Rebecca Nelson
Hiram,GA
Summary
Patient access representative performing diverse administrative functions for patient care with high degree of diplomacy and problem-solving acumen. Positive and upbeat team player with good communication and time management abilities, while demonstrating extreme attention to detail with accuracy of medical records.
Overview
13
13
years of professional experience
1
1
Certification
Work History
Authorization Specialist
Wellstar Cobb Hospital
09.2021 - Current
- Managed complex authorization requests, ensuring compliance with policies and procedures.
- Collaborated with healthcare providers to resolve authorization issues and enhance service delivery.
- Analyzed patient data to determine eligibility for services, improving accuracy of approvals.
- Maintained compliance with HIPAA regulations, safeguarding sensitive patient information during the authorization process.
- Resolved discrepancies with client applications to verify eligibility.
- Reviewed applications for different aid programs and determined which qualification criteria for individuals.
Medical Billing Specialist
Gohealth Urgent Care
04.2016 - 07.2021
- Submitted claims to Medicaid/Medicare with attention to detail and accuracy.
- Posted payments to patient's accounts and verified medical insurance.
- Researched and resolved denials and EOB rejections within standard billing cycle timeframe.
- Arranged Medical files in numerical order and schedule appointments.
- Reviewed billing edits and provided insurance company with correct information.
- Specialized in radiation oncology billing.
- Promoted to a "Super biller" based on demonstrated ability to determine priorities, establish timelines, and effective manage workflow.
- Responsible for all providers and/or practices that required special accounts receivable clean-up.
- Selected to participate in a high-visibility project, which resulted in refunds in the hundreds of thousands of dollars.
Medical Billing Specialist
Piedmont Cancer Institute
09.2012 - 01.2016
- All aspects of medical billing including coding, charge entry, transmission, correction and resubmission as required, posting of payments including patient/mail and ERA.
- Established guidelines for proper coding/billing for providers.
- Worked hand in hand with front office staff to ensure that the proper information was received for claims processing.
- Oversaw and ran necessary reports to ensure that all statuses were worked in a timely manner and helped in any capacity necessary.
- Maintained and updated all files including insurance companies, diagnosis, procedure, fees/profiles.
- Responsible for following up on claims, calling and collecting money from insurance companies.
- Resolved billing issues identified by insurance carriers and patients.
- Reviewed claim denials and payer requirements for corrective action and prevention in the future.
- Researched and replied in a timely manner to insurance, patient, and internal customer inquiries.
- Kept accurate records of all activity and conversations for each file.
- Identified and/or located patient, insurance carrier or third party responsible for payment.
- Identified account discrepancies and issues that hindered claim payments.
- Identified document and report payer trends.
- Managed high call from both inbound and outbound call from 300-1000 per day.
- Posted and updated account data to [company name] and client hospital systems to ensure accuracy.
- Ran processed and ensured accuracy of patient statements on a bi-monthly basis.
- Worked collections which included mailing of correspondence, working with patients to establish promissory notes for payment and if necessary forwarded accounts to collection agency.
Education
Bachelor of Science -
GORDON STATE COLLEGE
McDonough, GA05-2008
Skills
- Claims management
- Medical terminology expertise
- Insurance verification
- Data entry proficiency
- Prior authorization processing
- Microsoft office
Accomplishments
- Used Microsoft Excel to develop inventory tracking spreadsheets.
- Resolved product issue through consumer testing.
Certification
- Sales Manager Certificate
Timeline
Authorization Specialist
Wellstar Cobb Hospital
09.2021 - Current
Medical Billing Specialist
Gohealth Urgent Care
04.2016 - 07.2021
Medical Billing Specialist
Piedmont Cancer Institute
09.2012 - 01.2016
Bachelor of Science -
GORDON STATE COLLEGE
Similar Profiles
Davonna Troutman-BrownDavonna Troutman-Brown
Registered Nurse at Wellstar Cobb HospitalRegistered Nurse at Wellstar Cobb Hospital
PRECIOUS ALARIBEPRECIOUS ALARIBE
Registered Nurse, Medical-Surgical Unit at Wellstar Cobb HospitalRegistered Nurse, Medical-Surgical Unit at Wellstar Cobb Hospital
Atoya HughesAtoya Hughes
Registered Nurse, PACU at WellStar Cobb HospitalRegistered Nurse, PACU at WellStar Cobb Hospital
Ryan WhitlowRyan Whitlow
Owner at Card My YardOwner at Card My Yard
Bailey HarrelsonBailey Harrelson
Groundman at Pike ElectricGroundman at Pike Electric