TRACEY STAFFORD
Tallahassee
Summary
Accounts Receivable and Insurance Specialist with 20+ years of experience in healthcare claims processing, insurance verification, prior authorization coordination, denials resolution, and reimbursement follow-up. Strong knowledge of ICD-10/CPT coding standards, orthopedic coding alerts, and CMS guidelines. Skilled in payer communication, problem-solving, and maintaining accuracy in high-volume environments.
Overview
12
12
years of professional experience
Work History
Insurance & Accounts Receivable Specialist
Red Hills Surgical Center
Tallahassee
11.2014 - Current
- Processed and followed up on healthcare claims to secure accurate, timely reimbursements for services rendered.
- Resolved insurance denials by correcting billing issues and submitting appeals with supporting documentation, enhancing claim acceptance rates.
- Verify patient eligibility, benefits, and authorizations across commercial and government payers.
- Interpret and apply ICD-10/CPT codes and orthopedic coding guidelines to ensure compliant claim submission.
- Communicate with patients and insurance representatives to clarify financial responsibility and coverage.
- Review and interpret Explanation of Benefits (EOBs) and determine next-step resolution.
- Maintained documentation accuracy and streamlined workflows while managing high-volume caseloads to meet organizational standards.
Education
High School Diploma -
Skills
- Claims Processing & Follow-Up
- Insurance Verification & Authorizations
- Denials & Appeals Resolution
- ICD-10 / CPT Code Understanding
- Medicare / Medicaid / BCBS / UHC / TRICARE / Aetna
- Orthopedic Coding Alerts Review
- EOB Interpretation & Patient Estimates
- CMS Policy Compliance
- Communication & Team Collaboration
- Detail-Oriented Multitasking
Remote Ready
True
Licensure And Professional Development
All-Lines Insurance Adjuster License, In Progress
Timeline
Insurance & Accounts Receivable Specialist
Red Hills Surgical Center
11.2014 - Current