Front Desk Insurance Coverage
Resume:
CHARMIRA WILLIAMS
Chicago, IL 60624
*********@*****.***
PROFESSIONAL EXPERIENCE
Illinois Cancer Specialist Chicago, IL January 2025-Current
Patient Benefit Rep
Prior to a patient receiving treatment, obtains insurance coverage information and demographics; educates patient on insurance coverage, benefits, co-pays, deductibles, and out-of-pocket expenses.
Assess patients’ ability to meet expenses and discusses payment arrangements. May educate patients on financial assistance programs as well as identify sources and provide assistance with completing forms. Based upon diagnosis, estimated insurance coverage, and financial assistance, completes Patient Cost Estimate form.
Completes appropriate reimbursement and liability forms for patient’s review and signature. Forwards appropriate information and forms to billing office.
Responsible for obtaining, from Clinical Reviewer, insurance pre-authorization or referral approval codes prior to each treatment.
Review patient account balance and notify front desk of patients to meet with
Ensure that patient co-pay amount is correctly entered into system (or conveyed), allowing front desk to collect appropriately
At each patient visit, verifies and updates demographics and insurance coverage in computer system according to Standard Operating Procedures (SOPs).
Stays current on available financial aide. Develops professional relationships with financial aide providers. Networks with financial aide providers to obtain leads to other aide programs.
Adheres to confidentiality, state, federal, and HIPPA laws and guidelines with regards to patient*s records.
Maintains updated manuals, logs, forms, and documentation. Performs additional duties as requested.
Other duties as requested or assigned.
Nephrology Associates of Northern IL Oakbrook, IL August 2024-December 2024
Account Representative
Insurance Claim Service: Partners with third-party health insurers to ensure timely and complete payments of outstanding insurance claims. Coordinates and process payments from insurance carriers and troubleshoots any issues related to these payments. This involves properly documenting claim files, requesting reports and records, reviewing medical bills and A/R reports, and engaging in regular telephone and internet communications with third-party payers to discuss claims.
CLAIM STATUS MANAGEMENT: Monitors status of insurance claims pending payment by accessing various insurance portals. Corrects and resubmits claims to payers as necessary and notifies the billers of claim errors. Identifies payer trends and notifies managers of negative trends.
CLAIM APPEALS: Processes timely appeal of denied, rejected, or delinquent insurance claims taking into consideration established insurance deadlines. Familiarity with complex claims denial reasons and how to appeal the denials (i.e., denials due to medical necessity, bundled/global codes & procedures, inappropriate reimbursement per contracted fee schedule, insufficient documentation, etc.). Resolves denials or partially paid claims through interaction with insurance carriers, patients, hospitals, dialysis units or physicians.
DATA AND INFORMATION MANAGEMENT: Maintains accurate records and information, including preparing, generating and reviewing reports. Updates data discrepancies identify in reports and systems. Accurately documents pending and completed work activities using appropriate systems.
USA VEIN CLINICS, Northbrook, IL March 2024 - July 2024
Revenue Cycle Supervisor
Was responsible for the direct supervision of the staff within the department of the corporate office.
Managed patient billing and insurance claims.
Created and ran reports.
Identified lost revenue.
Analyzed data.
Implemented revenue cycle management strategies to minimize losses.
Worked with the collection agencies.
Posted adjustments on the accounts.
UI HEALTH, Chicago, IL December 2023 - March 2024
Transplant Billing Specialist
Worked on complex accounts.
Bundled transplant cases to payers for payment.
Worked on accounts that were underpaid.
Worked on assigned payer projects as directed.
UNITEDHEALTH GROUP, Chicago, IL/Remote June 2023 - December 2023
Credit Balance and Refund Specialist (Contract)
Effectively managed credit balance workloads.
Responded, resolved, and followed up on external and internal inquiries in a timely manner.
Processed refunds in credit balances to maintain positive accounts.
Worked on accounts out of Epic.
PRACTISYNERYGY, Des Moines, IA/Remote November 2022 - May 2023
Medical Billing Specialist
Researched any claims with no response from the payer to determine status of claim - notified the team lead if the explanation of benefits was not available from software or client.
Determined if the appropriate payment had been made by various entities.
Performed denial management, researched, and obtained proper documentation to support resolution of overpayments; resolved credit balances and resolved outstanding accounts receivable by interacting with third-party entities via websites.
Worked through insurance accounts receivable, utilizing reports to identify trends.
Understood and utilized LCD policies and commercial payer billing guidelines to ensure claims were accurate prior to submission.
REVCO SOLUTIONS, NE/Remote May 2022 - October 2022
Medical Insurance Follow-Up Specialist
Analyzed, reached, and prepared insurance claims for submission to payers (Commercial and Government).
Responded to inquiries, billing denials, and other communications.
Met production requirements by working accounts according to management specifications.
Attached the necessary documentation when mailing claims to the payer.
Made telephone inquiries according to policy on delinquent claims.
HEALTH BUSINESS SOLUTIONS, Cooper City, FL/Remote August 2020 - April 2022
Denial Recovery Specialist
Generated an appeal based on dispute reason and contract terms specific to the payer to include online reconsideration.
Validated denial reasons codes via remittance inquiries or art codes.
Worked to final resolution for aged greater than 90 days from the date of services.
Ensured coding was reviewed/corrected as necessary for resubmitting denied claims for payment.
Worked on assigned payer projects as directed.
Demonstrated commitment to organizational Values of Compassion, Trust, Respect, Teamwork and Innovation.
Performed research and tracked trends of accounts worked to create process improvement for trends identified related to user, system, and payer-related issues.
Escalated exhausted appeal efforts for resolution.
Followed specific payer guidelines for appeal submission.
LOYOLA HOSPITAL, Westchester, IL June 2019 - July 2020
Physician Billing Denials Representative (Contract)
Investigated and resolved insurance denials.
Collected outstanding insurance balances and identified other payers.
Performed appeals and reviews according to assigned payer’s guidelines.
Completed notes in Epic and IDX identifying invoices and claims denial information (specifying CPT and Diagnosis codes as needed).
Billed secondary payers or transferred to patient responsibility.
EDUCATION AND CERTIFICATIONS
COLLEGE OF OFFICE TECHNOLOGY
Certificate, 2012
ROBERT MORRIS UNIVERSITY
Associate Degree of Applied Science in Business Administration, 2001
SKILLS
ICD-10, ICD Coding, HCPCS
Medical Terminology
Medical Records
Epic, AllScripts, Cleo, IknowMed, Acumen, MediTech
Revenue Cycle Management
Accounting
Analysis Skills
Customer Service
EMR Systems
Management
Contact this candidate