CYNTHIA NASH

Maricopa, AZ 331-***-**** adux0w@r.postjobfree.com

MEDICAL SUPPORT SPECIALIST

Knowledgeable, customer service oriented Medical Support Specialist with 14 years’ experience in the healthcare and insurance industries. Kind and patient with strong troubleshooting skills and experience in:

Scheduling

Registration / Patient Access

Revenue Cycle

ICD 9 and CPT Coding

Commercial Payer Billing

Medicaid Billing

Prior Authorization

Coordination of Benefits

Medical Terminology

Managed Medicaid Billing

Medicare BFD Billing

Durable Medical Equipment

TECHNICAL SKILLS

Epic RCM TCS RTA CMS Reporter CCMIS HC360 MedMetrix Epremis Revenue Recovery

EXPERIENCE

CVS Health Corporate 2016 – 2022

Senior Lead Coordinator SME Medical Support Specialist QA Senior Billing & Billing Specialist

Executed internal Quality Audit reviews, monitoring billing trends, providing feedback and education based on results, Counseling upper leadership on recommendations

Conducted targeted review identifying payer issues & made appropriate recommendations to leadership

Implemented operational process improvements

Led orientation, initial, and ongoing training

Assigned projects and tracked and distributed results; Co-Led team meetings/huddles

Collaborated with the Medicare Consultant to update the billing grids and pull fee schedules as member of the Medicaid Support Specialist Team

Provided expertise on Revenue Cycle & billing for Commercial payers, Medicaid, Managed Medicaid, and Medicare BFD

Considered the go-to person with the problem-solving ability to complete the billing of more difficult or problematic claims; Contacted payers as required in-order to resolve claim rejections

Offered recommendations to leadership after identifying and reviewing payer issues

SIMONMED IMAGING Prior Authorization Specialist & Scheduler 2015 – 2016

Reviewed & inputted insurance information for authorizations & referrals prior to Patient Services

Reviewed documentation from the referring physician to meet the needs of the payee

Verified diagnosis codes for patient billing was accurate and reimbursable / payable

Cooperated with patients’ insurance companies to pre-certify / authorize CT/MRI procedures

Scheduled CT / MRI procedures, balancing patient & provider needs, adjusting schedules as necessary

Provided patients with care instructions to follow prior to the procedures

PROTECTIVE LIFE Tele-Life Representative I & II 2012 – 2015

Completed client interviews, verified information supplied by a licensed agent and documented additional information such as health history and lifestyle questions

Enhanced process improvements, simplifying current processes & procedures in daily workload manual

Trained and coached new hires

Handled problematic calls and projects

ADVOCATE HEALTH CARE Patient Access Specialist 2008 – 2012

Executed registration process in accordance with HIPPA, State, Federal, Hospital & Department policy

Collected, analyzed & recorded demographic, insurance, financial & clinical data

Contact this candidate