Thiquita McConaga
Boston
Summary
Experienced Financial Counselor with a passion for improving healthcare financial processes and patient satisfaction. Over 20+ years of customer service experience, including 10 + years in hospital billing and follow-up. Strong problem-solving skills, excellent communication abilities, and meticulous attention to detail. Enthusiastic about joining a dynamic team and contributing to the mission of providing exceptional customer service.
Overview
17
17
years of professional experience
Work History
Patient Access Coordinator
Tufts Medical Center
12.2024 - Current
- Review documents sent by referral source (via portal, fax or other method) to determine information received and needed to complete the referral based on department guidelines.
- Prioritizes completion of specified referrals based upon referral department prioritization process (e.g., hospice referrals and using start of care date as a guide).
- Input referrals in Forcura and Epic timely and accurately based on department guidelines, which includes productivity and quality requirements.
- Accepts or declines referrals based on service area and the services HHF provides.
- Determines home care eligibility based on payer, along with the having the knowledge to accept referrals based on payer regulations, contracts and plan types.
- Timely and accurately verifies eligibility and benefits for insurances identified through the eligibility process; obtains the effective date of coverage and includes whether services are covered.
- Has expert knowledge of payers and plan types.
- Understands billable services under home health and hospice.
Patient Financial Counselor
South Shore Health System
07.2024 - 12.2024
- Completes MassHealth's curriculum for Certified Application Counselor and renews certification annually.
- Interviews patients, in a language and manner best understood, to determine eligibility and communicate enrollment options and plan benefits for which patients qualify.
- Explains subsidized Qualified Health Plans available through premium tax credits or informs patients of expected out-of-pocket expenses, co-pays, and deductibles when applicable.
- Utilizes protected software programs to determine patient eligibility for MassHealth, Health Safety Net, ConnectorCare, and other insurance carriers and assists with enrollment process.
- Initiates communication with patients, by phone, mail, or email, , to initiate new applications or plan renewals for health insurance coverage. Informs patients of important deadlines, effective dates for coverage, and required documentation to determine eligibility.
- Scans MassHealth applications and supporting verification documents into HIX and patients' Epic record.
- Documents in Epic the status of all applications initiated by adding a financial tracker and recording actions taken and follow-up efforts required to complete and submit for processing.
- As requested, assists patients with enrolling in an ACO or changing selection of ACO, to ensure continued access to covered services.
Financial Assistance Representative
Piedmont Healthcare
07.2016 - 07.2024
- Screened patients for uncompensated care eligibility and assist with completion of the application and documentation requirements
- Followed up with clients by phone, or in writing as needed to encourage completion of applications and to ensure enrollment and ongoing access to needed health care service
- Demonstrates working knowledge of all public assistance programs and is able to screen patients for eligibility for these programs and initiate application
- Worked as a liaison between the patients and other internal entities to provide resolution for concerns such as billing, coding, charge accuracy, medical records, and detail billing
- Communicated and coordinated with admitting staff, case management, and billing daily to retrieve and share information
- Maintain effective liaison with all collateral agencies, including physician offices, governmental agencies, and all community contacts
- Kept complete and accurate files in compliance with all regulatory requirements in Epic
- Protected patients sensitive financial and demographic information in a consistently responsible manner.
Revenue Cycle Consultant
ABLM Inc.
01.2016 - 07.2016
- Client liaison for Dignity Health (Greater Atlanta Area)
- Analyzes and resolves issues within the revenue cycle process to decrease client's Inventory/AR of $1.9 Billion improving financial performance
- Reconciled over $20M in aged accounts within a 2-month period contributing to positive financial standing
- Identify process breakdowns in the hospital billing, collections, and implanting innovative solutions to address new issues that arise
- Consulted with clients to determine their needs and priorities
- Detailed knowledge of Medicaid, Medicare, Managed Care, HMO’S PPO’s and Commercials Insurances
- Follow-up, collections, adjustments, write-offs in addition to reconciliation
- Increased revenue through loss prevention, cash acceleration and denial management
- Perform in depth root causes analysis to determine process improvements
- Prepare and/or provide recommendations for initial and next level appeals for denied and/or underpaid claims.
Hospital Revenue Cycle Consultant
Expeditive LLC
11.2015 - 01.2016
- Client liaison at the University of Massachusetts Memorial Hospital (Worcester MA)
- Follow Up and Collections on accounts more than 180 days
- Managed accounts receivable collections to achieve targeted receivables monthly and expedited cash flow
- Revenue Cycle, managed care, 3rd party reimbursement, and hospital financial resources as well as payer specific regulatory and contractual billing obligations for Medicare, Medicaid and Commercial
- Patient Access updates including Eligibility, Insurance Verifications, Authorizations and Pre-Certifications
- Verified Coding and ICD-9 codes on claim forms electronically and manually
- Resolved denial discrepancies for payments
- Implemented all secondary insurance and coinsurance claims if applicable.
Accounts Receivable Team Lead
Pediatric Services of America
07.2015 - 11.2015
- Customized daily workflow by analyzing and delegating daily communication to team
- Assisted with difficult denials or notices of non-payment, contacting Payer representatives on large trends identified by team members
- Handled difficult daily follow-ups that come from other departments involving open AR and Communicates with others in leadership on action taken
- Assigned daily correspondence to the team for their assigned Payers
- Notified Supervisor of any critical or unusual payer requests or trends
- Received adjustment and refund requests from team members and reviews accounts for any further actions needed prior to passing to Supervisor
- Ran reports on productivity, monitors and audits employee work
- Mentored new employees and assists with training
Accounts Receivable Collector
Pediatric Services of America
10.2013 - 07.2015
- Worked and collected delinquent A/R accounts
- Maintained current AR levels per established AR team goals
- Achieved cash collection goal on a quarterly basis
- Submitting adjustments in an accurate and timely manner
- Ensured claims are refiled and/or billed to the secondary/tertiary insurance in a timely manner
Front Back Office /Billing Specialist
Surgery Partners
11.2012 - 10.2013
- Greeted patients and visitors in a courteous and friendly manner
- Typed correspondence, summary, memos, and forms as requested by physician and practice manager
- Followed up and collect outstanding aged debt
- Enter all procedure and diagnose codes in Nextgen
- Reviewed, and worked daily correspondence
- Verified insurance eligibility
- Gathered appropriate documentation for claims submission
- Followed up on unpaid claims and denial.
Medical Billing Specialist
Nationwide Recovery Services
07.2009 - 06.2012
- Client Liaison for Grady Health System (Atlanta, GA)
- Ensured claims are entered and submitted with 48 hours of receipt
- Bill and collect for different entity (Radiology, Anesthesia, Hospital and etc.) Processed a minimum of 100 claims a day conforming to ICD-9 and CPT-4 standards
- Improved revenue for most recent provider over 32% with same patient load
- Handled claims for all commercial insurance, Workers Compensation, MVA, Medicare and Medicaid
- Accurately apply payments to patient accounts
- Post and reconcile insurance and patient payments
- Research and resolve incorrect payments, EOB rejections, and other issues with outstanding accounts.
Medical Secretary
Harvard Vanguard
06.2008 - 06.2009
- Interfaced directly with a diverse population of patients, responding to various inquiries and concerns
- Communicated with physicians and medical support staff to determine the need for patient services
- Performed a broad scope of clinical procedures, effectively communicating and recording test results
- Obtained patients medical insurance information quickly and accurately
- Ensured the quality control of laboratory procedures, equipment functionality, and regulatory compliance
- Maintained up-to-date computer-based laboratory test results and patient information
- Manage a medical front desk in areas of manual and computerized scheduling, billing, and medical/insurance information, including major carriers and Medicaid.
Education
Human Resources Management
Georgia Piedmont Technical College
Clarkston, GASkills
- Data entry proficiency
- Teamwork and Collaboration
- MS Office
- Decision-Making
- Medical Billing
- Payment posting
- Claims Management
- Account resolutions
- Call Center Customer Service
- Driven Work Ethic
- Friendly, Positive Attitude
- Problem-Solving
Technologysummary
Knowledge of MS Office and MS Windows. SMS, Nextgen, Encore, EPIC, Meditech, and Passport. Medical Manager, PCACE, Medisoft, Smart Term, Visual Info, On Demand, The Visionary Office, Oracle and PTOS medical software.
Timeline
Patient Access Coordinator
Tufts Medical Center
12.2024 - Current
Patient Financial Counselor
South Shore Health System
07.2024 - 12.2024
Financial Assistance Representative
Piedmont Healthcare
07.2016 - 07.2024
Revenue Cycle Consultant
ABLM Inc.
01.2016 - 07.2016
Hospital Revenue Cycle Consultant
Expeditive LLC
11.2015 - 01.2016
Accounts Receivable Team Lead
Pediatric Services of America
07.2015 - 11.2015
Accounts Receivable Collector
Pediatric Services of America
10.2013 - 07.2015
Front Back Office /Billing Specialist
Surgery Partners
11.2012 - 10.2013
Medical Billing Specialist
Nationwide Recovery Services
07.2009 - 06.2012
Medical Secretary
Harvard Vanguard
06.2008 - 06.2009
Human Resources Management
Georgia Piedmont Technical College
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