Account Representative Medical Insurance
Resume:
MICHELLE
JONES
***********@***.***
Hiram, GA 30141
TRC Staffing - Senior Account Specialist
Atlanta, GA • 01/2022 - 10/2023
FFAM 360 - Patient Account Representative
ATLANTA, GA • 01/2021 - 11/2022
Change Healthcare - Third Party Advocate
Atlanta, Ga • 02/2017 - 01/2020
WORK HISTORY
Resolved complex billing and payment issues for balanced, accurate accounts.
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Adhered to standards of quality and service as well as all compliance requirements.
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Reviewed account activity to assess financial status and evaluate discrepancies.
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Observed financial transaction laws and regulations for full accounts compliance.
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Liaising with medical insurance providers to resolve payment issues, assisting patients in understanding medical insurance benefits and processing patient refund.
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• Resolve denied/underpaidclaims in timely manner
Analyzed claims and made corrections with patient
information/coding
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• Verified insurance via web and automation verification Worked with outside entities to resolve issues with billing, claims and payments.
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Contacted patients after insurance was calculated to obtain payments.
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• Electronically submitted bills according to compliance guidelines.
• Posted payments and processed refunds.
• Reconciled statements with patient records.
Monitored flags and resolved urgent items with accuracy and efficiency.
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Provided Process Improvement recommendations with goal of enhancing both customer and employer experience to leadership staff
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Analyze, identify and assist in the implementation of workflow process optimization
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SKILLS
• Cerner
• EPIC
• Nextgen
• Power Wo0rks
• Star
• Microsoft Office
• Gateway
• Emdeon
• P-Scribe
• Data Analysis
• Problem Solving
• Time Management
Durham Staffing - Staffing Specialist
Atlanta, Ga • 02/2016 - 09/2017
Payment MD - A/R Denials Analyst
Atlanta, Ga • 02/2016 - 08/2016
Piedmont Hospital - Revenue Cycle Specialist
Atlanta, Ga • 03/2014 - 12/2015
• Consistently surpassed productivity standards
Scheduled interviews with potential candidates, filled out required paperwork and prepared introduction manuals.
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Managed applicant tracking system (ATS) database by entering, updating and maintaining candidate contact details, resumes, and supporting documentation.
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Collaborated with manager to determine department's short and long-term hiring needs.
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• Developed and facilitated new-hire orientations. Engaged in regular trainings to become subject matter expert in healthcare staffing industry
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• Fostered professional relationships with providers
• Verified insurance via call, web and automation verification
• Balanced daily batches and reports
• Prepared income reports and statistics to be distributed
• Initiated billing and coding corrections and modifications Handled claim disputes, resubmissions and followed up on appeals, redeterminations and resolution
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Served as claim denial subject matter liason between operations and other departments, including finance dept to identify issues and optimize resolution
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Developed, implemented and/or recommended claim root denial cause reporting as appropriate
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Processed account information and documentation by resolving inconsistencies and reviewing data for errors
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Verified insurance benefits and followed up with insurance companies regarding revenue
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Provided patients with accurate and detailed information pertaining to their accounts
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Maintained daily aging reports and handle incoming patient account inquiries
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Contact this candidate