Yashika Nelson
Memphis,United States
Summary
Detail-oriented and gifted finance professional with over 10 years of Business/Administrative Management, analytical techniques, strategic Planning, organizational programs and developing partnerships. Recognized as an effective communicator and liaison with abilities in team building, program enhancement, and Personnel management. Delivers results with proven skills, enrich strong networks and understands how to establish profitable and Enduring undertakings
Overview
14
14
years of professional experience
Work History
Senior Billing Analyst
Accredo/Express Scripts/Cigna
11.2017 - Current
- Train and mentor selected individuals from the operational areas to provide them with
development and support so they can effectively facilitate for a variety of operational needs. - Processing copay claims for drug prescriptions and review and verify invoice payments
- Investigates coverage options for uninsured or poorly insured Individuals to include being point of contact for copay assistance programs and physicians
- Assigned special projects which required research and problem solving skills
- Coordinate with payers and physicians to resolve denied claims including prior authorization initiation and follow up
- Processed CMS/HFCA 1500 claim forms
- Assist with Prior authorizations and re-authorizations and updated in RX Home prior to each shipment
- Resolved rejected claims, pricing discrepancies, and other miscellaneous billing issues
- Handles inbound/outbound client calls and written correspondence regarding patient
eligibility - Monitored accounts to ensure timeliness of Cash posting.
- Processed vendor and supplier payments on weekly basis
- Used coded data to produce and submit claims for coordination of benefits reimbursement
- Examines voluminous and complex books and records which may be incomplete, poorly organized, or intentionally disorganized or arranged in order to conceal true nature of payment
Billing Analyst
United BioSource Corporation
10.2014 - 11.2017
- Maintained strict confidentiality with all personal data as per company guidelines.
- Updated pricing on orders in system to promote invoice accuracy for special items, agreements, substitutions and unauthorized deliveries.
- Reviewed full history of past due accounts and contacted client or attorney regarding collection, implementation of payment plan or pursuit of legal remedies on unpaid accounts.
- Analyzed payment information and applied changes correct customer accounts.
- Utilized provider guidance and eligibility processes to make necessary updates to various
internal systems - Worked collaboratively with Systems Analysts, Eligibility Associates, and Managers to
provide seamless support - Made independent judgment calls in order to respond to complex or critical member issues
- Maintained accurate and complete documentation of all contacts as needed; this
continuously improved the processes and reduced potential lawsuits for legal concerns or
payouts
Claims Specialist
Complete Healthcare Services
08.2010 - 10.2014
- Reviewed insurance and claims documents to verify required information and secure any missing data for settlements.
- Followed up with customers on unresolved issues.
- Monitored compliance with regulations and industry best practices to promote fair and proper treatment for insured customers.
- Performed administrative duties by verifying documentation, researching facts and contacting other parties involved to determine fault percentages and minimize potential losses.
- Prepared claims to ensure billing accuracy according to insurance carrier policies and
procedures - Followed up frequently with payers and patients on outstanding accounts until the accounts
are brought current - Understood requirements for disputes, gathered evidence to support claims and prepared customer cases to handle appeals.
Education
Bachelor of Arts - Business Administration
Strayer University
Washington, DC10.2018
Certification - Medical Insurance Coding
Remington College
05.2011
Certification - Medical Office Assistance
Concord Career College
12.1997
Skills
- Business Administration
- Statistical Analysis
- Analytical Techniques
- Organized, and diligent
- Google Sheets/Excel
- Billing-B2B
- Excellent oral and written Communication
- Strategic Planning
- Problem Solving
- Financial Managerial Skills
- Time management skills
- Salesforce/CRM
- Oracle
Timeline
Senior Billing Analyst
Accredo/Express Scripts/Cigna
11.2017 - Current
Billing Analyst
United BioSource Corporation
10.2014 - 11.2017
Claims Specialist
Complete Healthcare Services
08.2010 - 10.2014
Bachelor of Arts - Business Administration
Strayer University
Certification - Medical Insurance Coding
Remington College
Certification - Medical Office Assistance
Concord Career College