Revenue Cycle Enrollment Coordinator
Resume:
Nikesha P. Barber
Charlotte, NC 28216
**********@*****.***
OBJECTIVE:
Versatile business professional seeking a position that will allow me to apply my knowledge and skills as an Enrollment Coordinator to advance my career. I possess excellent communication skills, interpersonal skills, great attention to detail, self-motivated and function effectively both as an individual contributor and as part of a team.
PROFESSIONAL EXPERIENCE:
RCS Managed Care Contract Enrollment Coordinator
Novant Health Medical Group-(RCS) Strategic Growth
May 2021-Present
SME in Medicare Part B enrollment to include individual providers and group enrollments.
Performs Medicare Part B credentialing and re-credentialing services for providers in compliance with Revenue Cycle Services, the guidelines of the National Committee for Quality Assurance (NCQA), Utilization Review Accreditation Commission (URAC), the legal requirements of the NC, SC, & VA Department of Insurance, as well as all other applicable State and Federal Laws.
Responsible for maintaining and updating provider files for Medicare Part B primary source verifications on all credentials including medical licenses, certifications, and provider Drug Enforcement Administration (DEA) records.
Provides support to Revenue Cycle Services in the identification and credentialing process and acts as liaison with managed care organizations, self-insured businesses, insurance companies and Revenue Cycle Services.
Exceeds quantitative metrics on accuracy, productivity, and provider satisfaction.
Patient Access Specialist/Registration Admitting
Novant Health Medical Group-Hospital
August 2018-May 2021
Captures and enters accurate patient demographic and financial information via telephone interviews and hard copy documentation (mail-in, facsimile, etc) or direct patient contact. Adapts interview process to the age of the patient/family member. Enters all information gathered into the Patient Management system.
Coordinates with insurance verification and financial counseling to ensure appropriate insurance authorization is obtained prior to the scheduled appointment. Assists patient with billing issues and questions about insurance coverage and refers unsponsored or underinsured patients to financial counseling.
Maintains up to date knowledge and competency of a wide variety of third party plans and insurance carriers, both participating and non-participating plans, which are complex and everchanging.
Communicates the financial liability to the patient and collects the patient’s portion of the financial responsibility.
Patient Account Representative II
Ensemble Health Partners
April 2018-August 2018
Contact insurance carrier specific to their assigned account queue, and following up on the underpaid claims, to result in payment on the account.
Reviewed account specifics to evaluate how to follow up with the insurance payer on the aged or delayed claims.
Identifying trends in payments discrepancies amongst payers.
Contact via phone insurance carriers to move by phone to move the account forward in the payment process.
Auditing account notes appropriately per objective quality standards following phone conversation with insurance carriers.
Surgery Scheduler/Medical Biller
Thrive HealthCare
May 2017-April 2018
Schedule clients for appointments with the chiropractor, massage therapist, and aesthetician.
Schedule office appointments for patients with physicians for integrated and personalized care.
Schedule clients for appointments with the chiropractor, massage therapist, and aesthetician.
Receive and submit faxes to and from providers hospitals to update referral information for patient records.
● Schedule surgeries and procedures performed in office and at other facilities.
● Assist patients with billing and insurance inquiries, referrals, and specialty testing.
Revenue Cycle Advocate
Patient Service Coordinator IV-Referral Coordinator
Patient Account Representative III
Novant Medical Group- (RCS) – Charlotte, NC
December 2008- May 2017
Audit patient accounts researching unpaid claims and follow up with insurance carriers.
Resolve patient accounts taking the necessary actions to get their balance to zero.
Meet RCS quality standards of 95% or better monthly/quarterly.
Complete several Special Projects within RCS assigned by Management Team.
Trained to work Novant Practice Management systems with proficiency.
Assist patients with bills for lab charges, benefit coverage, referrals and specialty testing.
Provide resources for patients that need financial or insurance assistance.
Ortho Carolina- Charlotte, NC Appointment Scheduler
March 2008 – December 2008
Scheduled office appointments for patients/providers with orthopedic physicians and/or therapists.
Received and submitted faxes to and from providers/hospitals to update referral information for patient records.
Maintained IC task priority queues with nurses on behalf of patient/providers in a timely manner.
Setup medical charts/registration for patients new to the clinic.
CIGNA HealthCare- Charlotte NC
Senior Appeal Processor Level II (Work-at-home)
Internet Customer Service Associate (Promotion)
Customer Service Associate III (Promotion)
September 1998- March 2008
Interacted with members/providers via Internet or telephone to assist with benefit inquiries.
Researched, analyzed, and rendered decisions for member/provider administrative and medical appeals.
Collected and maintained current information on CIGNA Regions and ERISA accounts/groups and their benefit plans, standard Group Service Agreements and related policies and procedures.
Forwarded appeals/complaints to matrix partners (HP, MCC, Claim, etc.) as necessary and provides information for their review.
Sent correspondence to members/providers or their representative on Complaints and appeals within designated time frames.
Processed appeals in a timely fashion. Meets turnaround timeframes established by the national member/provider appeal policy and state specific legislation.
Proofed all outgoing documentation for precision and accuracy.
Set up filing for appeals and other documentation effectively, prioritizing appeal caseload.
Achieved a required level of production, quality, and compliance standards in processing appeals.
Completed all activities associated with ongoing volume reduction initiatives.
May interpret provider contracts and exceptions by market/provider for provider appeals.
EDUCATION:
Pfeiffer University 2017
Human Relations/Substance Abuse
Bachelor of Art
SKILLS:
Self- Management skills
Communication skills
Problem-solving skills
Strong organizational skills
Interpersonal skills
Computer proficiency
Detail-Oriented
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