Keyonna Archer

Collects and maintains up to date demographics and insurance information for all clients and alerts supervisor and additional designated staff when there is a change to insurance of any kind. Completes daily verification of insurance for all patients through web-based portals. Tracks policy renewal dates for all patients and manages renewal checks. Alert appropriate staff of renewal and communication of updated benefits. Verify insurance eligibility and benefits via phone, web-based applications, fax and documents as required. Completes documentation of

verification of benefits, financial responsibility, and Electronic Medical Records (EMR) notes.Prepares internal documentation regarding collections and financial agreements. Identifies and evaluates patients whose eligibility has failed and will work to resolve through payer websites and or contacting patients in a timely manner via telephone. I complete all assigned tasks in a

timely manner while meeting productivity and quality standards. Maintain spreadsheets for reporting and complete data entry in the clinical management and billing system. Understand and

adhere to HIPAA policies, procedures, and regulation, maintaining strict confidentiality

As Patient Financial Services Representative 3, I was responsible for the timely and accurate editing, submission, and/or follow-up of assigned claims. I process claims for multiple payer types (i.e., commercial, managed care, Blue Cross, Medicare, Medicaid, etc.) and ensure that all assigned claims meet clearinghouse and/or payer processing criteria. I ensure appropriate follow-up on assigned work lists while meeting all departmental productivity and quality review standards. Informed management of issues and potential resolutions regarding problems with the claims process. Provides support, education, and guidance to team members while performing duties, as assigned, in the absence of the supervisor or manager.

I was responsible for various reimbursement functions, including benefit investigations, prior authorization support, and call triage. I respond to all provider account inquiries, appropriately documents all provider, payer and client interactions into the CareMetx Connect system and ensures that the necessary data for prior authorization request are obtained.

• Collect and review all patient insurance benefit information to the degree authorized by the SOP of the program.
• Provide assistance to physician office staff and patients to complete and submit all necessary insurance forms and program applications. Completed and submits all necessary insurance forms in a timely manner as required by all third-party payors for prior authorizations. Track and follow up on prior authorization requests.
• Processes any necessary insurance or patient correspondence. Provides all necessary documentation required to expedite a prior authorization request. This includes demographics, authorizations and referrals, the National Provider Identification (NPI) number, and referring physicians. Coordinates with inter-departmental associates as necessary.
• Communicate effectively with payors to ensure accurate and timely benefit investigations. Work on problems of moderate scope where analysis of data requires a review of a variety of factors. I exercise judgment within defined standard operating procedures to determine appropriate action. Reports all adverse events (AE) disclosed in alignment with training and Standard Operational Procedures (SOP)

• CallCenter Representative I was responsible for the overall scheduling process for 12 urgent care locations and 5 pediatric offices.
• Sent messages to the oncall doctors, providers staff regarding any patient concerns
• Received inbound and outbound calls from patients, pharmacies and third-party vendors.
• Used Microsoft Office (Word/Excel) programs
• Handled customer inquiries and complaints
• Answered billing questions and assisted with payment services.
• Researched information, identified resources and resolved issues.