Improvement Specialist Prior Authorizations

TiJuana K. Rone *** Wyatt St. Waxahachie, TX ad2sxy@r.postjobfree.com Medical Process and Improvement specialist with experience in managing and monitoring accounts to ensure compliance with state and federal regulations. Familiar with policies for functioning in a range of medical facilities and suppliers.Process and Improvement Specialist 07/01/2022 to PresentAccentureVerify all insurance information that’s provided to us to insure we collect the correct amount prior to or after the patient’s appointment. Process rebills and refunds when the patient did or didn’t pay enough.Update the patients charts with new medications, sickness, or illnesses.Call and get prior authorizations codes and approval prior to any procedures that requires it. Support LeadMaryland Department of Labor by way of Accenture 11/01/2021 to Present Second voiced calls Reviewed accounts to better assist the agents help the claimants. Attendance Tracking Start and end daily meetings Assist Supervisor with one on ones. Monitor Calls Perform weekly audits. Took calls 2x a week to allow agents to hear what a 100 call sounds like Trained new hires. Assisted claimants with opening and reopening claims, backdating claims, put in snow tickets for claims that require additional assistance from adjudication. Reset user credentials.

Front and Back Office Medical AssistantDr. Sternberg 01/2018- 01/19/2021Dallas, Texas * Review charges, patient information, and insurance information prior to billing to minimize underpayment, denials and re-bill attempts.* Verifies successful import of claims from host system daily. Reconciling both number of claim count as well as dollars of daily import.* Working knowledge of CMS guidelines to include Medicare the DDE and FSS systems.* Works additional daily reports (72 hr. report, prior day rejection report, etc.) to ensure these claims are added timely to the daily transmission.* Timely submission of clean, accurate claims of all hospitals assigned either electronic or paper according to payer/hospital requirements and following specific state and federal guidelines per established procedures. To include primary, secondary, and tertiary insurance companies with the appropriate explanation of benefits (EOB) attached, if applicable.* Works errors and halted claims daily. Ensures additional transmission of the corrected claims are completed by end of day or designated time depending on facility, system and or clearinghouse.* Selects and prints any claims designated as paper (once errors have been corrected).* Mails paper claims daily attaching any additional pertinent documentation necessary to ensure prompt adjudication and payment of the claim.* Ensures proper account documentation, which is clear, concise and includes all pertinent information.* Add claims needing additional information from facility (i.e., medical records, authorization numbers etc.) is added to appropriate request log to ensure timely completion of claim transmission.* Consistently follows established processes and procedures for all assigned accounts and projects to ensure prompt payments and account resolutions.* Makes appropriate and necessary corrections to patient account information after verification from the facility as needed to ensure timely correction and submission of claim.* Immediate and appropriate escalation of payor trends and issues to management which impact cash, aging and processes.* Maintains or exceeds 95% of established productivity goals and quality standards.

* Utilizes electronic software in all daily activities, documenting account daily following established procedures.* Promotes working toward paperless environment by identifying potential new electronic payors* Ensures professional verbal and written communication with facilities, clients and co-workers following established guidelines. Obtains management approval when necessary to communicate with external clients about internal processes and procedures.* Follows and maintains patient, account and client confidentiality at all times. Adheres to HIPAA and Compliance Policy Guidelines.* Follows timekeeping and attendance policy daily.* Verify insurance and coverages prior to patient’s appointment (Deductibles and OOP, Patient’s responsibilities.* Preform order of Draws, Blood Pressure, Chief Complaints, Call in prescription, Schedule follow up appointments, Call patients after surgeries to follow up.Medical CollectorMadigan Army Medical Center 01/2009 - 12/2017Ft Lewis, WAMaintained patient account balances based on required time frames. Managed delinquent accounts initiating collection procedures as required. Advised in resolution of customer billing issues through typical inquiries. Worked with customers to Establish patient payment plans. Gathered medical records to input and update patient information in computer system. Ensured medical collection activity was conducted as per company local and state guidelines. Reported patient and payer credit balances on monthly basis.Medical CollectorPremiere Health Center 01/2004 - 01/2009Columbus, OhioReviewed commercial contracts per reimbursement regulations. Coordinated correspondence with insurance carrier. Managed process with business office for writing off payments. Ensured state and federal regulation compliance for medical collections. Prepared and distributed work aged account receivables report.

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