Winona L. Thomas
Trainer
Keego Harbor,MI.
Summary
Passionate Trainer with 15+ years knowledge of health care industry practices and skill to provide long-term success for companies. Trained in Epic system as well as facilitated training on the use of Epic. Known for goal-oriented mindset, strong analytical and communication skills, detailed oriented, and research and investigation. I am excited about the opportunity to work with Epic in leading as a Trainer for physicians, nurses, and other healthcare users.
Overview
25
25
years of professional experience
1
1
Certification
Work History
Payment Resolution Analyst
Trinity Health
06.2017 - Current
- Use the EPIC Healthcare System to review and resolve payment resolution functions for Medicare Advantage accounts.
- Train new and seasoned employees for Payment Resolution functions and Payer environments, regulations, and contracts.
- Handle claim adjudication for inpatient and outpatient hospital claims.
- Conduct formal account review for timely and accurate payments.
- Account analyzing and documenting of payment delays and variances identified.
- Review and research to determine root causes for discrepancies.
- Interaction with internal and external resources in recommendations for payment resolutions and delays.
- Communicate with Medicare Advantage and commercial plans for claim inquiries.
- Communicate with provider reps to resolve claim issues.
- Identify payor issues to discuss in the monthly contract meetings.
- Attend monthly payer meetings.
- Resolution of payer refund requests.
- Understand functional and technical Revenue Cycle Management.
- Understand and interpretation health care insurance contracts.
Medical Biller
J&B Medical Supply
07.2016 - 04.2017
- Handled Durable Medical Equipment billing for Blue Cross and Blue Shield of Michigan and Out of State Blue Cross Blue Shield
- Handled Coordination of Benefits Insurance plans, which entails insurance verification
- Effective communication to handle patient billing inquiries
- Also, communicated with various Blue Cross Blue Shield health plans
- Dealing with all levels of employees, proofreading, drafting letters, creating spreadsheets, creating presentations, making travel arrangements, preparing reports, project coordination and customer relations
- Handled departmental tasks to ensure claim adjudication, adjustments and cash posting tasks
- Ran weekly Rejection, Aging and Payment Other Than Expected Reports for claim resolution
- Handled monthly timely filing reporting to ensure A/R is billed timely to the prospective payor
Systems Analyst / Quality Analyst II
Blue Cross Blue Shield Michigan
01.2011 - 03.2016
- Training and mentoring of new employees
- Co-facilitated brown bag training sessions
- Handled professional and facility claims processing on the Nasco System by facilitating the testing of these types of claims to ensure projected outcome
- Handled claim Recovery (overpayments) and Restored (underpayments) for various employer groups and providers
- Manipulated Ad hoc reports to achieve key data results for analytical review and testing
- This task also included the use of Excel Spreadsheets to warrant accurate results and achieve data management
- Checked claims documents for errors and grammatical mistakes, editing
- Retrieved reporting data needed for Recovery Residuals processing and distribution
- Participated in the process for Executive Summary Reporting and the FEP Protocol Overpayment Audit
- These reporting tasks were used as a tool to meet department standards of reducing overall administrative costs and adhere to departmental budget goals
- BCBSM customers to handled inquiries and facilitate the resolution of Recovery and Restored issues as well as built relationships within the organization
- Updated and Distributed weekly recovery restore tracker for auditing purposes, to provide status updates to meet deadlines and ensured detailed accuracy along with quality for project completion
- Created and published alerts as method of communication to support the outcomes of Recovery / Restore projects
- Participated with the testing and implemented system upgrades to meet Corporate goals of moving the IT department forward
- Participated in the support and enhancement of the organization by attending workshops, webinars and town hall meetings for professional growth and to align with Corporate goals
- Acted as liaison to Benefit Analysts to facilitate and ensure accurate processing of Recovery Restore requests
Medical Billing / Patient Accounting Representative
Detroit Medical Center
04.2001 - 01.2011
- Training and mentoring of new employees.
- Handled Inpatient and outpatient billing for Blue Cross and Blue Shield of Michigan and Blue Care Network, which included participating in the DRG Audit process
- Handled Coordination of Benefits Insurance plans, which entailed insurance verification and registration updates
- Effective communicated to handle telephone and written status inquiries to facilitate the resolution of claims issues with patients, insurance companies, medical staff and attorneys
- Handled departmental tasks to ensure claim adjudication, adjustments and cash posting tasks
- Accomplished weekly and monthly reporting tasks to analyze, investigate and research to ensure claim payments, address billing errors and provide supporting documentation to facilitate claim payment
- Handled insurance and patient refunds as needed
- Achieved goals and adhered to billing practices of Managed Care Organizations, Medicare Advantage plans, Blue Cross and BCN plans, Medicaid and Commercial insurance carriers
- Participated with the testing and implementation of the Denial Management process to capture and resolved claim issues that were being rejected
- Worked with the Blue Cross consultant to resolve Medicare recovery reports and auditing claim issues
- Trained staff to further support and enhance departmental goals
Education
Bachelor of Science Degree - Health Care Services
University of Phoenix
Skills
- Teaching Medical Insurance, Mentoring New Employees, Instructional Design
- Facilitating on-the-job Training Sessions
- Account Auditing
- Strong organization skills, Health Care Data Management System, Navient System
- Access various health insurance online provider portals
- Microsoft Office
- Course Materials Development
- Google Drive
- Dispute Resolution
- Knowledge of Health Care Contracts
- Knowledge of Project Management
- Claim Processing
- Microsoft Outlook
Accomplishments
Epic System, NASCO Blue Cross, Excel, Sharepoint, Powerpoint, Ad-hoc Reporting tool, EHR System,
Virtual Learning Platforms: Microsoft Teams, Zoom, Google Meet
Instructional Design
October 2022 - Course Development
Developed an online course on how to design a digital magazine. Facilitated the course as a live training session.
Certification
- Pursuing Project Management Certificate – Online Google Career Certification - October 2022 to Present
- Medical Certificate - Medical Insurance Billing, Ross Medical School, Oak Park, MI, August 1995 to January 1996
Timeline
Payment Resolution Analyst
Trinity Health
06.2017 - Current
Medical Biller
J&B Medical Supply
07.2016 - 04.2017
Systems Analyst / Quality Analyst II
Blue Cross Blue Shield Michigan
01.2011 - 03.2016
Medical Billing / Patient Accounting Representative
Detroit Medical Center
04.2001 - 01.2011
Bachelor of Science Degree - Health Care Services
University of Phoenix
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