Rosa Hamilton

• Delivered technical help desk support by managing inbound calls and troubleshooting issues.
  Researched technical problems and explored solutions through phone, email, and chat.
  Provided accurate information and alternative solutions to enhance customer experience.
  Assisted customers by resolving inquiries and ensuring timely follow-up on outstanding issues.
•  Troubleshooting and Problem Solving  Ticketing Systems  Security and Firewall Configuration

● Review and verify patient information, insurance coverage, and medical codes to ensure accuracy.

● Adjudicate medical claims based on insurance policy terms, medical necessity, and regulatory guidelines.

● Validate diagnosis and procedure codes (ICD-10, CPT/HCPCS) submitted on claims for accuracy.

● Investigate and resolve claim discrepancies, coding errors, and billing issues through communication.

● Analyze claim denials and appeals, identify root causes, and take corrective actions to resubmit or appeal.

● Maintain accurate records of claims processing activities, generate reports on claim status, payment trends, and denial rates, and document audit trails for compliance purposes.

● Analyze reimbursement rates, fee schedules, and payer contracts to ensure accurate reimbursement.

● Monitor payer contracts, fee schedules, and reimbursement policies to ensure compliance.

● Manage the revenue cycle process, including claims submission, payment posting, & denial management.

● Conduct coding audits and reviews of medical claims to ensure coding accuracy.

● Track and analyze key performance indicators (KPIs) related to reimbursement.

● Provide education and training to healthcare providers and staff on coding best practices, documentation requirements, and reimbursement policies to support accurate claims submission and maximize reimbursement potential.

● Prepare and submit medical claims, invoices, and billing statements to insurance companies.

● Enter charges for medical services rendered into billing systems accurately, ensuring alignment.

● Verify insurance coverage, eligibility, and benefits for patients, confirming authorization requirements.

● Process payments received from insurance companies, patients, and third-party payers.

● Assist patients with understanding their medical bills, insurance coverage, and financial assistance options, providing guidance and support in navigating the billing process and resolving billing disputes.

• Resolving customer billing and collections issues. Key responsibilities include acting as a billing consultant, collaborating with internal teams to improve customer experience, reviewing disputes, and providing status updates. Handles customer transactions, posts transactions, and verifies cash receipts.  Payment Processing & Account Maintenance.  Handling Collections Issues/Payment Arrangement/Troubleshooting.  Documentation & Record Keeping