Summary
Work History
Education
Skills
Timeline
Generic

Terri Clayborn

The Colony,TX

Summary

Results Driven Professional with over 5 years experience working in Hospital Billing and Collections. Demonstrate leadership skills that enable the processing of high volumes of claims to achieve revenue goals.

Work History

Revenue Cycle Specialist

Guidehouse
Lewisville, TX
3 2020 - Current
  • Post payments , contractual adjustments and write offs in accordance to policies and procedures.
  • Research payment variances and determine accuracy of reimbursement based on contract terms , fee schedules and summary of plan documents.
  • Submit appeals and compile necessary supporting documentation to ensure proper processing and payment reimbursement.
  • Bi-weekly meeting with clients to evaluate claim denial trends and A/C over 90 days.
  • Validate denial reasons, billing errors, payor rejections and follow-up work queues.

Denial Specialist

Parallon
Irving, TX
3 2018 - 3 2020
  • Research accounts appearing on aging report. Forwarded denial information to correct workqueue to ensure proper denial resolution
  • Reviewed and verified patients benefits and eligibility using provider portal or calling payor directly.
  • Use Waystar clearinghouse to verify timely and accurate claim submission.
  • Fulfill payer billing requirements by submitting itemized statements, medical records and required forms to process the claim.

Claim Representative

Allstate (Contract)
Dallas, TX
12 2015 - 3 2018
  • Negotiated with insurance underwriters to obtain better coverage and improved rates for clients.
  • Calculated premiums and established payment methods for sales.
  • Educated clients on insurance policies and procedures.
  • Maintained high standards of customer service by building relationships with clients.
  • Updated field operations staff on status of open claims and current actions.

Education

Bachelor of Science - Business Administration

University of Phoenix
Dallas, TX
05.2007

Skills

  • Interpret EOBs & Payor Contracts
  • Variance Analysis
  • Denials Resolution
  • Medical Appeals
  • Epic Resolute
  • Pivot Tables , Vlookup, Xlookup

Timeline

Revenue Cycle Specialist

Guidehouse
3 2020 - Current

Denial Specialist

Parallon
3 2018 - 3 2020

Claim Representative

Allstate (Contract)
12 2015 - 3 2018

Bachelor of Science - Business Administration

University of Phoenix
Terri Clayborn