Detail-oriented Authorization Denial and Accounts Receivable Representative with experience in healthcare billing, prior authorizations, and insurance follow-up. Proven ability to resolve denied claims, secure approvals, and maximize reimbursement while maintaining accuracy and compliance. Strong communication, organizational, and customer service skills with a commitment to supporting revenue cycle success.
Work History
BILLING - Accounts Receivable/Authorization Denial Representative: Current Role
4 Years 9 Months
Envision Radiology | 11.2021 - Current
Contacts insurance companies to confirm claim denials, attempt retro authorizations when available, and submit appropriate claim reconsiderations in accordance with payer guidelines.
Works daily denial queues according to department directives to ensure all payer specific authorization requirements are met.
Identified authorization process issues and provided detailed denial documentation specific to insurance plans, enabling accurate reporting and improving workflow.
Documents accurately into the EMY system all actions, interactions and authorizations surrounding the insurance process for each patient.
Interfaced directly with insurance carriers to pursue claim overturns, clarified denial reasons, and ensured submission of all required documentation to support reconsideration efforts.
Verified consistency between Imagine and RIS systems, ensuring accurate patient demographics, insurance plan details, provider, facility, exam, authorization, and billing information to prevent downstream claim errors.
Created and submitted medical necessity appeals to insurance companies to ensure coverage for necessary treatments.
Provide quality customer service to all patients and customers through prompt and courteous professional communication.
Participated in peer-to-peer learning sessions to enhance knowledge and improve team collaboration.
Performed various additional tasks as assigned to support department operations and workflow.
Served as prior authorization representative, facilitating pre-approval processes for patient treatments.
Enters, updates and verifies Patient Referral Data into various systems for use by all personnel.
Reviews and verifies data entered into database to ensure accuracy.
Confirms that medical scripts and referral documentation have the correct procedures listed.
Effectively communicates with Center employees if additional information is needed to process request.
Greet patients professionally and in a timely manner
Check patients in and out
Collected co-payments and co-insurance upon patient arrival and discharge, ensuring accurate financial transactions.
Verify medical insurance
Balance deposits
Scan IDs and medical cards into EMR system
Digitally scanned patient documents into the electronic medical records system.
Monitored and responded to emails daily to ensure timely communication.
Prepared surgery estimates for orthopedic surgeons and collected deposits for upcoming surgeries, facilitating financial planning.
Check patient balances
Update patient demographics
Medical Office Assistant / Front Office Lead
Greet patients courteously.
Answers phone in a timely manner.
Verifies all patient insurance coverage at time of patient visit.
Schedules patients' appointments.
Return patients' phone calls when necessary.
Collect co pays, deductibles, and balances upon discharge of patient's visit
Orders office supplies and maintains DME inventory.
Maintained and balanced petty cash drawer and log, supporting accurate financial tracking.
Brings deposits weekly to the bank.
Scan IDs, insurance, paperwork into EMR system.
Submits invoices to manager.
Coordinated and scheduled follow-up appointments for patient care..
Scans in daily deposits and puts total on monthly spreadsheet.
Medical Office Assistant/Tech
1 Year 1 Month
Dr. Thom Dinh OD, LLC | 06.2015 - 07.2016
Front office receptionist:
Greet patients professionally
Retrieved patient charts from storage
Scheduled patient appointments to optimize office workflow and enhance patient experience
Collects co pays, deductibles, and balances upon discharge of patient's visit
Verify medical, vision insurance and patient charts prior office visit
Update patient information (Scans IDs, patient information, insurance cards)
Performed filing and faxing of documents
Collects co-pays, deductibles, and balances upon discharge of patient's visit
File medical and vision insurance
Pre-test patients
Conducted preliminary tests for patients before appointments
Unit Secretary
7 Months
Lafayette General Medical Center | 11.2014 - 06.2015
Answered multiple phone lines, ensuring timely communication with patients and staff
Answer Multiple phone lines
Managed patient room notifications
Paged doctors for urgent matters
Restocked supplies on the floor
Check e-mail daily
Called in consults to multiple physician offices, coordinating patient referrals effectively
Reviewed and responded to emails daily
Cut and attached EKG strips to patient charts
Receptionist/Optometric Tech
7 Months
Target Optical | 04.2014 - 11.2014
Front office representative:
Managed incoming phone calls
Set Up appointments
Verify Insurance
Collected payments to ensure accurate financial transactions and maintain records
Performed various administrative tasks
Sell Contact Lens
Teach patients how to insert and take out contacts
Instructed patients on contact lens insertion and removal for proper usage and care
Conducted preliminary patient assessments
Education
Diploma
Teurlings Catholic High School
Bachelor's - Child Development
Walden University | 01-2016
Skills
Billing
Insurance Verification
Clerical support
Child development
Revenue Cycle Management
Documentation review
Medical Office Experience
Medical office management
Front desk
Clerical experience
Scheduling
Medical receptionist duties
Document management
Client service
Customer relations
Customer support
Patient Education
Insurance Billing
Patient Care
Healthcare Billing
Supervising experience
Staff training
Laboratory Experience
Hospital Experience
Sales
Retail sales
Experience with Children
Childcare
Special Education
Autism Experience
Terminology
Ophthalmology
Computer skills
Claims Resolution
Process Improvement
Client relations
Data entry
Community Service
YMCA Of Acadiana, Camp Counselor, 2008-08, 2014-04, After care camp counselor, Assist students with homework, Monitor students, Activities
Lafayette Parish School System, Teacher Assistant/Clerk (Green T. Lindon Elementary), Youngsville, LA, 2008-08, 2014-04, Assist Teacher in an autistic classroom, Fill in for office clerk when absent, CPR certified, First aid Trained, CPI Trained, Medicine Trained, Clerical duties when needed
Timeline
BILLING - Accounts Receivable/Authorization Denial Representative: Current Role