Yvonne Thomas
Clinton,USA
Summary
Dynamic health care services manager with over 20 years of experience in optimizing insurance processes and improving patient access. Proven track record in collaborating with key stakeholders and implementing effective strategies that enhance operational efficiency and patient care.
Overview
20
20
years of professional experience
Work History
Insurance Coordinator
Fresenius Medical Care (FMC)
Washington, DC
01.2013 - Current
- As an employee of FMC, I support the FMC National Administration mission, vision, core values, and customer service philosophy, adhere to the FMC Compliance Program, and follow all regulatory and policy requirements.
- Supports the strategic initiatives of the Insurance Coordinator Programs to maintain an exceptional commercial payer mix for FMS through in-depth knowledge of the eligibility rules for Employer Group Health Plans (EGHPs), COBRA, Medicare, Medicaid, Medigap, Exchange Programs, and the Veteran Administration (VA) Health Plans.
- Provided expert insurance guidance to 10 facilities under the Fresenius Medical Care Teams.
- Assisted patients with applying for Medicare and Medicaid, facilitating access to essential health coverage.
- Updated patient demographic and insurance information for billing group, ensuring accuracy for timely billing processes.
- Provided monthly reports to Director of Operations on patient insurance coverage, highlighting uninsured/underinsured patients for proactive management.
- Collaborates effectively with the District of Columbia and Maryland Departments of Health and Human Services, American Kidney Foundation, U. S. Social Security Administration, and the metropolitan area's four major Health Insurance Carriers.
Denial Management Analyst
Providence Hospital
Washington, DC
01.2011 - 01.2013
- Utilized CPT coding and conducted the recovery of the payments rejected or unpaid by payers for technical reasons; provided support for the accounts denied for clinical reasons, following the federal, state, and local government regulations and hospital policies.
- Analyzed and resolved all technical denials and variances related to the Hospital claim payments under federal, state, and local government regulations.
- Processed rejections and underpayments, completed appeals, resolved patient account discrepancies under hospital and insurance contract procedures, analyzed accounts, investigated technical rejections, identified appeal strategies, and reviewed variance reports for accuracy.
- Composed appeal letters while collaborating with 300-hospital staff from Case Management Team, Health Information Management, Admitting, and Ancillary Department Managers to build cases supporting proper reimbursements and maximizing appeal success.
- Followed hospital and departmental policies, procedures, and regulations regarding denial and rejection codes.
- Coordinated efforts with U.S. Department of Veterans Administration to strengthen collaboration.
Patient Access Lead
Providence Hospital
Washington, DC
01.1995 - 01.2011
- Led a team of 16+ in coordinating healthcare delivery, managing integration of healthcare systems, technological innovations, and regulatory compliance while focusing on preventive care.
- Supported onsite Patient Financial Services Operations (PFSO) by managing customer service, patient reception, telephone inquiries, mail distribution, report creation, insurance pre-authorizations, and providing direction to Bed Management.
- Utilized knowledge of the medical terminology and the ICD-9 and CPT coding while conducting the accurate, efficient, and sound management of planning, direction, coordination, and supervision of the registration process for the 1500 patients in the Hospital Emergency Room and the outpatient settings.
- Oversaw patient co-payments and cash operations; verified demographic and financial data for each patient to ensure accurate payment processing.
- Provided training for the new employees and instructions for integrating the employee schedules that ensured full coverage and quality care that ultimately improved the efficiency of the Providence health care system.
- Collaborated with U.S. Department of Veterans Administration to enhance patient access services.
Provider Service Representative
Care First/Blue Cross Blue Shield
Washington, DC
01.2001 - 01.2007
- Managed and assisted physicians, hospitals, health care insurance companies, and other medical providers in reviewing and approving claims up to $5,000 and processing payment requests.
- Conducted investigations and negotiations, authorized claims payments, and ensured compliance with HIPAA guidelines and Federal and State laws.
- Participated and coordinated the claimant’s appeals and inquiries and conducted the negotiation of the appeal process, which included expeditious (24-48 hours) resolution of the inquiries.
- Settled claims and advised hospitals, physicians, and medical providers on policy direction regarding controversial benefit inquiries.
- Followed medical protocols consistently.
- Instructed management in the marketing and sales department to recruit new clients.
- Conducted the orientation to the office procedures and provided training and supervision for five new employees.
Medical Case Manager
National Rehabilitation Hospital
Washington, DC
01.1996 - 01.2001
- Conducted and managed the daily supervision of 35 out-patient clients and supervised 50 Medicaid/Medicare patients weekly while managing the Post-Polio Clinic with a caseload of 8 international patients.
- Developed discharge service plans for out-patient and Medicaid/Medicare clients, monitoring patient progress to support successful transitions.
- Provided case management services aligned with standards and principles, coordinating services, resources, agencies, and clients to achieve agency goals.
- Negotiated payments with health insurance carriers and reviewed self-pay cases while collaborating with community-based representatives and care facilities on patient eligibility claims.
- Maintained patient medical records in compliance with HIPAA regulations, ensuring organization and accuracy for final completeness.
- Collaborated effectively with U. S. Department of Health and Human Services, Social Security Administration, U. S. Department of Veterans Administration, Department of Medicare and Medicaid, Vocational Rehabilitation, and the D. C. Department of Housing Development.
Education
Bachelor of Science (BS) - Business Management
The University of Maryland
College Park, MDMaster of Business Administration (MBA) - Health Services Administration
Strayer University
Temple Hills, MDSkills
- Knowledge of Medicare
- Knowledge of Medicaid
- Health Insurance Software
- Insurance Claims Management
- Denial management
- HIPAA compliance
- Health care policy
- Health care procedures
- Health care services
- EMR software expertise
- Leadership
- Multitasking
- Verbal and written communication
- Multitasking
Specialized Computer Skills
- Microsoft PowerPoint Presentation
- Practice Management Software
- Data Summarization Spreadsheet
- Electronic Medical Records (EMR)
Professional Development Training
- Health Exchange Marketplace, Online Training Course
- Medicare Regulations, Online Training Course
Timeline
Insurance Coordinator
Fresenius Medical Care (FMC)
01.2013 - Current
Denial Management Analyst
Providence Hospital
01.2011 - 01.2013
Provider Service Representative
Care First/Blue Cross Blue Shield
01.2001 - 01.2007
Medical Case Manager
National Rehabilitation Hospital
01.1996 - 01.2001
Patient Access Lead
Providence Hospital
01.1995 - 01.2011
Bachelor of Science (BS) - Business Management
The University of Maryland
Master of Business Administration (MBA) - Health Services Administration
Strayer University