Tracy Hutcherson-Cook
Revenue Cycle Professional
Winchester,VA
Summary
Detail-oriented individual with exceptional communication skills. Proven ability to handle multiple tasks effectively and efficiently in fast-paced environments. Recognized for taking proactive approach to identifying and addressing issues, with focus on optimizing processes and supporting team objectives.
Overview
15
15
years of professional experience
1
1
Certification
Work History
Appeals Specialist
Parallon
03.2021 - Current
- Conducting thorough investigations of grievances and appeals, gathering relevant information from various sources.
- Validate denial reasons and ensures coding in DCM is accurate and reflects the denial reasons.
- Ensuring adherence to regulatory standards, organizational policies, and relevant laws.
- Developing appeal letters and communicating appropriate resolutions to individuals, providers, and other relevant parties.
- Escalate exhausted appeal efforts for resolution.
- Review denial reasons on EOBs to determine denials.
- Familiarity with tools and systems used to track and manage grievances and appeal.
Billing Specialist
Selma Medical Associates
01.2020 - 01.2021
- Researched denied claims and contacted insurance companies to resolve these issues.
- Reached out to insurance carriers to obtain prior authorization for testing and procedures.
- Provided prior authorization support for physicians, healthcare providers and patients in accordance with payer guidelines.
- Review EOB’s, remits, and payer correspondence in the course of performing account follow-up and escalate any identified issues to the appropriate area for review and response.
- Computer applications and programs used: EPIC, ZirMed, NaviNet, Availity
A/R Billing Specialist
Meritus, Equipped for Life
08.2017 - 01.2020
- Access A/R aging reports of denied claims.
- Resolve claims denial issues including coding issues, authorizations, precertification, missing information for commercial and managed care claims.
- Verified eligibility and compliance with authorization requirements for service providers.
- Input all patient data regarding claims and prior authorizations into system accurately.
- Tracked referral submission during facilitation of prior authorization issuance.
- Reached out to insurance carriers to obtain prior authorization for testing and procedures.
- Identify areas for continued process improvements through data and reporting analysis, that will decrease claims denials and working with leadership on process improvements.
- Computer applications and programs used: EPIC, ZirMed, SurgiNet, NaviNet, Availity
Medical Claims Specialist
HCA
04.2016 - 08.2017
- Filed for appeals, inquiries and reconsideration for denied and underpaid claims.
- Placed calls to insurance companies to get claim status and keep the patient record updated on all activity until the claim is finalized.
- Billed insurance claims electronically and on paper.
- Composed letters to insurance co to overcome objections to paying claims with documentation.
- Verified eligibility and compliance with authorization requirements for service providers.
- Provided prior authorization support for physicians, healthcare providers and patients in accordance with payer guidelines.
- Identify charging or clinical documentation issues and work with appropriate leadership and ancillary departments to resolve issues.
- Perform audit reviews by verifying billing data versus documentation and making corrections in the patient accounting system.
- Computer applications and programs used: EPIC, Emdeon and NaviNet
Patient Account Representative III
Emory University Healthcare
11.2003 - 12.2014
- Team leader of Surgery Scheduling in the Revenue Cycle Management Department.
- Generate electronic insurance verification.
- Analyzed hospital contracts to determine negotiated rates and covered benefits.
- Analyzed denied claims reports to capture information needed to adjudicate future claims for returning patients.
- Obtained pre-certifications and referrals.
- Assisted with creating training plans for new employees.
- Computer applications and programs used: EPIC, Emdeon, GE Centricity, Outlook, LotusNotes, IDX, Availty, Patient Pricer(PPP), MPV, Experian and NaviNet
Education
No Degree - Healthcare Administration
Clayton State University
Morrow, GASkills
- Medical Terminology
- Microsoft Outlook
- Organizational skills
- HIPAA
- Medical Office Experience
- Medical Records
- Microsoft Office
- Clerical Experience
- Microsoft Excel
- Insurance Verification
- Hospital Experience
- ICD-10
- Managed Care
- EMR Systems
- ICD-9
- Medical Billing
- Data entry
- Anatomy Knowledge
- Epic
- Windows
- Medical Coding
- Analysis skills
- Microsoft Word
- Data entry proficiency
- Effective communication
- Insurance verification
- HIPAA compliance
Certification
Certified Professional Coder (CPC), 2005-12-01, 2016-02-29, American Academy of Procedure Coders
Personal Information
- Authorized To Work: US
- Visa Status: Authorized to work in the US for any employer
Timeline
Appeals Specialist
Parallon
03.2021 - Current
Billing Specialist
Selma Medical Associates
01.2020 - 01.2021
A/R Billing Specialist
Meritus, Equipped for Life
08.2017 - 01.2020
Medical Claims Specialist
HCA
04.2016 - 08.2017
Patient Account Representative III
Emory University Healthcare
11.2003 - 12.2014
No Degree - Healthcare Administration
Clayton State University