Support Representative Management Specialist

Deatrice Williams

Email: ***********@*****.***/********.********@********.*** Phone: 702-***-****

CAREER HIGHLIGHTS

Industry Skills: ICD-9, CPT-10, HCPCS, Medical Terminology, Medical Coding & Billing, HIPPA

Technical Proficiencies: Microsoft Office Suite, Centricity, EPIC, Cerner, AS 400, IDX, HOST, Citrix, Onbase

Customer Service Management

Performance Management

Revenue Cycle Management

Certified Revenue Cycle Representative (CRCR)

Certified Specialist Physician Practice Management (CSPPM)

EDUCATION

Masters, Healthcare Administration, University of Grantham, Arkansas, Lenexa, KS (2022)

BS, Arts and Science, Tennessee State University, Nashville, TN (2007)

PROFESSIONAL EXPERIENCE

Ensemble Health Partners, Cincinnati, OH: 2021-Present

Denial Prevention Analyst/Interim Supervisor

Utilizes multiple analytics tools to identify patterns of trends in relation to acute denials based on clinical and technical data of clients and operational areas.

Uses high-level problem-solving skills to identify root causes of denials and extrapolate those causes to large volumes of data identified as denial trends for clients.

Assist the Denial Manager in the creation of standardized denial improvements with SIPOC Diagrams

Compile the results of assessments and identify areas for improvement.

Guides and influences subject matter experts by applying improvement expertise and persuasion skills to analyze operations and prepare policies, procedures, and tip sheets that prevent future problems.

Managed multiple process improvement projects

Responsible for the design and formulation of denial decrease for several major hospitals

Identify high-opportunity areas for reduction in first-pass denials and final write-offs to accelerate accurate reimbursement and increase net revenue for clients.

Facilitate weekly and monthly denial avoidance committee meetings

Reduce denial rate from 20% over a nine-month span for leading clients for different departments

Utilizing Lean Six Sigma for training and operational purposes.

Parallon/HCA, Nashville, TN, 2015-2021

Patient Support Representative: 2021

Performing Medicaid screenings and disability screenings to determine whether a patient qualifies for Medicaid.

Managed accounts billable, retro authorizations, and troubleshoot technical issues for the department.

Involved in the preparation and analysis of reports for the emergency department, inpatient stays, and outpatient services using proprietary software.

Retro Certification Specialist, 2015-2021

Obtaining retroactive authorizations for all HCA facilities in specific states and working closely with the Department of Health.

Developed extensive relationships with the Medical Directors and Registered Nurses at various managed care entities when requesting retroactive authorization and/or appealing denial claims.

Review clinical information to ensure that documentation is appropriate for obtaining retroactive authorization for the length and length of stay.

Validated the patient’s insurance coverage and eligibility.

Developed effective working relationships with Case Managers, Provider Enrollment, claims department, and Utilization teams.

Created a confirmation protocol in order to reduce the turnaround time for retro authorization request, which reduce denial write-offs.

Vanderbilt University Medical Center, Nashville, TN 2009-2015

Infusion/Chemotherapy, Insurance Management Specialist, 2012-2015

Obtaining authorizations and verifying information on documents containing physician orders.

Provided exceptional service by collecting pertinent information from insurance companies, financial counselors, and patient assistance programs.

Registered patients, collected co-pays and payments on accounts prepared deposits, cash logs, and scanned checks. Answered phones, ordered supplies, and maintained inventory.

Utilized and applied knowledge of ICD-9, CPT codes, and EMR for indexing. Obtained insurance authorizations for office visits and procedures as needed. Investigated insurance claim status.

Assured that infusion billing processes were accurate by keeping abreast of pharmaceutical companies’ specific goals, requirements, protocols, and techniques.

Provided direct negotiation support for work-related and patient-related issues.

Contact this candidate