Authorization Specialist Service Representative
Resume:
Sabrina Williams
********.*******@***.***
SUMMARY
Accounts Receivable Follow-Up Collector possessing strong problem solving and decision-making skills Experience following up with government Medicare and MCO payers to ensure complete and timely follow-ups on claims that have open balances, were rejected or denied. DME industry experience recently with third party collector IKS Health and Connect Hearing. Professional demeanor, sound judgement, pride in work and attention to details
Technical experience includes Microsoft Word, Excel, Outlook, I2K, Vision, ACSS, CATS, E-Credit, RMS, IFD, Access Referral system, Accurint, TU Desktop, EOscar, TU Authentication, CACS clinical Skills, Waystar, Oracle, Epic, Cisco Finesse phone system
EXPERIENCE
Health Resource Solutions- Lombard, IL
Billing Specialist 07/19-Present
Work the aged accounts receivable reports in Homecare Homebase to track and follow-up on delinquent accounts
Responsible for gathering information needed to resolve account discrepancies
Identify the correct documents and billing information needed for the rebilling process
Identifies claim denials or holds and cause for such; provides analysis and action for claim corrections and coordinates with agency management and staff members to resolve and bill for services.
Processes appeal requests within the timeframe required by the payor
Documents all collections activity in the Homecare Homebase system
Performs special projects related to billing and collections
Performs other duties as assigned
Edward-Elmhurst Hospital
Patient Service Representative Rehabilitation Services 12/2021-Present
Schedule patients for occupational therapy, physical therapy and speech therapy. Timely and accurate pre-registrations, registrations, order management, charge capture, cash collection functions and medical information systems.
Collects, analyzes and records demographic, insurance/financial and clinical data from multiple sources and obtains other information and signatures necessary for the above processes.
Screens for third-party eligibility and enters medical necessity coding to ensure accurate payment is secured. Interacts in a customer-focused manner to ensure the needs of patients and their families are met and that they understand the hospital’s revenue cycle expectations, including resolution of personal liabilities through various payment options.
RevMD
Follow-Up Specialist 05/2017-06/2019
Provides customer service to various healthcare contract customers
Prepare research and collect from various health insurance payers Read through healthcare contracts and contract language and ensure proper contract flow
Research remits and EOB'S for complete accurate payments and denial
Provide or arrange the additional information when needed
Submits corrected claims or appeals
Request appropriate adjustments when required
Ensure legal compliance by following company policies and guidelines, as well as state and federal insurance relations
Additional duties as assigned
IKS Health-Burr Ridge, IL
Revenue Cycle Collections Specialist 07/2016-02/2017
Identifies problem accounts with payers; investigates and corrects errors and resolves past-due accounts
Responsible for making decisions on routine problems and working with managers on non-routine questions or escalations
Contact responsible party to resolve delinquent problems and working with managers on non-routine questions or escalations
Contact responsible party to resolve delinquent accounts; prepare installment plans and monitor adherence to plan by responsible party; direct accounts to drop to outside collections agency when necessary
Answer inquiries by phone regarding past due accounts as well as for returned statements and letters mailed from our department
Accurately bill and re-bill claims per the payer requirements ensuring all required documentation is attached when needed
Maintain accurate and completed records concerning collection activity on all accounts touched/worked by documenting all account activity in appropriate systems
Other duties as assigned
Connect Hearing
Revenue Cycle Collection Specialist Naperville IL 02/2015-06/2016
Analyze the claim, explanation of benefits, correspondence, payer website and/or any additional information necessary to identify the next appropriate action toward account resolution
Follow government and third-party payer guidelines to ensure complete and timely follow-ups on claims that have open balances, were rejected or denied
Perform appeals by following government and third-party payer appeals guidelines.
Review payer contracts and fee schedules to perform underpayment appeals
Contact patients or appropriate payer representative via phone or electronically to coordinate benefits and submit claim filing order.
Identify other payers when possible and ensure all payers and filing order is current in the registration applications
Collaborate with the Revenue Cycle Analyst to identify patterns and interpret denial trends.
Notify Supervisor when insurance plans deny services, which are covered based on the contract terms or government guidelines
Minimize write-offs by exhausting all resolution options and performing through research/review of all appropriate resources.
Adjust account or request write-offs adhering to Connect Hearing policies and procedures
Review denial repots and recommend edits modifications and additions base on claim denials. Analyze and track appeals
Meet productivity and quality standards
Research payer and government website and/or medical resources to identify payer requirements required to resolve open account receivable
Collaborate with Coding Analyst/Specialist or Clinician to resolve coding related denials
Target and report and internal procedure or processes that may increase days in accounts receivable or delay claim resolutions.
Interact with patients, governments and third-party payers to respond to billing request
Provide customer service for patients by responding to inquiries and processing posting patient credit card payments as needed
Document using standardized notes all insurance follow-up and account resolution activities in the revenue cycle applications
Remain current with trends, regulatory requirements, and business strategies related to the revenue cycle • Perform other duties as assigned
Ensure accurate claims submissions are entered in Zirmed.
Connect Hearing Naperville IL 10/ 2014-02/2015
Benefit & Authorization Specialist (Contract)
Contact insurance companies (medical groups) and/or payers to obtain policy benefits/benefit limitations, analyze benefits eligibility and complete eligibility and completer eligibility/benefit verification.
Ensure accurate benefit data is entered into Sycle/Oracle systems for each patient.
Request pre-authorization for hearing aid services & hearing aids (DME) when needed.
Maintain insurance verification log accounts.
Respond to emails and phone calls from field offices and/or patient.
Complete 30-50 benefits per day
Apria Health Care, Schaumburg IL
Customer Service Associate 05/2013 – 04/2014
Answered 70-80 calls a day in high-volume call center environment, provided information on equipment, supplies & service and resolved patient/customer issues
Responded to telephone, fax and EDI and orders from referrals, sources and homecare patients
Scheduled appointments through Microsoft Outlook
Provided documents referral requested for coordination of care
Ensured proper selection of information online to ensure timely delivery and appropriate revenue recognition for order
Maintained appropriate documentation received for orders and conducted follow-up as applicable
Verified insurance information eligibility and benefits of patients for accuracy and completeness and resolves discrepancies as needed
Obtained verbal/written authorization for medical treatment from appropriate sources
Obtained clinical information needed for order processing or reimbursement
Contacted patients to advise them of the order placed on their behalf and to confirm all demographics
Verizon Wireless, Schaumburg, 10/2001 – 03/2012
Fraud Investigator 05/2006 – 03/2012
Answered 100-125 calls a day in high-volume call center environment for claims of possible ID fraud
Worked as a team to proactively identify accounts as ID Fraud
Responded to assigned customer inquiries within the required 48-hour period
Navigated CACS F37 queue, for possible fraud referrals, routing out as needed
Utilized E-Oscar system, processing automated customer disputes
Displayed sound judgment for accounts as whether an investigation should proceed on the account retrieved and distributed all written correspondence
Assisted in projects for Associate Director and Supervisor as necessary
Administrative Assistant
Associate Director CFS MW Area 05/2004 – 05/2006
Handled all incoming calls as necessary, scheduled appointments and maintained Associate Director calendar
Typed correspondence, filed, handled payroll discrepancies, arranged travel arrangements, and processed expense reports
Coordinated department and interdepartmental meetings
Maintained attendance and personal records
Organized special events, quarterly meetings and staff meetings
Responsible for timely flow of communication in and out of the department
Ordered supplies, and reconcile P-Card statements, phone bills
Initiated monthly reports, such as update organization charts
Maintained vendor/customer relationships, internal and external
Managed new hire process. (Logins, network access, locker, etc.)
Supported Administrative Supervisor with STD/FMLA tracking and reporting
Maintained confidentiality of internal records (personal and business)
Senior Representative
Financial Services CFS 10/2001 – 05/2004
Handled escalated customer calls for Financial Services
Managed problem resolution through effective contact handling and application of policy and procedures
Conducted offline work, which includes contacting customers regarding accounts
Assisted the Financial Service Management Team in root cause analysis and prevention of escalated calls
EDUCATION
Proviso West High School Diploma Received
American Business Institute
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