United States
Highly skilled essential for interacting with patients, ensuring a positive experience. Knowledge of CMS guidelines, ICD-9/10 coding, and accreditation are all specific to the healthcare industry and demonstrate expertise in medical billing, coding, and regulatory compliance. Creating and overseeing goals related to company spend and patient volume falls under the purview of management, focusing on financial performance and operational efficiency. Communicating goals and creating scheduling procedures highlight leadership qualities and the ability to organize and motivate a team.
Responsible for analyzing and managing hospital reimbursement under the Prospective Payment System (PPS), ensuring accurate billing, compliance, and optimal revenue capture. Reviews patient accounts, coding, and payer guidelines to confirm proper reimbursement based on DRGs (Diagnosis-Related Groups) and federal/state regulations. Works closely with billing, coding, case management, and finance teams to identify discrepancies, resolve claim issues, and improve reimbursement outcomes. Monitors payer trends, audits claims for accuracy, and ensures compliance with Medicare, Medicaid, and commercial insurance policies. Assists with appeals, denials management, and reporting to support revenue cycle performance. Uses data analysis to identify opportunities for process improvement, reduce revenue leakage, and support financial goals of the organization.
Provided high-quality customer support to members, providers, and clients regarding benefits, eligibility, and claims. Handled a high volume of inbound calls, resolving issues efficiently while maintaining accuracy and professionalism. Explained plan benefits, processed inquiries, and assisted with claim status updates and discrepancies. Maintained detailed documentation of all interactions and ensured compliance with company policies and HIPAA regulations. Collaborated with internal departments to resolve complex issues and improve overall member satisfaction.
Supervised daily operations of front-end patient services, including registration, scheduling, and check-in/check-out processes. Led and supported a team to ensure efficient patient flow, excellent customer service, and accurate data collection. Trained, coached, and evaluated staff performance while ensuring adherence to organizational policies and patient confidentiality standards. Resolved escalated patient concerns and worked collaboratively with clinical and administrative teams to improve workflow and patient experience. Monitored productivity, implemented process improvements, and ensured compliance with insurance verification, authorizations, and billing requirements.
Provided administrative support to leadership and departmental teams, ensuring smooth daily operations and efficient workflow. Managed calendars, scheduled meetings, coordinated travel arrangements, and prepared reports, presentations, and correspondence. Maintained accurate records, handled data entry, and supported project coordination while ensuring deadlines were met. Assisted with organizing audits, meetings, and compliance-related documentation, particularly in support of healthcare quality improvement initiatives. Acted as a point of contact for internal staff and external stakeholders, demonstrating strong communication and organizational skills. Ensured confidentiality of sensitive information and compliance with HIPAA and company policies.