Follow Up Patient Access
Resume:
Nooria Hussain
*************@*****.***
******.*******@***************.***
Objective
My goal is to become associated with a company where I can utilize my skills and gain further experience while enhancing the company’s productivity and reputation.
Professional Summary
I have extensive knowledge in the area of claims resolution. Area of expertise is government and non-government health coverage products such as traditional Medicaid. Also experienced with commercial Health Plans. Trained to maintain a high level of service to patients and operate according to HIPAA guidelines.
Skill Highlights
Health Quest, Microsoft word, Excel, all MCO web portals, Availity, Medicare, chart- Maxx prod 7.0 Cisco Jabber 12.5, Health- Ques, Office 365 Outlook, Office 365 word, office 365 Teams, workday, IAR, EPIC, Atlas, Business object, RA Relay Assurance soft Med system, Telligent, self- directed, time management professional and mature, strong problem solver, resourceful, claims appeal procedures, insurance eligibility verifications,In-dept claims knowledge, Understanding of Medical and insurance terminology, Compliance, Law Ethics(HIPAA), following up on claims and appeals, leadership skill as supervisor,Support the missin,vision,and values of the organization, treat others and their ideas with respect.
Accomplishments
Employee of the month
High claim payment records
Complimentary feedback from patients
High claim payment outcomes
Received awards Certifications of appreciation
Been complimented by Managers & Directors
Worked on special projects
AAHAM CRCS-I Certification August 31, 2017
Professional Hospital Experience
October 2020- to Current Trinity PBS
Technical Denial Management Specialist II
Sole responsible of all first and second levels of appeal with extensive knowledge of all insurance payers-resubmit all claims denied due to technical reasons follow up on all claims denied for clinical reason - Ensure follow-up of on denied claims occur on a timely basis and adheres to contractually binding conditions
Ensure all clinical denials assigned to clinicians, Patient Access and or HIM denial staff are acknowledge in a timely manner and appropriate follow up action taken as defined by the respective policy-collaborate with other departments payer teams UR to assist with timely filling
Reviews, research, and resolves payment delays and or variances resulting from rejected and or denied claims, overpayments, and underpayments.
Processes payments as appropriate in accordance with contracts and policies to ensure that all potential liabilities are paid in a timely and accurate fashion.
Resolves claims, conducts formal accounts reviews, identifies lost charge recovery, and analyzes and documents delays and payment variances.
Identifies systemic issues and either resolves or escalates to supervisor payment resolution for resolution.
Assisted in training payment Resolution Specialist I colleagues upon hire
Resolved problems on issues as needed.
Investigated and addressed overpayment and under payment
Ensured that all claims are paid settled in the timeliest manner possible
Coordinates follow up activities with Utilization review case management coding nurse liaison to provide required clinical support, as well as to ensure timely follow up and action for account appeals
Worked with patient Access and other necessary parties to resolve account authorization issues
Daily review of denials and payment discrepancies identified in denial Trac/ RWS system fed by 835 files, manually posted R/A'S EOB'S, or payer Correspondence
Tracks and documents all denials by payer, visit type and denial category.
Review patient medical records and utilize clinical and regulatory knowledge and skills as well as knowledge of payment requirements to determine why cases are denied and whether an appeal is required-effective interpersonal skills with the ability to maintain a self-directed and professional approach to completing daily duties.
Works with the payers to understand specific reasons for denials and preventable measures available to prohibit future denials.
Accesses and updates payer websites for eligibility and claims status and holds confidential all passwords obtained through the various payer sites.
Meets quality and productivity standards and deadlines established by management.
Extensive knowledge of third-party billing and payment mythologies.
Ability to prioritize and multi-task.
Perform other duties as assigned by Manager
August 23, 2014 -10-01-2020 Holy Cross Health Hospital Silver Spring MD Supervisor
Sole responsible of all second and third levels of appeals & grievances complain with extensive knowledge of all insurance payers both Government & non-Governmental, WC& PIP.
Resubmit all claims & appeals denied due to technical reason and follow up on all claims denied for clinical reason. Collaborate with other departments (payer teams UR) to assist with Timely Filling of Appeals.
Ensure follow-up of on denied claims occur on a timely basis and adheres to contractually binding conditions Daily review of denials and payment discrepancies identified in denial RWS system fed by 835 files, manually posted R/A'S EOB'S, or payer Correspondence
Assisted Managers and Director including complaint management which addresses the needs of the hospital internal and external customers.
Effective interpersonal al skills with the ability to maintain a self -directed and professional approach to completing daily duties. Ability to prioritized and multi-task, problem-solving skills & strong supervisory and team leader experience.
Manages numerous projects within time constrains and work with other department of Revenue cycle identifying and troubleshooting any technical issues to endure timely filling.
Reviewed and analyzed any past due amounts using aged Accounts receivable reports including both patient and insurance Accounts.
Assisted with team coverage and provided support when needed and performs technical duties of all staff and customer service.
Performed other duties as assigned by managers and directors.
April 18, 2005- August 22, 2014 Med Star Montgomery Medical Center
Patient Account Representative
Prepares and submits hospital and hospital-based physician claims to third party
Insurance carriers either electronically or by hard copy billing
Follow up with third party insurance carriers on unpaid claims until claims paid only self-pay balance remains
Processes all late charges, adjustments, allowances on assigned accounts, subject to Supervisory approval
Identifies missing requirements of submitted claims and aggressively follow-up on unpaid accounts.
Works with physician or medical record staff to ensure that correct diagnosis procedures reported to third party insurance carriers
Knowledge and expertise to navigate Medicare claims system including working suspended claims timely
Participates on inter-departmental teams and committees, communicating unit Team Lead in training all new staff on how to use the billing/collection systems
Provides department/unit with information and knowledge acquired during participation with interdepartmental teams and committees
Answers telephone queries and complaints
December 2002- November 2004 St. Joseph Wayne Hospital & Paterson Regional Center, NJ
Clinical & AR Technical
Self-pay Account. Follow up on all inpatient and outpatient accounts
Answer patient and insurance inquiries by phone or correspondence
Responsible for merging letters and printing statements analyze the medical
records of discharges patients and placed it in their charts
Process Transaction Report
Perform other duties as assigned by senior manager and assistant manager
Collected, tested, analyzed and labeled samples
Followed EPA &OSHA mandates to endure the proper, safe disposal of hazardous sample and waste
Assist hospital physicians in the diagnosis and treatment of illnesses, injuries and medical conditions by providing clinical testing and specimen analysis
Perform other duties as assigned by senior manager and assistant manager
Education
Majoring Medical Laboratory Technology Degree 1993-1995
Dover B College, Dover, New Jersey, Medical Assistant Certificate Summer of 1997
High School Diploma Parsippany Hills High School Graduated 1992
AAHAM CRCS-I (Ex CPAT) Certification August 31, 2017
Certificate of Training first Receiver-Operations June 7, 2012
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