Patient Insurance Specialist II
Baylor College Of Medicine
12.2021 - 05.2022
Hi, I’m
Alaysha Easterling
Katy,TX
Summary
Results-driven Operations Leader and Supervisor with a wealth of knowledge and experience in several areas of Healthcare, Mental Health, Benefits, Insurance, claims, Hipaa guidelines human capital development, risk mitigation, legal, crime investigation, management and operations. A proven leader in effective teamwork who has led teams and collaborated with leaders across the organization. Strong focus on strategic, tactical, and technical business partnerships with a successful track record of implementing strategies that result in the achievement of desired business outcomes. A successful change advocate and leader for organizational transformation initiatives that build high-performance cultures and results in increased employee engagement and talent.
Work History
Baylor College Of MedicineHouston, TX
Patient Insurance Specialist II
12.2021 - 05.2022
Job overview
- Coordinated with contracting department to resolve payer issues.
- Processed eligibility and benefits verification and authorization requests.
- Acted as subject matter expert, answering internal and external questions and inquiries.
- Resolved discrepancies in insurance payments by collaborating with carriers.
- Communicated effectively with members of operations, finance and clinical departments.
- Communicated verification and authorization status updates with several department to facilitate decision-making for patient admissions and insurance coverage.
- Responded to customer calls swiftly to resolve issues and answer questions.
- Verified insurance eligibility for both medical and vision insurances for upcoming appointments etc.
- Educated patients and families on insurance issues. Communicated patient's fiscal responsibility.
- Contacted departments regarding missing clinical information if required by patients' insurance company.
- Notified appropriate work units of patient's insurance coverage, authorizations, or status.
- Answered help line calls, emails, and assisted patients with questions
- Identified all patients without third party financial benefits and directed them for financial counseling.
- Reviewed patient deductibles and/or copays and entered into billing system.
- Entered insurance referrals as needed.
- Initiated and completed referrals through phone and websites.
- Participated in development of organization procedures and update of forms and manuals.
- Answered questions from patients, clerical staff and insurance companies.
- Maintained strictest confidentiality; adheres to all HIPAA guidelines/regulations.
- Assisted in development and communication of SOP for key areas to improve accuracy and understanding of processes.
- Accurately obtained benefits from insurance companies for upcoming services.
- Provided accurate estimates for patient out of pocket expenses, submitted any follow-ups on insurance authorization requests, and financially cleared patients for upcoming services.
- Entered ICD-10-CM Diagnosis codes and CPT codes into database.
Beyond FinanceHouston, Texas
Junior Administrator
09.2019 - 03.2021
Job overview
- Codified office structures and processes to promote teamwork and performance.
- Interpreted management directives to define and document administrative staff processes.
- Improved information collection and recordkeeping accuracy by creating, updating and managing customer communications.
- Assisted executive leaders in decision-making procedures by creating daily reports to advise leaders on corrective actions and process improvements.
- Maintained accurate, current and compliant financial records by monitoring and addressing variances.
- Reduced recordkeeping errors by efficiently and precisely handling all financial transactions, journal entries and accounts payable and receivable activities.
- Established positive working relationships with colleagues, manager and customers through regular communication and effective anticipation of needs.
- Successfully juggled multiple projects simultaneously to aid executive leaders.
- Prepared 100 plus daily client reports to assist business leaders with key decision making and strategic operational planning.
- Assessed personnel performance and implemented incentives and team-building events to boost morale.
Houston Methodist HospitalHouston, Texas
Admitting Representative II
09.2018 - 08.2019
Job overview
- Verified patient details and insurance coverage and collected co-pays.
- Handled admission processes and discharge procedures to transfer patients from hospital to home care, extended facility and self-care plans.
- Registered patients for labs, surgeries and radiology.
- Calculated collectible amount due for procedures.
- Assisted 50 plus patients in filling out check-in and payment paperwork.
- Reviewed and corrected claim errors to facilitate smooth processing.
- Arranged forms and charts for each patient.
- Compiled and reviewed medical charts.
- Educated patients on medicine and at-home healthcare tools.
- Used multiple systems to schedule appointments.
- Explained plans for treatment and payment options.
United Healthcare GroupSugarland, Texas
Jr. Benefits Coordinator
11.2012 - 08.2016
Job overview
- Identified, researched and resolved billing variances to maintain system accuracy and currency.
- Handled high volume of in-bound calls pertaining to reconciliation of delinquent accounts.
- Worked effectively with medical payers such as Medicare, Medicaid, commercial insurances to obtain timely and accurate payments.
- Trained and mentored new team members and managers on accounts payable systems and policies to build cohesive groups and promote operational performance.
- Verified accuracy of accounts payable payments, resulting in 98% reduction in payment errors and check reissue
- Resolved issues and inquiries from plan participants regarding health and welfare benefits and deductions through telephone, email and in-person interactions.
- Trained new team members in policies and procedures and offered insight into best ways to manage job tasks and duties.
- Served customers in ad various benefit programs, including 401K, medical, dental and vision packages.
- Explained benefits friendly, with efficiency following outlined steps of service.
- Directed and explained to plan participants in easy-to-understand terms in order to educate each on available options.
- Observed strict procedures to maintain data and plan participant confidentiality.
- Evaluated patients and implemented comprehensive treatment plans to enhance mental health.
- Provided clients with recommendations to community resources.
- Leveraged positive uncertainty and multi-systemic family systems therapy to help clients deal with ambiguity, accept inconsistencies and adopt intuition when making decisions.
- Documented client progress in confidential files.
- Performed client assessments and advised treatment plans.
- Created customized care plans, working with hospital staff and families to assess and meet individual needs.
- Conducted research, gathered information from multiple sources and presented results
- Developed and implemented performance improvement strategies and plans to promote continuous improvement
Natchitoches Parish Correctional FacilityNatchitoches, LA
Correctional Officer
11.2010 - 09.2012
Job overview
- Made rounds at specified intervals and conducted head counts and roll calls.
- Maintained custody and control of 300 inmates housed in maximum security unit.
- Prepared, processed and maintained forms, reports, logs, records and activity journals.
- Led intake and processing of inmates by handling paperwork, searches, interviews and fingerprinting.
- Observed and supervised inmates throughout visits, meal time, recreation, phone calls and showers.
- Discussed with offenders links between criminal behavior and anger management problems or drug and alcohol abuse.
- Investigated attempted escapes and conducted searches for escaped inmates.
- Booked new inmates into facility and processed inmates for release.
- Built solid relationships with staff and residents to keep institution safe and secure.
- Escorted inmates to and from cells, court, hospitals and medical appointments.
- Created and maintained arrest files on all inmates processed through jail.
Cloyd Benjamin Attorney At LawNatchitoches, Louisiana
Paralegal
04.2007 - 11.2010
Job overview
- Coordinated trial exhibits by organizing materials, writing documentation and preparing digital materials and displays.
- Created highly researched and articulate legal paperwork such as pleadings, contracts and briefs.
- Researched various laws and regulations and delivered analysis and assessments to all parties.
- Drafted, signed and certified key legal documents for judicial review.
- Answered 50 plus client calls per day to respond to inquiries, using open-ended questioning skills to attain applicable information.
- Investigated facts and laws to determine causes of action and to prepare cases.
- Prepared legal briefs, motions and pleadings.
- Mitigated legal team's workload by reviewing and evaluating legal documents, including discovery materials and contracts.
- Analyzed elements of civil litigation, including evidence gathering and presentation and client counseling, in addition to evaluating jury selection methods processes.
- Adhered to privacy laws to avert possible information breaches and protect client data.
- Conducted detailed client intakes and entered information into company database.
Education
American InterContinental UniversitySchaumburg, IL
Bachelor of Science from Criminal Justice
09.2021
American InterContinental UniversitySchaumburg, IL
Associate of Science from Criminal Justice
08.2017
Skills
- Strong communication and listening skills
- Strong writing and computer skills
- Excellent interpersonal skills
- Criminal investigative skills
- Treatment planning skills
- Counseling techniques
- Social work expertise
- Teamwork
- Multi-Tasking
- Decision-making
- Problem solving
- Time management
- Adaptability
- Management
- Critical thinking
- Social skills
- Leadership
- Typing
- Research
- Flexibility
- Self-Starter
Timeline
Junior Administrator
Beyond Finance
09.2019 - 03.2021
Admitting Representative II
Houston Methodist Hospital
09.2018 - 08.2019
Jr. Benefits Coordinator
United Healthcare Group
11.2012 - 08.2016
Correctional Officer
Natchitoches Parish Correctional Facility
11.2010 - 09.2012
Paralegal
Cloyd Benjamin Attorney At Law
04.2007 - 11.2010
American InterContinental University
Bachelor of Science from Criminal Justice
American InterContinental University
Associate of Science from Criminal Justice
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