology procedures.
- Diagnostic Imaging.
- Adhered to established standards to safeguard patients' health information.
- EOB knowledge.
- Researched CPT and ICD-9 coding discrepancies for compliance and reimbursement accuracy.
- Examined patients' insurance coverage, deductibles, insurance carrier payments and remaining balances not covered under policies when applicable
Education
Some College (No Degree) - Nursing
Georgia State Perimeter
Atlanta, GAHigh School Diploma -
Miami Northwestern Senior High School
Miami, FL05.1988
Skills
- Teamwork
- Epics software proficiency
- PeopleSoft
- Critical thinking
- Self-motivated professional
- MS Office
- Billing
- Conflict resolution
- HCPCS
- CPT Coding
- ICD-10
- Medical Terminology
- Typing 45wpm
- HIPAA Compliance
- Claims Adjustments
Accomplishments
- Documented and resolved denials which led to approvals
- EPIC cadence training
- Medical Billing certificate of completion
Timeline
Insurance Authorization Specialist
Grady Memorial Hospital
11.2008 - Current
Insurance Verification Specialist
Emory Hospital
01.2006 - 10.2008
Payment Poster
Piedmont Hospital
05.2003 - 06.2006
Medical Billing Specialist
Papp Clinic
02.2000 - 04.2003
Some College (No Degree) - Nursing
Georgia State Perimeter
High School Diploma -
Miami Northwestern Senior High School
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