Viana Richards
Loganville,GA
Summary
Results-driven business health administration professional with 20 years of experience in medical billing, benefits management, and insurance investigations. Proven track record of successfully interpreting and following laws, procedures, and regulations while managing budgets and negotiating settlements. Skilled in program development, stakeholder engagement, data analysis, community engagement, training delivery, budget management, and collaborative initiatives. Reliable business professional with experience in project management, process improvement and financial analysis. Proven track record of successfully streamlining business operations and reducing costs. Adept at analyzing data to identify trends and developing strategies to improve efficiency.
Overview
11
11
years of professional experience
Work History
Accounts Resolution Specialist Managed Care Team Lead
Children’s Healthcare of Atlanta
Atlanta, GA
03.2023 - Current
- Performs daily billing of claims to third-party insurance following the guidelines of the UB04 and HCFA 1500 manual
- Ensure that special billing needs by payor are performed to prevent denial of claims and delay in payment
- Prepare and submit all final bill claims, secondary claims, rebills, and late charges on a daily basis, maintaining a current status
- Perform routine follow-up on unpaid insurance claims, taking appropriate action to resolve problems causing delay in reimbursement
- Assist Supervisor and/or Manager with development of staff by being available to teammates, acting as a resource to help complete complicated/complex tasks, providing on the job training to team, and seeking out opportunities to become actively involved in staff workflow and development
- Provide Supervisor and/or Manager feedback on staff performance, educational needs, and workflow status
- Run reports as needed to track claims aging days
- Participate actively in meetings/process improvement initiatives to support goals of the Revenue Cycle Department.
Medical Technology Instructor/ Business Administration
Gwinnett Technical College
Lawrenceville, GA
07.2016 - Current
- Designed and delivered customized training assignments to meet specific workforce needs in collaboration with healthcare systems across the state
- Forged partnerships with healthcare providers, technical colleges, K-12 schools, and other stakeholders to create a seamless approach to healthcare education and training
- Collected and analyzed crucial workforce data from healthcare facilities throughout Georgia to inform the development of effective training programs
- Led communities in the design and implementation of healthcare pathways tailored to meet the unique needs of rural areas
- Delivered high-quality and practical training programs, utilizing instructional design capabilities
- Collaborated with healthcare employers to provide practical, clinical-based training for uncertified workers, leading to certification and employment
- Communicated data analysis results to TCSG and other stakeholders for feedback.
Revenue Cycle Specialist
Perimeter Healthcare
Alpharetta, GA
08.2020 - 03.2023
- Verified and corrected claims billing information in the HCS database
- Obtained missing or unclear billing information by contacting appropriate individuals
- Documented all tasks in HCS notes/history
- Reviewed funding invoices to determine correct billing method
- Completed claim forms accurately through HCS or vendor/insurance carrier web portal
- Followed up on unpaid and denied claims through worklists in HCS and aging report
- Handled vendor questions, complaints, and problems after invoicing
- Ensured timely completion of necessary follow-ups to prevent payment delays
- Interacted with vendors in a prompt and courteous manner via phone, email, or correspondence
- Met monthly collection goals for each facility.
Out of Network Appeals Specialist
CarePlus Management
Athens, GA
02.2019 - 07.2020
- Prepared and submitted clean claims to various insurance companies either electronically or by paper
- Reviewed accounts for possible assignment and made recommendations to the Billing & Support Manager
- Performed various pre-collection actions including contacting patients by phone, corrected and resubmitted claims to third party payers
- Maintained the strictest confidentiality; adhered to all HIPAA guidelines/regulations.
Research & Resolution Specialist
Global Care, Inc.
Alpharetta, GA
09.2014 - 08.2016
- Navigated the claim process of medical services through contractual provisions to include adjustments and investigations
- Utilized reference-based pricing specialty for Medicare fee contracting
- Negotiated contracts between stakeholders and potential clients
- Created and composed the corporate benefits communications for employees and providers
- Coordinated benefits for over 90,000 eligible beneficiaries
- Administered budgets of approximately $45 million and remained within budget annually
- Reviewed patient bills for accuracy and completeness and obtained missing information
- Prepared, reviewed, and transmitted claims using billing software including electronic and paper claim processing
- Maintained knowledge of insurance guidelines including HMO/PPO, Medicare, and Medicaid
- Followed up on unpaid claims within standard billing cycle timeframe
- Checked each insurance payment for accuracy and compliance
- Called insurance companies regarding discrepancies in payments, if necessary
- Identified and billed secondary insurances
- Analyzed and researched and appealed denied claims
- Understood and articulated medical policies and presented information to clients
- Provided expertise and direction to team on client medical policies
- Ensured compliance with HIPAA regulations and requirements
- Trained staff on proper bill repricing practices, Medicare, and provider community improving submission rates and increasing processed payments.
Senior Collections Specialist
Cardinal Health, Inc.
Suwanee, GA
02.2014 - 10.2014
- Resolved Medicare claim issues through investigations of members and providers
- Implemented new Medicare claims process, increasing efficiency and accuracy
- Processed post payment reviews resulting in 100% of overturned claims paid
- Reviewed and cleaned 90% of aging claims for commercial and private payers
- Reduced delinquency for assigned accounts and negotiated payment plans
- Utilized computer programs such as Sales Logix, Facets, and various commercial insurance portals.
Grievance and Appeals Medicare Specialist
Emblem Health
New York, NY
04.2013 - 01.2014
- Responded to grievances, appeals, and disputes in compliance with regulations
- Analyzed and categorized inquiries, making critical decisions for resolution
- Conducted thorough investigations of complex cases
- Provided recommendations for cost savings and process improvements
- Served as a liaison to resolve cases with various stakeholders
- Prepared written responses addressing complainants' concerns
- Monitored and ensured timely completion of cases
- Classified and coded inquiries for auditing and reporting
- Negotiated high overturn rate of claims correspondence.
Education
Masters in Health Administration -
Barry University
Miami, FLBachelor of Business Administration a specialization in Health Services Administration -
Barry University
Atlanta, GAPhD in Public Health and Epidemiology -
Capella University
Lawrenceville, GA01.2025
Skills
- De-Escalation Techniques
- Assertiveness
- Conflict resolution skills
- Document Preparation
- Negotiation Management
- Interviewing abilities
- Legal knowledge
- Agreement preparation
- Meeting facilitation
Timeline
Accounts Resolution Specialist Managed Care Team Lead
Children’s Healthcare of Atlanta
03.2023 - Current
Revenue Cycle Specialist
Perimeter Healthcare
08.2020 - 03.2023
Out of Network Appeals Specialist
CarePlus Management
02.2019 - 07.2020
Medical Technology Instructor/ Business Administration
Gwinnett Technical College
07.2016 - Current
Research & Resolution Specialist
Global Care, Inc.
09.2014 - 08.2016
Senior Collections Specialist
Cardinal Health, Inc.
02.2014 - 10.2014
Grievance and Appeals Medicare Specialist
Emblem Health
04.2013 - 01.2014
Masters in Health Administration -
Barry University
Bachelor of Business Administration a specialization in Health Services Administration -
Barry University
PhD in Public Health and Epidemiology -
Capella University