Accounts Receivable High School
Resume:
EMPLOYMENT HISTORY
JAN **** - PRESENT
CSR Consultant, Salem Solutions (Triwest), Arizona City, AZ
JAN 2024 - JAN 2025
Specialty Referrals Specialist, Health Net Federal Services (HNFS), Tampa, FL FEB 2018 - DEC 2023
Accounts Receivable Specialist, Sonic Healthcare, Austin, TX EDUCATION
AUG 1990 - JUN 1995
High school diploma, Anderson High School, Austin, TX Montgomery, US, 77316
*****.**********@*****.***
DIANA HAYES
MEDICAL B I LLING SPECIALIST
PROFESSIONAL SUMMARY
Medical Billing Specialist with over 7 years of experience and a strong foundation in medical insurance, specializing in accounts receivable, specialty referrals, and authorizations. Proficient in Microsoft Office and HIPAA compliance, with a focus on enhancing customer service and maintaining meticulous data integrity. Committed to fostering seamless communication between providers and members, driving efficient healthcare processes and improving customer satisfaction.
Handle member inquiries on referrals and claims, ensuring accurate information and solutions. Maintain HIPAA compliance while documenting cases, enhancing data integrity and security. Resolve issues on first contact, improving customer satisfaction and service efficiency. Participate in ongoing training, staying updated on industry standards and best practices. Managed high-volume inbound healthcare inquiries with precision, ensuring accurate documentation and resolution tracking in CRM while maintaining HIPAA compliance
Provided comprehensive support to ADSM members and families, addressing complex healthcare matters including referrals, authorizations, and claims status inquiries
Analyzed and processed healthcare authorization requests, ensuring thorough evaluation while maintaining strict adherence to compliance standards Process referrals, ensuring guideline adherence; maintain detailed records for accuracy. Manage member and provider communication, improving authorization efficiency. Verify eligibility and benefits, facilitating accurate authorization procedures. Assess treatment requests, assign billing codes; enhance documentation accuracy. Coordinate with healthcare providers, ensuring timely and precise information exchange. Maintained comprehensive documentation of referrals and authorizations, strengthening data integrity and facilitating seamless care coordination between providers
Orchestrated effective communication channels between members, physicians, and specialists, improving care coordination and reducing authorization delays Streamlined eligibility verification processes through systematic benefit reviews, enhancing authorization accuracy and reducing processing time Facilitated seamless care transitions by coordinating with healthcare providers, ensuring timely information exchange and proper documentation of patient care requirements
Analyze data to resolve account issues, ensuring swift payment collection. Maintain strong customer relationships, enhancing payment compliance. Generate comprehensive reports to monitor account statuses effectively. Handle calls to verify patient eligibility, ensuring accurate billing. Process payments with billing software, ensuring regulatory compliance. Analyzed complex billing data and resolved account discrepancies through systematic investigation, ensuring accurate revenue capture and reduced payment delays
Maintained meticulous compliance with HIPAA regulations while processing sensitive patient information, safeguarding data integrity and organizational security
Fostered strong relationships with healthcare providers and insurers through proactive communication, facilitating smoother payment processes and reduced aging accounts
Implemented enhanced reporting procedures for account tracking, enabling better visibility into collection trends and informing strategic decisions SKILLS
Microsoft Outlook CPT Coding
Customer Service Microsoft Word
Medical Billing Medical Office
Customer Retention Accounts Receivable
Microsoft Excel Data Entry
Organizational Skills Microsoft Office
Communication Skills HIPAA Compliance
Time Management Attention to Detail
Problem Solving Data Entry
Medical Terminology
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