Billing Specialist Revenue Cycle
Resume:
Christine I. Hamilton
Atlanta, GA ***.***. **** ********@*****.***
Dedicated and highly skilled Medical Billing Specialist with over 20 years of experience in medical coding, billing, and reimbursement processes across a variety of healthcare settings. Proficient in handling complex billing systems, insurance claims, and patient accounts with a strong focus on accuracy, compliance, and timely payments. Expertise in ICD-10, CPT, and HCPCS coding, as well as managing denials, appeals, and collections. Exceptional problem-solving abilities and a keen eye for detail, ensuring maximum revenue cycle efficiency. Known for building strong relationships with healthcare providers, insurers, and patients, while maintaining a comprehensive understanding of evolving healthcare regulations. Committed to continuous professional development and contributing to organizational success through process improvement and quality assurance.
WORK EXPERIENCE
Northside Hospital 02/2022 - Present
Refund Specialist / Patient Billing
Responsible for processing payor correspondence, refund requests, and pricing agencies.
Ensure correct reimbursement rates based on current client contracts and respond to payor requests in a timely manner.
Utilize knowledge of the revenue cycle and patient accounts to maximize productivity.
Abide by and promote HIPAA compliance at all times.
Contact insurance companies to follow up on correspondence and refund requests.
Hold payors accountable for timely response and resolution of all correspondence.
Utilizes/reviews account information from all available sources; online data, hard copy reports, referral forms, UB/HCFA and EOBs to fully discuss conditions with the payor.
Refers accounts to the appropriate departments for necessary actions including balance transfers, coding review, remit posting, etc.
Maintains appropriate and accurate system documentation with notes and standard note codes.
Designed a monthly report of departmental trends and denials for leadership.
Change Healthcare 04/2019 - 01/2022
Reimbursement Specialist / Patient Services II
Handled patient and insurance inquiries associated with patient accounts, including identification and resolution of billing discrepancies.
Managed account inquiry communication with inbound and outbound guarantors/patients, or insurance companies.
Managed self-pay, insurance receivables, and related client payments.
Managed accounts receivable to optimize cash flow to meet organizational goals and objectives.
Established budget plans and payment arrangements within company guidelines/policies.
Documented all account follow-up activities in the CHC Workflow tool.
Handled escalation calls/accounts to ensure both patient and client satisfaction.
Resolved and appealed claim denials and rejections.
Identified and reported all billing, system, and collection issues and trends to leadership.
Training and mentorship for all newly hired Specialists.
Managed daily upkeep of Artiva physician portals to maintain up-to-date patient information, appointments, and insurance data.
PruittHealth 04/2008 - 04/2019
Executive Assistant
Coordinated the admission, transfer, and discharge of patients.
Managed pre-admission and admission process including insurance and financial pre-verifications.
Managed cross-departmental communication with all associated departments and teams regarding new admissions.
Managed partnerships with third-party patient advocacy and support agencies.
Patient/family support and education on long-term care, advance directives, Medicare, Medicaid, private pay, and third-party reimbursement.
Managed plan of care and services dependent on State conducted pre-admission data.
Initiated the development of facility policies and procedures to ensure medical records were complete, organized, accessible, and compliant with applicable record retention laws.
Managed closed records maintenance process.
Managed request for authorized access to medical records
Partner issue management including payroll and benefit eligibility, open-enrollment, communication materials.
Managed benefit enrollment data and changes to PeopleSoft HRIS.
BIOSCRIP, INC. 04/2013 - 09/2014
Regional Reimbursement Specialist
Walgreen Infusion 04/2011 - 02/2012
Regional Reimbursement Specialist
EDUCATION & CERTIFICATIONS
OmniTech Institute, Medical Billing/Coding Certificate
DeVry University, Bachelor of Science, Business Administration
SKILLS
Data Management, Analytical,Documentation Management, Medical Records, Medical Terminology, Medical Claims Resolution, Insurance Verification, Insurance Benefits, Customer Service, Accounts Receivable, Accounts Payable, Collections, Microsoft Suite, AS400, Centricity, Med-Metrix, MedFM, MedMatrix, Legacy, Laserfiche, Medisoft, Emphysis, Zirmed, Wells Fargo LB, Patientco, Waystar, PeopleSoft, Artiva, EPIC, IDX, Global Transport Payment Solutions, LTC, CPT/ICDCM/HCPCS
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