Tonia Crenshaw
Pediatric Home Services
Royse City,TX
1
Language
15
years of professional experience
Claims professional well-versed in intricacies of claim management and resolution. Known for strategic approach to resolving disputes and ensuring compliance with industry standards. Reliable team collaborator with focus on achieving optimal outcomes and adapting to changing requirements. Skilled in negotiation and critical thinking.
Work History
Claims Specialist
3 Years- Adjudicated complex claims using claim processing systems and documented resolution details.
- Investigated denials, payment discrepancies, and benefit issues to determine appropriate action.
- Communicated with providers and members to clarify claim status and required documentation.
- Reviewed claim files for accuracy, completeness, and compliance with plan guidelines.
- Monitored aging inventory and prioritized pending claims to support timely resolution.
- Applied HIPAA and regulatory standards when handling sensitive claim information.
Reimbursement Specialist
3 Years 5 Months- Collaborated with Medicare, Medicaid, and commercial insurance companies to ensure accurate and timely posting of payments to patient accounts.
- Obtain and review Explanation of Benefits (EOB) and retrieve supporting documentation to aid in cash posting
- Obtained and reviewed Explanation of Benefits (EOB) while retrieving supporting documentation to facilitate accurate cash posting.
- Researched and corrected adjudicated claims lacking payment or adjustment/denial reasons to ensure proper reimbursement.
- Ensure that appropriate medical records are maintained according to HIPAA guidelines
- Verified insurance benefits and eligibility for durable medical equipment coverage.
- Processed prior authorizations and followed payer-specific reimbursement requirements.
Collections Administrator II
4 Years 7 Months- Managed patient account collections, resolving delinquent balances with accurate follow-up and documentation.
- Reviewed aging reports to prioritize accounts, verify balances, and route complex issues for escalation.
- Reconciled account activity, applied payments correctly, and corrected posting discrepancies.
- Investigated denied or unpaid claims, coordinating with billing and insurance teams to resolve outstanding balances.
- Maintained collection records in billing systems, ensuring clear notes and audit-ready account histories.
Collections Specialist
1 Year 1 Month- Managed delinquent account portfolios, resolving balances through consistent follow-up and payment negotiations.
- Researched healthcare accounts to determine medical payment and denial statuses, ensuring accurate follow-up actions. Managed all phases of the collection process.
- Reviewed customer accounts for billing discrepancies, updating records to maintain collection accuracy.
Revenue Cycle Specialist
1 Year- Managed revenue cycle workflows for durable medical equipment accounts, ensuring accurate claims, authorizations, and payer follow-up.
- Reviewed insurance eligibility and benefits to support timely order processing and reduce reimbursement delays.
- Monitored billing data for accuracy, identifying trends that improved coding, charge capture, and payment integrity.
- Partnered with cross-functional teams to streamline revenue cycle processes and strengthen collection efficiency.
- Resolved claim denials by analyzing billing errors, correcting documentation, and resubmitting clean claims through payer systems.
Intake Coordinator
7 Months- Coordinated patient intake workflows, ensuring accurate demographic, insurance, and referral data entry.
- Verified eligibility and authorization details, reducing delays in therapy scheduling and service start.
- Scheduled evaluations and therapy appointments, balancing provider availability with patient needs.
- Streamlined intake procedures, improving handoffs between administrative and clinical teams.
- Supported front office operations by resolving intake issues and maintaining consistent workflow accuracy.
- Provided excellent customer service to patients, family members, and healthcare providers during the intake process.
Education
Diploma - General Studies
Skills
Claims
Claims management
Claims investigation
Claims analysis
Insurance coverage verification
Documentation review
Compliance management
Trend analysis
Attention to detail
Work organization
Time management
Decision-making
Verbal communication
Claims processing
Accomplishments
I am currently enrolled with College of Healthcare Professions pursuing my Associates in Healthcare Administration. Date of graduation is scheduled 2/2028.
Languages
English - Fluent
Personal Information
Work Permit: Authorized to work in the US for any employer
Timeline
Claims Specialist
Pediatric Home Services
03.2023 - 03.2026Read More
Reimbursement Specialist
Inogen-Richardson
09.2019 - 02.2023Read More
Collections Administrator II
Mednax
02.2015 - 09.2019Read More
Collections Specialist
Ancillary Care Services
09.2013 - 10.2014Read More
Revenue Cycle Specialist
CCS Medical
08.2012 - 08.2013Read More
Intake Coordinator
Platinum Therapy
05.2011 - 12.2011Read More
Desoto High School
Diploma from General Studies
Read More