Yvette Y Green
Tucker,GA
Summary
Performance-Focused experienced reimbursement specialist and billing with over 20+years in healthcare both professional and ambulatory surgery centers. Advanced in all Commercial Insurance carriers plans and types to include Worker's Compensation carriers.
Efficient billing professional with 15 years of experience. Productive and diligent with passion for resolving discrepancies through attention to detail and creative problem-solving. Passionate about perpetuating company values through impeccable work ethic and drive.
Veteran Patient Account Representative bringing 13 year background to growing collections agency. Expert in debt collections, repayment negotiations and repayment plan development. Successful in managing escalated accounts and producing aging reports to cut down delinquent invoices.
Proactive and goal-oriented professional with excellent time management and problem-solving skills. Known for reliability and adaptability, with swift capacity to learn and apply new skills. Committed to leveraging these qualities to drive team success and contribute to organizational growth.
Detail-oriented individual with exceptional communication and project management skills. Proven ability to handle multiple tasks effectively and efficiently in fast-paced environments. Recognized for taking proactive approach to identifying and addressing issues, with focus on optimizing processes and supporting team objectives.
Thorough team contributor with strong organizational capabilities. Experienced in handling numerous projects at once while ensuring accuracy. Effective at prioritizing tasks and meeting deadlines.
Results-oriented achiever with proven ability to exceed targets and drive success in fast-paced environments. Combines strategic thinking with hands-on experience to deliver impactful solutions and enhance organizational performance. Workers Compensation and Commercial Dedicated Reimbursement Specialist with exemplary analyzation and negotiation abilities. Highly skilled in customer service and coverage evaluation. Specializing in workers compensation and commercial insurance claims with a well-established knowledge of the general industry. Experienced Reimbursement Specialist dedicated to. Ensuring patients and clients receive due compensation for services rendered for the insurance claims. Proficient in use of SIS Charts, Amkai and Athena for client information input and billing. Confident and competent in negotiations and policy analysis. Dedicated Reimbursement Specialist with exemplary analyzation and negotiation abilities. Highly skilled in customer service and coverage evaluation. Specializing in health insurance claims with a well-established knowledge of the general industry.
Overview
26
26
years of professional experience
Work History
Reimbursement Specialist
Peachtree Orthopedic Surgery Centers P.C.
10.2014 - 02.2025
- Responsible for Aging A/R Accounts open an outstanding claims billing on the UB-04.
- Electronically through Waystar Clearinghouse.
- ASC (Ambulatory Surgery Center) for Piedmont, Northside and Piedmont North Facilities.
- Timely follow-up aging buckets 30, 60, 90 120+ days.
- Reviewing all open and denied facility claims to ensure proper reimbursement on billed Worker's Compensation Claims according to the WC Fee Schedule Rates and guidelines, also in accordance of the POC Contracts.
- Coordinated with various insurance carriers and networks.
- Carriers Gallagher Bassett, Esis, Liberty Mutual, Travelers, Nationwide, Genex, Careworks, Amtrust, Amerisys, FCCI Insurance Group, Sedgwick, Zurich, Zenith and Paradigm.
- Clients to include DOL, Delta, Southwest Airlines, Walmart, Publix, QuickTrip, Atlanta Public Schools, Atlanta Publix Schools, Dekalb County, Gwinnett County various list of clients.
- MVA's accident related injuries are also major clients of Peachtree Orthopedic Surgery Centers.
- Responsible for follow-up and providing requested documents to attorneys when requested for depositions, court cases.
- Also responsible for the follow-up on Special contracts/reimbursements as assigned by surgery and payer's to include LOA's, LTA's, SCA's for surgery procedures.
- Implants, Revisions, Spine, Cervical, Knee Replacements, Total Joint, Shoulder, Hip Replacements, Ankle and Hand Injuries to include any injury related to orthopedic.
- Maintains follow-up on all Lien Accounts payers include (Amicus, Cherokee Funding, and ML Healthcare, also included are various other companies as defined in the contract agreement.
- Identifies delays in revenue, assist patient to resolve account balances.
- Account Corrections, adjustments, posting errors (variances) for underpaid claims.
- Resubmitting claims electronically to all responsible parties through the clearinghouse Waystar.
- Responsible for all phases of denial management, to include rejections, eligibility issues, coding and billing errors (when applicable).
- Forward claims to the billing departments when necessary.
- Provided POTF to payers when needed from clearinghouse claims history.
- Written reconsiderations for 1st, 2nd and 3rd levels of appeals.
- Submitted requests for letter of medical necessity to the physician's as required per payer to assist with the appeal process.
- Prevented delays and claim denials by correcting information prior to submission.
- Coordinated with insurance providers to verify customer's policy benefits in relation to claims.
- Delivered timely information to insurance representatives to resolve common and complex issues.
- Contributed knowledge to help improve financial management, billing and tracking systems.
- Followed up on denied and unpaid claims to resolve problems and obtain payments.
- Trained department employees in proper billing and accounting procedures.
- Created documents in accordance with payer guidelines and submitted to appropriate parties.
- Compiled department-specific reports to help senior managers identify trends and improve progress.
- Helped minimize escalations by reaching out to clients in advance of expected problems.
- Audited and corrected billing and posting documents for accuracy.
Denial Management Coordinator, Medical Billing Specialist, Patient Account Representative
Cardiology of Atlanta, PC
04.2011 - 10.2014
- Responsible for insurance follow-up Aging A/R buckets 30-60-90-180 days for all major Commercial carriers (Aetna, BCBS, Cigna, Coventry, Medicare, Medicaid, UHC) to include Medicare Replacements.
- Professional claims billed on HCFA 1500 Claim Forms.
- Billing procedures, Nuclear Stress Test(s), Cardiac Catheterizations, Stents, Echo's, EKG Inpatient and outpatient procedures billed on HCFA 1500 claim form.
- Responsible for reviewing and correcting the rejections in denial management to ensure resubmission of both primary and secondary claims for proper processing.
- Resubmission of corrected claims, billing errors, financial counselor to patients balanced billed after insurance, uninsured assistance, payment arrangements.
- Worked correspondence, mailed statements to patients.
- Verification of referrals, authorizations, which include request for retro-auth if and when applicable.
- Responsible for preparing and placing accounts with agency Placements (Frost & Arnett), (Alpha Collections) outsourced accounts to include bad debt patient balances.
- Posting both insurance and patient payments, adjustments, posting zero-pays, filed claims electronically through clearinghouse; Navicure.
- Patient/insurance refunds, reconciling account credits.
- Responsible for writing reconsiderations for 1st, 2nd and 3rd level appeals.
- Kept high average of performance evaluations.
- Resolved issues through active listening and open-ended questioning, escalating major problems to manager.
- Communicated with insurance providers to resolve denied claims and resubmitted.
- Examined patients' insurance coverage, deductibles, insurance carrier payments and remaining balances not covered under policies when applicable.
- Liaised between patients, insurance companies, and billing office.
- Researched CPT and ICD-9 coding discrepancies for compliance and reimbursement accuracy.
- Collected payments and applied to patient accounts.
- Evaluated patients' financial status and established appropriate payment plans.
- Located errors and promptly refiled rejected claims.
- Posted and adjusted payments from insurance companies.
- Precisely completed appropriate claims paperwork, documentation and system entry.
Reimbursement Specialist
Care Medic/Ingenix/United Health Group Outsource Company/Virtual Business Office Call Center
02.2010 - 04.2011
- Responsible for the follow-up of assigned and unassigned hospital and clinic claims, Surgery Pro-fees billed on HCFA 1500 Form.
- Critical Access charges billed on UB04 Follow-up Aging A/R 30-120 days.
- Filing primary and secondary claims at the client's requests.
- Non-VBO claims returned to clients as outlined in each contract.
- Each client request that all Medicare, Medicaid, Workman's Compensation, MVA, VA assigned and unassigned worked by VBO same as all commercial payers.
- Posting payments, applying adjustments, in Web-mats to mirror EFR (Meditec) that were assigned to the VBO less than 30 days as outlined in the client's contracts.
- Patient follow-up balance billing patients after insurance; to include phone calls, mailing demand letters.
- Customer service department responsible for the actual collections of self-pay accounts, all billing of medical claims reflect the State of Oregon.
- Prevented delays and claim denials by correcting information prior to submission.
- Delivered timely information to insurance representatives to resolve common and complex issues.
- Followed up on denied and unpaid claims to resolve problems and obtain payments.
- Created documents in accordance with payer guidelines and submitted to appropriate parties.
- Compiled department-specific reports to help senior managers identify trends and improve progress.
- Monitored and documented accounts receivable trends and account-specific profitability.
- Produced and mailed monthly statements to customers and assisted with related requests for information and clarification.
- Audited and corrected billing and posting documents for accuracy.
- Monitored outstanding invoices and performed collections duties.
- Reconciled accounts receivable to general ledger.
Central Business Office Coordinator/Collections Supervisor
Piedmont Heart Institute/Piedmont Medical Care Corporation
11.2007 - 04.2009
- Direct report to the CBO/Mgr.
- Insurance follow-up for BCBS and Workman's Comp.
- I assisted other departments in the implementation of systems policies and procedures to include the first ever training manuals for both front and back-end departments.
- I was the direct support for the collections follow-up teams.
- As supervisor department staff 25 employees.
- Facilitated the collection of the account receivables.
- Substitute for the Business Manager in their absence.
- Communicated with all levels of the organization: Physicians, Executive Management, practice managers & staff.
- Trained, implemented policies and procedures for CBO.
- Aging A/R 30-60, 90-120 days (goal follow-up before 121 + days).
- $4 million dollar A/R reduced to $1.6 million. Monthly goal $4 million (met).
Collections Supervisor Central Business Office
The Atlanta Cardiology Group, P.C.
07.1999 - 11.2007
- Company Overview: (merged with Piedmont Hospital and became Piedmont Heart Institute)
- Responsible for the collection of Aging A/R 30-60-90-120 +.
- Met and exceeded monthly goal - collect $3.5 million.
- Assisted with coding (ICD-9) CPT issues when applicable.
Education
No Degree - Business Administration
Owensboro Business College
Owensboro, KY01.2009
Certificate - Business Administration
Owensboro Business College
Owensboro, Kentucky01.1979
Business Administration - Career Change-Medical
Atlanta College of Business
Atlanta, Georgia01.1978
Skills
- Source Med Analytics
- Envi
- Waystar
- SIS Charts
- SIS Office
- SIS Comple
- Amkai
- Athena One
- ICD-10 coding
- Medicare
Websites
Accomplishments
- Successful in recouping over 98% collections revenue, on billed claims, 95% collections with contract issues.
- Excellent results in the submission of reconsideration in appeals when applicable.
- Achieved 100% success in stream-lining policies and implementation of procedures as the collections supervisor for the Atlanta Cardiology Group, PC.
- CBO Coordinator Piedmont Medical Care Corporation
Diploma
Received my Clerk Typist Diploma from Morganfield, KY
Certificate of Business (Course taken Owensboro, Business College)
Timeline
Reimbursement Specialist
Peachtree Orthopedic Surgery Centers P.C.
10.2014 - 02.2025
Denial Management Coordinator, Medical Billing Specialist, Patient Account Representative
Cardiology of Atlanta, PC
04.2011 - 10.2014
Reimbursement Specialist
Care Medic/Ingenix/United Health Group Outsource Company/Virtual Business Office Call Center
02.2010 - 04.2011
Central Business Office Coordinator/Collections Supervisor
Piedmont Heart Institute/Piedmont Medical Care Corporation
11.2007 - 04.2009
Collections Supervisor Central Business Office
The Atlanta Cardiology Group, P.C.
07.1999 - 11.2007
Certificate - Business Administration
Owensboro Business College
No Degree - Business Administration
Owensboro Business College
Business Administration - Career Change-Medical
Atlanta College of Business
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