Breon Terrance
Lafayette
Summary
Reimbursement Variance Appeal Specialist with extensive experience in claims processing and insurance verification at Schumacher Clinical. Demonstrated success in enhancing revenue cycle management through effective communication and appeal strategies. Expertise in medical billing, regulatory compliance, and client advocacy, resulting in improved efficiency of appeals processes. Strong negotiation and conflict resolution skills contribute to fostering positive client relationships and maintaining industry knowledge.
Overview
18
18
years of professional experience
Work History
Reimbursement Variance Appeal Specialist / Medical Billing Team Leader
Schumacher Clinical
01.2017 - Current
- Apply fundamental knowledge of billing, codes, authorizations, and payer requirements.
- Researching and identifying variance payments on different insurance for payments, configure insurance denials to assure payment, multitask and effective communication between insurance.
- Inbound and outbound calls, verifying active/inactive insurance, upfront collections and EOB explanations, multi-task, office duties, explaining invoice details, handle a high volume of complex calls.
- Reviewed and processed appeals for insurance claims with attention to detail.
- Collaborated with clinical teams to gather necessary documentation for appeals.
- Communicated with insurance providers to clarify appeal requirements and procedures.
- Trained new staff on appeal processes and regulatory compliance standards.
- Analyzed case files to identify issues impacting claim approvals and denials.
Account Receivable Specialist
Adreima
05.2016 - 02.2017
- Provides financial administrative and clerical services to ensure accuracy and efficiency of operations, processing and monitoring incoming payments and securing revenue by verifying and posting payments and Account follow-up and/or grievance preparation of assigned Client Hospital, appeals for denied services, serve as a liaison to clinical auditors, other team members, hospital staff, government agencies and health plans to facilitate the appropriate and prompt payment claims.
Business Dept- Surgery (check in desk)
Park Place Surgical Hospital
07.2014 - 10.2015
- Updating insurance and demographic patient information, preparing surgery charts with signed consents and paperwork, updating family members, and communicating effectively with Surgery Doctors, perform all office duties.
- Completed day-to-day duties accurately and efficiently.
- Worked successfully with diverse group of coworkers to accomplish goals and address issues related to our products and services.
- Provided excellent service and attention to customers when face-to-face or through phone conversations.
Patient Account Rep II (Billing for St. Martin Hospital)
Lafayette General Hospital
07.2013 - 07.2014
- Business billing and communicating between insurance and patients to get needed information for clean claim processing, effective A/R worker, calculating discounts for adjustments on bills and investigating claims for payments, appeals for in and out of network office duties maintaining accurate documentation on research and abide by all HIPPA violations.
Eligibility Specialist/ Financial Intake
LHC Group
06.2010 - 08.2012
- Verifying insurance, obtaining authorization, and determining in and out of network for Home Health Services, setting up the correct payers for bill to drop and maintaining a high workload, perform all office duties and reception duties, Appeals for home health.
Patient Access Registrar
Women's and Children Hospital
01.2008 - 06.2010
- Registration, perform all office Duties, Insurance Verification, appeals for denied services for therapy and other medical services, Work Departments: Main Hospital, ER, Lab, Rehab Dept, PT/OT/ST Dept, etc.
- Registered patients and collected necessary information for healthcare services.
- Processed medical records and maintained confidentiality of sensitive information.
- Managed patient inquiries and provided assistance with registration processes.
- Provided support to other departments within the organization such as billing or collections when needed.
Education
General Studies, Business/ Bus. Management
University of Louisiana At Lafayette
Lafayette, LA12.2006
Some College (No Degree) - Billing And Coding
Baton Rouge Community College
Baton Rouge, LASkills
- Accounts receivable specialist
- Medical billing
- Patient access registration
- Medical insurance filing
- Claims processing
- Healthcare authorization
- Verification processes
- Bookkeeping
- Upfront collections
- Data entry
- Customer service
- Microsoft Office applications
- Word, Excel, PowerPoint, Outlook
- QuickBooks, Peachtree, and Advantx
- Meditech, Salesforce, Centricity
- IDI
- Medical coding
- Freehand
- Fountain Blue Management System
- Multiple Software Systems
- Appeal management
- Insurance verification
- Quality assurance
- Revenue cycle management
Timeline
Reimbursement Variance Appeal Specialist / Medical Billing Team Leader
Schumacher Clinical
01.2017 - Current
Account Receivable Specialist
Adreima
05.2016 - 02.2017
Business Dept- Surgery (check in desk)
Park Place Surgical Hospital
07.2014 - 10.2015
Patient Account Rep II (Billing for St. Martin Hospital)
Lafayette General Hospital
07.2013 - 07.2014
Eligibility Specialist/ Financial Intake
LHC Group
06.2010 - 08.2012
Patient Access Registrar
Women's and Children Hospital
01.2008 - 06.2010
General Studies, Business/ Bus. Management
University of Louisiana At Lafayette
Some College (No Degree) - Billing And Coding
Baton Rouge Community College