Tracy Edobor
Baltimore
Summary
Seasoned Revenue Specialist with solid background in finance and accounting. Demonstrated track record of maximizing revenue growth, reducing costs, and improving operational efficiency. Well-versed in financial forecasting, budgeting, and financial analysis. Skilled at identifying revenue opportunities and implementing strategic initiatives to drive profitability. In previous roles, consistently improved financial performance through development of strong customer relationships and implementation of innovative strategies.
Overview
22
22
years of professional experience
1
1
Certification
Work History
AR Revenue Specialist
Johns Hopkins University
Middle River
06.2021 - Current
- Follow up with insurance companies on overdue balances.
- Monitor accounts from assigned work ques on a daily regimen.
- Research and implement effective collection techniques.
- Contact insurance companies by telephone for claim status and denials.
- Resolve insurance and patient balances.
- Update and notate patient account following each phone call.
- Print explanation of benefits to send to insurance companies.
- Process Maryland Medicaid Claims with accuracy.
- Review contracts to ensure compliance with company policies.
- Streamline invoicing procedures to enhance accuracy and efficiency.
- Analyze patients accounts for discrepancies and resolved issues promptly.
- Review invoices for accuracy prior to payment processing.
- Monitor competitors' activities in order to stay ahead of the competition.
Account Receivable Biller/Collections
Aerotek Temporary Job Agency
Nottingham
05.2019 - 06.2021
- Reviewed unpaid accounts to determine status and appropriate action required from workflow generated from practice management systems.
- Documented follow-up appropriately in practice management systems.
- Received, reviewed, researched and responds to correspondence from insurance companies and patients.
- Utilized facility correspondence websites, phone and/or correspondence to contact payers regarding reimbursement for unpaid accounts.
- Researched and follow-up on denials and requests for additional information utilizing the denial management reports and correspondence.
- Collaborated with management to identify payer trends and non payment issues.
- Contacted providers as needed to collect appropriate information or to collect patient balances.
- Identified and verified adjustments that need to made to accounts and follow-through with requests and documentation.
- Ensured services level and timely productivity requirements are met.
- Maintained positive working relationships with internal and external customers by providing superior customer service.
- Utilized Medical and Billing Terminology.
- Adheres to Clean Claims Act and HIPAA policy and procedures.
Medical Claims Processor
Versant Health
Baltimore
03.2016 - 03.2019
- Efficiently and effectively processed a large volume of medical claims on a daily basis.
- Based the payment or denials of medical claims upon well-established criteria for claims processing.
- Reviewed administrative guidelines whenever questions arose during the processing of claims.
- Stayed current on HIPAA regulations, benefits claims processing, medical terminology, and other procedures.
- Researched and resolved claim status inquiries contingent to members benefit guidelines.
- Reviewed and completed daily check run, action code, and open age reports.
- Efficiently and Accurately input Coordination of Benefits on a daily regimen.
- Recouped and reconciled overpayment's based upon providers requests.
- Adjudicated prior authorizations approvals for plans from a daily report.
- Responded and resolved provider and member inquiries via Uniflow.
- Launched and completed mandatory training related to all aspects of the company.
- Inputted data into the system, ensuring that provider coding information and reported services were correct.
- Reviewed medical claims for accuracy and completeness.
- Processed claims using advanced software and tools.
- Coordinated with healthcare providers to resolve claim issues.
- Analyzed claim data to identify trends and discrepancies.
- Documented claims processing procedures for team reference.
- Maintained compliance with industry regulations and guidelines.
- Verified accuracy of provider data entered into the system including tax ID numbers, NPI numbers, address changes .
Patient Billing Representative
Baltimore Washington Eye Medical Center
Glen Burnie
08.2015 - 01.2016
- Reviewed and posted patients credit card and check payments with efficiency and accuracy.
- Compiled, printed, and scanned patients payments.
- Generated payment reports to providers via payment system with detail.
- Correctly submitted frames and lens orders online.
- Requested and submitted corrected claims for services rendered to providers.
- Reviewed members Explanation and Coordination of benefits from participating plans.
- Inbound and outbound Customer Service.
- Outreached to patients to overview delinquent or missed payments for services rendered.
- Verified insurance for surgical services.
- Overviewed and advised members of their benefits and patient liability prior to surgery.
- Confirmed scheduled appointments and cancellations.
- Complied with OSHA, HIPAA and PHI rules and regulations.
- Launched and completed online mandatory training related to all aspects of the company.
- Processed patient billing inquiries and resolved payment discrepancies efficiently.
- Communicated with patients to explain billing statements and payment options clearly.
- Utilized electronic health record systems to maintain accurate patient billing information.
- Collaborated with medical staff to gather necessary information for accurate billing.
- Reviewed patient accounts for accuracy and initiated follow-up on outstanding balances.
- Ensured compliance with healthcare regulations in all billing practices consistently.
- Performed administrative duties such as filing, copying, scanning, faxing.
- Adhered to HIPAA regulations when handling confidential patient information.
- Entered data into the computer system accurately and efficiently.
- Verified insurance eligibility for services rendered prior to submitting claims.
- Followed up with insurance companies regarding unpaid or denied claims.
- Assisted in the preparation of monthly financial reports.
Claims Examiner
Carefirst Bluecross Blueshield
Owings Mills
10.2003 - 08.2015
- Gathered information from various third parties to determine claim acceptability.
- Researched and followed up on denied insurance claims.
- Resolved and reviewed pend resolutions using proper processing implementations.
- Processed medical and hospital claims contingent upon members eligible benefits.
- Requested and routed claims to Case Managers for medical review using external and internal routes.
- Generated plan to plan general inquiries using an inter plan teleprocessing service.
- Utilized standard operating procedures to reference pend resolutions, for diagnosis and procedure codes.
- Launched and completed mandatory training relevant to all aspects of the company.
- Complied with HIPAA and PHI rules and regulations.
- Evaluated claims for medical procedures and services to ensure compliance.
- Reviewed documentation and records to confirm coverage eligibility.
- Maintained detailed records of claims decisions and communications for audit purposes.
- Performed data entry into the computer system to record information regarding claim status.
- Paid and processed claims within designated authority level.
- Reviewed and resolved open claims and change orders to determine entitlement for additional payment.
- Tracked progress of pending cases through manual follow-up or automated systems.
- Collaborated with internal departments such as Underwriting, Provider Relations, Medical Management, and Quality Assurance, as needed.
- Completed required investigations on referred files within established timeframes.
- Participated in quality assurance activities such as peer reviews and audits.
- Evaluated evidence with ultimate goal of creating positive outcomes for client's claims.
- Maintained up-to-date knowledge about changes in healthcare reform legislation affecting provider reimbursements.
- Double-checked and reviewed documentation for denied and accepted insurance claims.
- Reviewed medical records and documents to determine coverage eligibility of claims for insurance benefits.
Medical Support Representative
Nationwide Better Health
Hunt Valley
11.2006 - 12.2010
- Answered inbound and outbound calls in a call center.
- Verified, data entered, and edited patient demographics with confidentiality and accuracy.
- Inputted information from customer calls and onsite service visits into the company's system.
- Educated qualified clients regarding their core medical conditions relating to Asthma, diabetes, Depression, chronic obstructive pulmonary disease, Hypertension, Hyperlipidemia, Maternity and various forms of Cancer along with other Core medical conditions.
- Promoted health and wellness awareness.
- Enrolled clients in the program designed for their specific conditions.
- Assigned and scheduled clients with a case manager to educate and coach members relevant to their conditions.
- Moderate clerical duties.
- Complied with HIPAA and PHI rules and regulations.
- Assisted patients with inquiries regarding health and wellness programs.
- Managed appointment scheduling for healthcare consultations and follow-ups.
- Coordinated communication between patients and healthcare providers effectively.
- Educated clients on benefits and services of health plans offered.
- Processed patient information accurately in electronic health record systems.
- Conducted outreach to promote health initiatives within the community.
- Created patient records and updated existing medical files.
- Processed incoming and outgoing correspondence related to medical care.
- Provided clerical assistance with filing, copying, scanning and faxing documents.
- Answered phone calls from patients regarding their health concerns.
- Maintained confidentiality of all medical records according to HIPAA regulations.
- Performed data entry tasks such as entering patient information into the computer system.
- Verified insurance coverage prior to providing services to patients.
- Reviewed patient charts prior to each visit to ensure accuracy.
- Obtained informed consent and payment documentation from patients and filed in system.
Education
High school or equivalent - Dental Assisting
Medix School
High School Diploma -
Lake Clifton Eastern High School
Skills
- AUTO INSURANCE
- Claims
- Claims processing
- Insurance claims
- Medical terminology
- Direct Support
- ICD-9
- CPT Coding
- Customer Service
- Medical Billing
- Office Experience
- Microsoft Outlook
- Home Health
- Medicare
- ICD-10
- Insurance Verification
- Clerical experience
- Revenue reconciliation
- Medical billing
- Insurance verification
- Collection techniques
- Contract compliance
- Effective communication
- Problem solving
- Attention to detail
- Time management
- Conflict resolution
- Team collaboration
- Payment processing
- Researching
- Account reconciliation
- Professional telephone demeanor
- Revenue quotas
- Account discrepancies
Certification
Driver's License
Personal Information
Assessments
- Attention to Detail, Completed, 10/01/19
- Medical Billing, Proficient, 07/01/19
- Organizational Skills, Proficient, 07/01/19
- Customer Focus & Orientation, Proficient, 06/01/19
Timeline
AR Revenue Specialist
Johns Hopkins University
06.2021 - Current
Account Receivable Biller/Collections
Aerotek Temporary Job Agency
05.2019 - 06.2021
Medical Claims Processor
Versant Health
03.2016 - 03.2019
Patient Billing Representative
Baltimore Washington Eye Medical Center
08.2015 - 01.2016
Medical Support Representative
Nationwide Better Health
11.2006 - 12.2010
Claims Examiner
Carefirst Bluecross Blueshield
10.2003 - 08.2015
High school or equivalent - Dental Assisting
Medix School
High School Diploma -
Lake Clifton Eastern High School
Similar Profiles
Lester Green, D.M.A.Lester Green, D.M.A.
Vocal Coach, Opera Coach, Lecturer II at Peabody Institute Of The Johns Hopkins UniversityVocal Coach, Opera Coach, Lecturer II at Peabody Institute Of The Johns Hopkins University
Travis PenningtonTravis Pennington
Undergraduate Research Intern at Johns Hopkins UniversityUndergraduate Research Intern at Johns Hopkins University
Kelley TaylorKelley Taylor
Budget Analyst at Johns Hopkins University, Center for Health SecurityBudget Analyst at Johns Hopkins University, Center for Health Security
La Tonya GauseLa Tonya Gause
Sr. Security Specialist at Johns Hopkins University, JHUSr. Security Specialist at Johns Hopkins University, JHU
DORVAN JOHNSONDORVAN JOHNSON
COSTODIAN at PARK AUTHRITYCOSTODIAN at PARK AUTHRITY