Resourceful Healthcare Revenue Cycle professional with 14 years of comprehensive experience in billing, accounts receivables, and contract review. Tech-savvy critical thinker committed to quickly identifying and resolving issues.
Hi, I’m
Tirrell Martin
Atlanta,GA
Summary
Overview
14
years of professional experience
Work History
Northside HospitalAtlanta, GA
Revenue Cycle Quality Auditor
03.2023 - Current
Job overview
- Process error disputes within quality assurance system, providing timely feedback
- Performs account review for account financial resolution opportunities and performance opportunities
- Reviews patient satisfaction data and detail comments for feedback and QA application
- Performs compliance process audits in relation to Medicare and Medicaid
- Assists training team by providing feedback regarding the registration process
- Analyzes data trends to determine areas of improvement for the QA and registration teams
- Ensures correct plan codes are placed on account so that the appropriate financial adjustments are posted
Northside HospitalAtlanta, GA
Commercial Post Payment Review Specialist
12.2019 - 03.2023
Job overview
- Calculated expected allowed amount based on contracts between insurance companies and Northside Hospital
- Issued refunds to patients and insurance companies
- Wrote appeal letters to insurance companies to dispute incorrect refund requests
- Verified demographic information including addresses, phone numbers, and correct spelling of patient names
- Used payer websites to verify patient eligibility by confirming term dates of insurance coverage
- Posted adjustments to patient accounts to correct balances
- Transferred patient credits to outstanding balances
- Researched payments to verify they are posted correctly
- Worked with Cash Posting and Treasury departments to verify if refund checks cleared in order to re-issue refunds
- Identified trends related to overpaid insurance claims and creates spreadsheets used by leadership to reduce future overpayments
- Assisted Government Post Payment Team with exception review for Medicare, Medicaid, Managed Medicare, and Managed Medicaid payers by determining correct allowed amount and applying adjustments
Cotiviti, IncConshohocken, PA
Payment Accuracy Specialist I
07.2016 - 10.2019
Job overview
- Used Structured Query Language (SQL) to search for potential overpaid claims used for new concepts
- Calculated correct payment of hospital, physician, and skilled nursing claims via review of complex contracts and fee schedules
- Used VLOOKUPs and PivotTables in Excel to construct spreadsheets used for bulk entry of overpaid claims
- Created service request tickets to enhance performance of existing standard reports
- Served as Subject Matter Expert for various concepts
- Responded to client disputes and resolves claims discrepancies
- Completed quality review of overpayments identified to ensure accuracy
- Assisted with training specialists on new concepts
Cotiviti, IncConshohocken, PA
Junior Auditor
02.2015 - 06.2016
Job overview
- Identified over $10 million dollars in overpayments over 5600 claims
- Met monthly productivity goals
- Assisted with onboarding new junior auditors by training with systems used for claims review
Northside HospitalAtlanta, GA
Post Payment Review Specialist (Team Lead)
12.2013 - 02.2015
Job overview
- Completed specialty adjustments for the bone marrow transplant, pulmonary rehabilitation, and drug replacement programs based on specialized contracts
- Determined the expected reimbursement for HMO/PPO and managed Medicaid payers
- Completed daily action plan used to determine how productivity goals will be met
- Distributed work daily to analysts based on contract specialty
- Reviewed error report daily to correct adjustment submission errors by analysts
- Identified trends with payers that may be causing underpayments/overpayments on accounts to get resolution
- Assisted supervisor with completing monthly qualitative analyses of analysts
- Trained new employees on in-house reimbursement tool used for contract review
- Created training manual for refund analysts that is currently in use
Northside HospitalAtlanta, GA
Refunds Analyst
03.2012 - 11.2013
Job overview
- Processed patient and insurance refunds
- Calculated expected reimbursement for insurance claims
- Transferred credits to outstanding balances
CHRISTUS HealthHouston, TX
Billing Specialist/Reimbursement Specialist
10.2009 - 01.2012
Job overview
- Reviewed rejected claims and researched commercial guidelines to ensure proper modifications to claims in accordance with documented billing procedures
- Ensured claims are submitted timely and no filing deadlines are received
- Responded to patient and insurance company complaints, correspondence, inquiries, and requests for information
- Analyzed bill errors to make appropriate corrections
- Validated payments to ensure they are paid per contract based on Explanation of Benefits received from payers once billing was completed
- Trained new employees on how to make bill corrections, submit claims, and clean rejected claims in SSI.
Education
Southern New Hampshire University
Master of Science from Health Administration
11.2024
University Overview
American Academy of Professional Coders
from Certified Professional Coder
10.2023
University Overview
Auburn University
Bachelor of Arts from Public Administration
05.2006
University Overview
Skills
- Microsoft Office
- Microsoft Outlook
- McKesson Star
- Meditech
- SSI
- Power BI
- Quality Control Processes
- Continuous Improvement
- Report Preparation
- Root Cause Analysis
- Process Implementation
- Performance Improvement
- Compliance Standards
- Payment Posting
- Contract Preparation
- Billing Dispute Resolution
- Audit Procedures
- Claims Processing
- Reimbursements
- Billing Codes
- Medicaid and Medicare Knowledge
- Claims Review
- Commercial and Private Insurance
- Data Analysis
- CMS-1500 Billing Forms
- HIPAA Compliance
- Insurance Collections
- CPT Code Modifiers
- Electronic Claims
- ICD-10 Coding
- CERNER
Timeline
Revenue Cycle Quality Auditor
Northside Hospital
03.2023 - Current
Commercial Post Payment Review Specialist
Northside Hospital
12.2019 - 03.2023
Payment Accuracy Specialist I
Cotiviti, Inc
07.2016 - 10.2019
Junior Auditor
Cotiviti, Inc
02.2015 - 06.2016
Post Payment Review Specialist (Team Lead)
Northside Hospital
12.2013 - 02.2015
Refunds Analyst
Northside Hospital
03.2012 - 11.2013
Billing Specialist/Reimbursement Specialist
CHRISTUS Health
10.2009 - 01.2012
Southern New Hampshire University
Master of Science from Health Administration
American Academy of Professional Coders
from Certified Professional Coder
Auburn University
Bachelor of Arts from Public Administration
Similar Profiles
PATRICK MOUTONPATRICK MOUTON
Imaging Support Specialist at Northside HospitalImaging Support Specialist at Northside Hospital
Terrance BelvinTerrance Belvin
Security Officer at Northside HospitalSecurity Officer at Northside Hospital
LaTedra TuckerLaTedra Tucker
Scheduler/ Secretary at Northside HospitalScheduler/ Secretary at Northside Hospital
Zhaniqua A. WashingtonZhaniqua A. Washington
Registered Nurse, Medical Intensive Care Unit at Northside HospitalRegistered Nurse, Medical Intensive Care Unit at Northside Hospital
Paul ComriePaul Comrie
Stream Manager at Nokia USA IncStream Manager at Nokia USA Inc