Medical Insurance

LaRicka Y. Roberts

**** ******** **. *****, ** 63137

Phone: 314-***-****

*******.*******@*****.***

PROFESSIONAL SUMMARY

Organized Healthcare Administration professional with foundation in revenue cycle solutions management with strong project development, implementation and management skills. Over ten years’ experience in a healthcare administration business office setting. Advanced medical terminology knowledge. Health insurance professional with background in preregistration, insurance verification, prior authorization, billing, insurance follow up, plan contracts, disputes/appeals and collections, records management and maintenance. Desires a role in a professional business setting or environment.

SKILL HIGHLIGHTS

Excellent verbal communication

Decision-making and team sharing

Specialized in Appeals, Billing and Collections

Highly proficient in excel reports

Office management professional

Research and data analysis

Composed and professional demeanor

Deadline-driven

Strong planning skills

Good written communication

Project implementation and management

Knowledge of HMOs, Medicare, Medicaid, Work comp, and Auto payers

Knowledge in UBO4, 1500 claims

Managed care contract knowledge

Electronic Medical Record (EMR) software

CPT and HCPCS coding

Internal medicine billing

Medical terminology expert

ICD-9 and ICD-10 coding

HCPCS Coding Guidelines

Liaison between clients and Healthcare providers

PROFESSIONAL EXPERIENCE

MANAGED CARE ACCOUNTS RECEIVABLE MANAGER 01/2015 to 08/2017

Conifer Health Solutions

Acted as a liaison between the business department, billers and third-party payers in resolving billing and reimbursement accuracy. Handled high level and detailed projects from implementation to completion and reduce aging by 90%. Perform detailed analysis on assigned projects. Provided mentoring to all levels of Specialists. Actively maintained current working knowledge of CPT and ICD-10 coding principles, government regulation, protocols and third-party requirements regarding billing. Interacted with providers and other medical professionals regarding billing and documentation policies, procedures and regulations. Proficiently identified, calculated, and pursued the reimbursement for all contact terms including stop loss, cost pass through items and fee schedules. Confidently and adeptly handled claim denials and/or appeals. Examined patients' insurance coverage, deductibles, possible insurance carrier payments and remaining balances not covered under their policies when applicable. Manages a team of Self Install Analysts by providing direction, leadership, motivation, and coaching.

PATIENT ACCOUNTS SUPERVISOR 02/2013 to 12/2014

Conifer Health Solutions

Handled all inpatient, Outpatient and Physician, claims billing follow up with commercial, managed care, and government insurance. All project reports Obtained medical charts and/or electronic medical record (filing, Op Reports, verbal and written appeals). Reviewed, analyzed and managed coding of diagnostic and treatment procedures contained in outpatient medical records. Lead problem solving and coordination efforts between various business units. Managed collections claims for unpaid bills against the estates of debtors. Identified and resolved patient billing and payment issues. Diagnose problems and identify opportunities for process redesign and improvement. Printed and reviewed monthly patient aging report and solicited overdue payments.

LEAD PATIENT ACCOUNTS ANALYST 02/2005 to 02/2013

Conifer Health Solutions

Billing and follow up on with all commercial, Managed care and government payers. Precisely completed appropriate claims paperwork, documentation and system entry. Defines and creates comprehensive reports regarding issues impacting the company. Assist with formulating and updating departmental policies and procedures Verified patients' eligibility and claims status with insurance agencies. Posted and adjusted payments from insurance companies. Diagnose problems and identify opportunities for process redesign and improvement.

ACCOUNTS RECEIVABLE DENIALS SPECIALIST 05/1999 to 01/2005

Conifer formally-Tenet Healthcare Solutions

Identify, communicate and effectively work to resolve issues including payer, system or escalated account issues. Participate and assist in special projects as well as provide A/R support to the team. Assist existing staff with training or techniques to increase production and quality as well as provide A/R support with Verbal and written appeals. Perform appropriate billing functions, including manual re-bills as well. Perform detailed analysis on multiple projects, recommend potential business solutions and ensure successful implementations

PATIENT ACCOUNTS SPECIALIST, 06/1996 to 04/1999

St. Louis Regional Medical Center

Developed and implemented centralized outpatient/impatient billing; follow-up with attorney liens and estate; submitted health insurance, Medicaid and Medicare claims for payment; answer client inquiries and resolve problems regarding billing and insurance. Maintain, generate and distribute statistical reports.

EDUCATION AND TRAINING

General Studies: Mansfield Business College Virginia Beach VA, US

Diploma: Cleveland ROTC High School -St. Louis MO

CERTIFICATIONS

the Certified Revenue Cycle Representative (CRCR)

January 2016 to January 2019

By becoming certified in the CRCR program, you or your team has the designation that proves a high level of revenue cycle knowledge and expertise has been reached.

ADDITIONAL INFORMATION

I am highly adaptable and I welcome challenges that enhance personal and professional growth

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