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Patient Account Representative

Location:
Dallas, TX
Posted:
April 14, 2020

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Resume:

NIKITA GRAY

RESUME COVER PAGE

LEAD/BILLING REVENUE CYCLE ANALYST

OBJECTIVE/PROFILE

My primary objective is to exceed in all aspects of my job duties, and conduct myself in a professional matter. Productive, responsible, time management, enthusiastic, and dedication.

To obtain a challenging position that will utilize and broaden my charge capture and root cause analysis experience within the healthcare system.

Experienced managed care healthcare professional seeking a permanent full-time position that will utilize my vast healthcare knowledge, strong people skills, organizational abilities and business experiences in a challenging environment that offers varied and potential growth to qualified individuals.

CONTACT

PHONE:

214-***-****

WEBSITE:

https://www.linkedin.com/in/nikita-gray-100b9482

EMAIL:

adctah@r.postjobfree.com

SKILLS/TRAINING

AllScripts, ACE, PatientPlus Suite, MedConnect, IMacs, Claims Adjudication, SharePoint, Certified Microsoft Word, WordPerfect, Excel, Outlook, Access, Google/Google Chrome/Apps, IE, Innovative Managed Care Systems, Ltd (IMACS), AS400, ICD9, ICD10, CPT, CCI, TX Workers’ Comp, CA Workers’ Comp, and WA Workers’ Compensation, Medicare/Medicaid billing, WASHINGTON STATE MEDICAID HCFA 1500 UB-04. ERISA

Microsoft Office (Word, Excel, PowerPoint, Access, Outlook), AllScripts, VI Web, e-Premis, SharePoint, ACE, MedAssets, PatientPlus, Centricity GroupCast, Vision, Emdeon, Nexgen, Dimension, Behavioral Health Pre- Authorization, CGX, Focus, Timesys Pharmacy, Vital Point Instant Claims Management, RX Claims Reporting, E-Clinical, Kinnser, Ability, Availity, GPMS, EPIC, DDE, Meditech, Navinet, ProviderOne, Kubra, Noridian Portal, One Health Port, Payspan, WA state Labor and Industry, USMON

EDUCATION

Codeologylic, Online

2019-Present: Billing and Coding Certification

University of Phoenix, Dallas, TX

2017 - Present, Undergraduate Bachelors of Science in Health Administration

Concorde Career College Memphis, TN

Jan 2007- Certificate of Diploma Medical Office Professional

Remington College Memphis, TN

Dec 2005 – Certificate of Diploma Medical Assistant

Hamilton High, Memphis, TN

June 1998 – High School Diploma

WORK EXPERIENCE

Sr. Accounts Receivable Rep - Medical Practice Solutions - Irving, TX

December 2017-March 2020

• Initiate billing on assigned claims in an expeditious manner, whether through hard copy claims or electronic format. Maintain control of claims billed and pending to ensure full accountability for all claims.

• Follow-up on all unpaid claims within the required timeframe. Submit all necessary level of appeals and maintain documentation of all collection activity. Advise AR Manager of workload problems, which may prevent timely, follow up on accounts.

• Work EOB/remittance advices on a daily basis to identify denials or short paid claims. Work with branch office designee on eligibility issues and necessary documentation to ensure timely collection of accounts.

• Demonstrate aggressive yet conscientious collection efforts. Request approval for account adjustments as appropriate

•Search for supporting clinical evidence to support appeal arguments when existing resources are unavailable.

• Work daily denials for assigned

• Prepare documentation for audits, appeals and redeterminations

•Proficiently read and understand abstract information from handwritten enrollee medical records.

• Resolve credit balances on a monthly basis and timely submission of refund request documentation to AR Manager

•Other duties as assigned.

Accounts Receivable Analyst (WA Workers’ Compensation- Medsynergies (Aerotek): Irving, TX

March 2017-December 2017

• Worked Washington state denial claims/ appeals claims and no response queue

• Worked denials and appeals

• Managed and alleviate credit risk by analyzing client yearly fiscal reports, regulatory statements (as accessible), arrears check ratings and other treatment apparatus. Supervise currency revenue and submission to appraise and modify the efficiency of current currency applications measures.

• Verified claims adjudication utilizing appropriate resources and applications. Initiate telephone or letter contact to patients to obtain additional information as needed.

• Performed appropriate billing functions, including manual re-bills as well as electronic submission to payers.

• Edit claims to meet and satisfy billing compliance guidelines for electronic submission. Manage and maintain desk inventory, complete reports, and resolve high priority and aged inventory.

• Participated and attend meetings, training seminars and in-services to develop job knowledge. Participate in the monthly, quarterly and annual

performance evaluation process with their Supervisor. Respond timely to emails and telephone messages as appropriate.

•Communicate issues to management, including payer, system or escalated account issues.

• Recognized and provide a solution for operational obstacles that delay thriving presentation by developing practical results to problems including the use of mechanization, practice revisions, executive changes, and partnership with other providers.

Claims Denial Auditor- Dr. Salman Ahmad, Richardson, TX

April 2014 – March 2017

• Directly worked with insurance payers, hospitals, and patients and resolved all account

discrepancies.

• Performed appeals and denial recovery procedures and corrected denied claims by reviewing medical

records

• Verified claims adjudication utilizing appropriate resources and applications. Initiate telephone or letter contact to patients to obtain additional information as needed.

• Verified the Explanation of Benefits (EOB) forms for accuracy and identified any misapplied payments.

• Edit claims to meet and satisfy billing compliance guidelines for electronic submission. Manage and maintain desk inventory, complete reports, and resolve high priority and aged inventory.

• Provided all necessary information such as medical records, prescription information, etc to payor

• Participated in quality assurance processes including but not limit to the audit program, case reviews and training session

Accounts Receivable Analyst - Conifer Health Solutions, Frisco, TX

April 2015 – April 2016

• Identify issues or trending and provide suggestions for resolution.

• Accurately and thoroughly documents the pertinent collection activity performed. Review the account information and necessary system

applications to determine the next appropriate work activity.

• Verify claims adjudication utilizing appropriate resources and applications. Initiate telephone or letter contact to patients to obtain additional information as needed.

• Perform appropriate billing functions, including manual re-bills as well as electronic submission to payers.

• Edit claims to meet and satisfy billing compliance guidelines for electronic submission. Manage and maintain desk inventory, complete reports, and resolve high priority and aged inventory

• Collected and managed account payment by assisting in the collection of past due payment

Grievance & Appeals Analyst – Lifesynch, Irving, TX

August 2014 – March 2015

• Handle the day to day processing of appeals which include record maintenance of each appeal and any action taken

• Monitor department compliance with timeframe requirements as well as collaboration with health care plans

• Monitor emails, fax, and voice mail on a daily basis for task distribution

• Investigate complaints and/or grievances received by members and providers

• Assist internal and external customers with complaints and appeals process

• Contribute to Corrective Action Plans put in place for quality improvement across all departments.

• Organization and preparation for accreditations through NCQA and URAC

• Utilize behavioral change approaches in communication with members.

• Develop and maintain productive and long-term working relationships with contractors, providers and internal Humana associates

• Assess the needs of identified Humana Achieve members and work with providers and medical counterparts to develop an individualized plan of care and provide care coordination assistance to members, guardians and providers

Client Benefit Administrative Analyst – RMK Consulting/Express Scripts, Irving, TX

September 2013 – July 2014

• Perform analysis and evaluation of services, coverage, and options to determine the best operational approach for plan design build and

maintenance.

• Coordinate transfer of data to external contacts for services, including documentation and testing of extract files

• Research and respond to complex inquiries from clients and internal partners regarding the interpretation of benefit plans, including eligibility,covered services and exclusions.

• Compiles information from System for Electronic Rate and Form Filing (SERFF) submitted by insurers writing pharmacy insurance

• Ensured benefits plans are administered according to plan provisions and company’s regulatory guidelines

• Worked with insurance carriers to resolve issues regarding eligibility and claims



Contact this candidate