Executive Assistant Customer Service, Denial Specialist, Medical Reco
Resume:
Nardos Haileleul
Davie,FL 33313
OBJECTIVE: Seeking a position in area of communications, sales that will utilize my skills and experiences in all facets of patient relations. In my lengthy and varied work history I have a solid combination of insurance/healthcare experience both third party and group health related.
HIGHLAND OF QUALIFICATION: Dedicated & focused, able to priories and complete multiple task and follow through to achieve projects goals
An independent and self motivated professional with excellent research & writing skills, able to grow positive relations with clients
Computer Skills' Word, Excel, ACT, Avatar, Artiva, Epic & Internet
Professional Experience
Release of Information Specialist- Medical Records
Hollywood, Florida
2019-2020 Sharecare
This position was responsible for processing all release of information requests in a timely and efficient manner ensuring accuracy and providing customers with the highest quality product and customer service. Associate must at all times safeguard and protect the patient's right to privacy by ensuring that only authorized individuals have access to the patient's medical information and that all releases of information are in compliance with the request, authorization, company policy and HIPAA regulations.
Essential Functions:
• Completes release of information requests including retrieving patient's medical chart and returning chart, scanning medical record accurately and correctly and transmitting daily, according to requests, established procedures, and established standards of quality and productivity.
• Date stamps all requests and highlights pertinent data to facilitate processing.
• Validates requests and authorizations for release of medical information according to established procedures.
• Performs quality checks on all work to assure accuracy of the release, confidentiality, and proper invoicing.
• Maintain equipment in excellent operating condition (inside and out).
• Provides excellent customer service by being attentive and respectful; insures understanding of customer request and follows-through as promised; and being proactive in identifying client concerns, or problems.
• May receive incoming requests including opening mail, telephone inquiries, and retrieving facsimile inquiries, depending on the needs to the client.
• Maintains a neat, clean, and professional personal appearance and observes the dress code established.
• Maintains a clean and orderly work area, insures that records and files are properly stored before leaving area.
• Maintains working knowledge of the existing state laws and fee structure
• Works within scope of position and direction; willingly accepts assignments and is available to take on additional facilities or help out during backlogs
Carries out responsibilities in accordance with client/site policies and procedures, including HIPAA, state/federal regulations related to operations, and labor regulations.
• Maintains confidentiality, security and standards of ethics with all information.
• Work with privileged information in a conscientious manner while releasing medical records in. an efficient, effective, and accurate manner.
Denial Recovery Specialist/ Collector and Medical Records
Fort Lauderdale, FL
2015 to 2019- Advanced Recovery Systems
GENERAL DESCRIPTION: The essential function of this position within the organization is to provide specified services to recover monies owed to substance abuse, facilities, physicians,by a third-party payers for services . This position is responsible for processing insurance claims, researching the cause for the rejection and or denial, correcting the error(s) that caused the rejection or denial, and reprocessing or rebilling the claim for payment, and performing related customer service, clerical, and administrative tasks.
1. Receive and analyze denied claim, including a. Reviewing the Explanation of Benefits (EOB) to determine denial type; b. Researching client data systems to determine current status/past actions on claim; c. Contacting insurance companies to verify denial reason; d. Determining appropriate action to resolve denial; and e. Documenting all actions taken in client and/or company SRS computer systems as appropriate. Reporting insurance and third-party payer rejection and or denial “issue” trend to project supervisor.
2. Take appropriate action to resolve claim for payment, including: a. Contacting insurance companies/patient to gather necessary information to resolve claim; b. Gathering information requested by the insurance company, including medical records and information from ancillary departments (i.e., labs); and c. Dropping a new claim for payment; d. Writing a letter of appeal; e. Requesting an adjustment; Transferring balance to patient liability; and . Documenting all actions taken in client and company computer systems as appropriate.Provide customer service, including timely response to telephone calls, e-mails, and other verbal or written correspondence.
4. Travel for business, as requested.
5. Seek technical assistance by notifying the immediate supervisor of problems/issues related to collections, accounts, employees, clients, or others, as necessary and appropriate.
6. Provide technical assistance to co-workers and/or clients as requested, including providing assistance/instruction to achieve task completion.
7. Compose and proof correspondence, including e-mail, letters, and other written documents.
8. Attend staff and other professional meetings, including technical or professional classes, workshop or seminars to exchange information and improve
8. Sending out medical records to insurance and patients
Denial Specialist
Cooper City, FL
2012 to 2015 Health Business Solutions
Job Description
• Proactively reviews and researches all accounts assigned and completing all necessary activity to resolve the claim. This includes:
• Bill correction and re-submission.
• Generation of appeal letters.
• Written and oral correspondence with payers.
• Calculating adjustments and forwarding appropriate requests to client.
• Responding to documentation requests from payers.
• Transfer of balance to patient liability or appropriate financial class as determined by review and research.
• Researching client data systems to determine current status, history and past actions on claim.
• Determining appropriate action to resolve denial.
• Investigating and/or ensuring that questions and requests for information are responded to in a timely and professional manner resulting in accurate resolution of assigned accounts.
• Perform ongoing monitoring of accounts worked to ensure maximization of collection dollars through appropriate follow-up and documentation of actions taken in client and/or HBS computer systems as appropriate.
• Review remittance advice for denials and trends for the payers assigned. Referring all payer issues/problems to Leadership in a timely manner, making recommendations to the Project Director/Revenue Cycle Director for resolution and elimination of denials where possible.
• Researching, reviewing and adhering to all federal, state and local regulatory collection guidelines, as well as payer specific billing/collection guidelines.
• Provide customer service, including timely response to telephone calls, e-mails, and other verbal or written correspondence. Resolve client complaints to satisfaction.
• Participate in special projects or other responsibilities as needed or assigned.
• Carries out the mission, vision, values and quality commitment of HBS.
• Practice HIPAA compliance.
• Attend staff and other professional meetings, including technical or professional classes, workshops or seminars, to exchange information and improve technical or professional
Medicare Collector
Nashville, TN
2007 to 2012 HCA (Healthcare Corporation of America)
The position performs account reconciliation between collections and host/mainframe computer systems for 15 regional hospitals.Position responsible for establishment of claims and confirmation of coverage. Work over MSC web tool to notify or locate Medicare payers with
delinquent accounts and attempt to secure payment. Calculate figures and amounts such as discounts, contractual by pulling EOBs. Request rebills
claims before pass timely. Determine that claim has correct procedure, diagnosis and revenue codes . Request Medical Records for appeals.
Work on denied accounts to appeals
Support Services
Nashville, TN
2002-2007- HCA (Healthcare Corporation of America)
Answered and screened a high volume incoming calls. Validated accounts by reviewing charges, payments and EOB establishing patient portion . Updated or change insurance information. Identified escalate patient complaints and audits and distribute to appropriate web tools.
Processes credit card payments and offer negotiate settlements. Faxed or mailed copies of bills to a requestor according to confidentiality guidelines.
Executive Assistant
Nashville, TN
2000-2002- The Danner Company, Nashville TN
Coordinated schedule, appointments and travel arrangements and managed accounts and recovery. Organized annual shareholders meetings, including site section, catering an preparation of appropriate materials. Created a highly effective system to easy access to information and streamlined office functioning
Assistant Manager-Bridge Lounge & Deli
Nashville,TN
1996-2000 Renaissance Nashville Hotel
Hiring, training, motivating and ensuring that all associates are properly oriented to into the department . Provided guests with highest quality of food and beverage services. Implemented training course for new recruits-speeding profitability. Forecasting and scheduling for the department
EDUCATION: Tennessee State University, Nashville, TN 1995
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