Patient Services Billing Specialist

GWENTINA FOSTER

703-***-**** • ***********@*****.*** • Herndon, VA 20171

ADVANCED MEDICAL BILLING SPECIALIST & APPEAL SPECIALIST

Highly motivated Master of Health Administration candidate specializing in Health Services Administration and seeking a challenging healthcare-related business position with a medical center / healthcare provider. Equipped with strong analytical skills, advanced knowledge of healthcare financial systems and patient services. Demonstrated understanding of healthcare data management, financial / accounting protocols, statistical analysis techniques; committed to utilizing expertise in healthcare data analysis, driving operational efficiency, and improving patient care delivery within a dynamic healthcare organization. CORE SKILLS INCLUDE:

Patient Engagement • Patient Services • Project Management • Regulatory Compliance • Data Analysis • Audits

Electronic Healthcare Records (HIPAA)• Healthcare Billing and Collections • Medical Insurance Knowledge

Reporting / Documentation • Troubleshooting / Problem Resolution • UB-92 Standards • Conflict Resolution •

Change Management • Managed Care • Blue Cross • Medicaid • Medicare • Process Improvement • Quality Review

Healthcare Operations • Procedural Development • Healthcare Informatics • Trend Analysis • Reimbursement Analysis

Technology Snapshot: MS Office • Netsmart • EPIC •Meditech • Multiple Insurance Company Payment / Benefits Portals

EDUCATION

Master of Healthcare Administration, University of Phoenix; (In Process – expected graduation 2025)

Selected Master’s Courses: Ethical Marketing, the New Healthcare Economics, Systems Thinking in Healthcare Environments, Leveraging Informatics in the Health Sector, Leveraging Results to Build Brand in the Health Sector, Scanning the Health Sector as an Industry Expert.

Special Project 1. Process Improvement: Analyzed the business and healthcare operations of a local hospital emergency room Emergency Room, providing recommendation to management about how to improve efficiencies, thereby lowering costs and improving both productivity and the patient experience.

Special Project 2: Credit and Collections: Proposed a new method to expedite collections from patient appointments within 48% of the completion of the appointment, including a 20% discount for fees paid prior to the medical consultation.

Special Project 3: Drafted a business proposal that recommended a method for changing the cost structure for telemedicine services that would incentivize the patient to accept phone consultations as opposed to having an office visit, predicting a decrease in missed / cancelled meeting by ~50%.

Bachelor of Science & Business, University of Phoenix; April 2023

PROFESSIONAL EXPERIENCE

Revenue Cycle Analyst, The Chappelle Group Remote May 2022 – Present

On behalf of a firm that identifies methods for improving organizational performance in the healthcare sector, analyze the rationale for benefits denial by insurance companies. Evaluates and updates new standard operating procedures (SOPs) as related to the research, analysis and methodologies for process denials. Handles uploading and reconciliations in the patient accounting system, payor portals and scrubber system, CMS fls, Medicare claims portal and payer websites.

Financial Counselor, TL Registrar (Part-time), Reston Hospital Center Reston, VA Dec 2021- Present

Offers both insured and uninsured patients a listing of available payment options as well as estimates for services rendered. Generates insurance verification and financial reports, coordinating efforts with case managers and department heads. Leverages eligibility systems and on-line resources to determine insurance benefits and pre-certification requirements. Maintains and updates patient files within the medical databases.

Patient Care Coordinator, Vitas Healthcare Hospice Fairfax, VA Feb 2022 – May 2022

Assumed the role as the leader of a hospice care providing team, handled admissions, discharges and other administrative functions including patient charts, discharge reporting and data collection, uploading and analysis. In addition, provided the Billing department with financial and insurance information as needed.

Financial Case Manager & Medicaid Specialist, Capital Caring Hospice Falls Church, VA July 2017 – Aug 2021

Served as Department Team lead; obtained authorizations for routine hospice and room and board. Medicaid Specialist for VA, MD and Washington, DC. Updated and informed organization of changes in Medicaid, Medicare, or commercial insurance policy and regulations; verified insurance benefits and added pay sources to system for billing purposes. Ensured patient data aligned with HIPAA privacy protocols and entered correctly in patient financial system.

Patient Account Representative, Inova Health System Falls Church, VA Jan 2008 – Jul 2017

Charged with collecting and processing patient payments and collections, and cash posting. Executed patient account reviews for insurance and third-party coverage. Managed patient claims and submitted data to the proper insurance providers; gained additional medical records or patient documentation as needed for payors.

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