VICTORIA IMONICHE
Dallas,GA
Summary
A Revenue Cycle Specialist with strong attention to detail and in-depth understanding of billing and follow-up procedures and process. Prepared to bring 5 years of experience with insurance claims management in healthcare sector, reducing denials and improving revenue outcome.
Overview
7
7
years of professional experience
Work History
Insurance Follow-Up Representative
BC Services
02.2022 - 10.2023
- Daily communication with insurance/payers either commercial or government to resolve discrepancies towards reimbursement on claims
- Examined and worked on claims needing medical record request from payers
- Track common claim errors, identify and report inaccurate reimbursement and contractual trends
- perform follow up actions and documents follow up activities, conversations with payers.
- Investigate and coordinates insurance benefits for insurance claims across multiple lines
- Daily communication with insurance companies and other commercial insurers to address coordination of benefits and claim resolution
- Contact patients if claim is missing correct information or member id is incorrect for claim to process
- Work within payer portals and interact with third-party payors and patients to resolve account balances
- Sets follow up activities based on the status of claim
- identified billing errors, underpayment or overpayment and resolved them accordingly
- Notating accurate information on the status on claims stated by payer and finding possible resolution for proper reimbursement
- Review, analyze, resolve, and trend for complex claims issues and payer behavior using Client billing system, payor portals, calling the payer, and EOB review
- Review daily clearinghouse rejections, resolving, and resubmitting accounts
- Post adjustments and collection of medicare, medicaid, and commercial insurance payers
- Report appeals to supervisor/manager to review if there is a strong supporting document that should be escalated at payer level
- Observed legal and ethical guidelines of HIPAA for safeguarding patient and company confidential and proprietary information
- Review aged accounts and take steps to resolve for payment by contacting payors for claim status, process rebilling requests and escalating issues when needed
- Collect patient co-pays/coinsurance/deductible amounts due after insurance
- Submit corrected claims billing
Revenue Cycle Specialist
Northside Hospital Atlanta
03.2020 - 01.2022
- Communicated with insurance providers to resolve denied claims and resubmitted.
- Ability to multitasks including navigating between computer applications while speaking with participants/patient
- Processed hospital claims and insurance collections commercial entity as well as government entity
- Verified insurance of patients to determine eligibility.
- Accurately entered patient demographic and billing information in billing system to enable tracking history and maintain accurate records.
- Posted payments and collections on regular basis.
- Provide support as needed for customer requests via telephone, email, fax, or other available means of contact to the Support Center
- Recognize operational challenges and suggest recommendations to management, as necessary
- Sets follow up activities based on status of claims
- Examines documents for missing information
Revenue Cycle Specialist
Medix Staffing
06.2019 - 02.2020
- Recognize and find resolution to potential issues within claims
- Work and managed claims from all aging buckets including posting and appeals
- Contacting/sending letter to patients for patient pending balance which is patient responsibilities applied to either copay, co insurance or deductible
- Sending appeals to appropriate payers depending on denial reason for reimbursement of claims
- Ensuring claims are billed at appropriate time to avoid going past timely filing
- Contacting payer for status updates on claims and probing live agent for accurate claim information
- Research missing payments and secure documents needed for posting
- Contact patient for COB update when necessary.
- Contacted responsible parties for past due debts.
- Follow-up with payers to ensure timely resolution of all outstanding claims, via phone, emails, fax or websites
- Outbound calls to insurance companies to verify coverage,eligibility as well as claim status
- Reviewed EOBs for correct payment, deductible, adjustments and denials
- Investigates and coordinates insurance benefits for claims across multiple service lines
Customer Service Representative
Molina Healthcare
02.2017 - 05.2019
- Handled customer inquiries and suggestions courteously and professionally.
- Promoted high customer satisfaction by resolving problems with knowledgeable and friendly services
- Accurately capture conversations with customers and notate correctly
- Resolve customers issues in regards to their benefits and eligibility
- Actively listened to customers, handled concerns quickly and escalated major issues to supervisor.
- Answered constant flow of customer calls with minimal wait times.
- Answered customer telephone calls promptly to avoid on-hold wait times.
- Managing customers medicaid accounts
Education
Bachelor of Arts - Psychology
University of Lagos
Nigeria01.2012
Skills
- Medical Billing
- Claims Review
- Coordinating Documents
- Detail oriented
- Hospital billing/UB04
- Maintaining detailed records
- Customer service
- Healthcare billing proficiency
Timeline
Insurance Follow-Up Representative
BC Services
02.2022 - 10.2023
Revenue Cycle Specialist
Northside Hospital Atlanta
03.2020 - 01.2022
Revenue Cycle Specialist
Medix Staffing
06.2019 - 02.2020
Customer Service Representative
Molina Healthcare
02.2017 - 05.2019
Bachelor of Arts - Psychology
University of Lagos
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