Kelly Shelton
Cisne
Summary
Dynamic Patient Account Representative with a proven track record at SSM Health Good Samaritan Hospital, excelling in claim processing and customer service. Adept at resolving billing inquiries and ensuring HIPAA compliance, I leverage strong problem-solving abilities to enhance patient satisfaction and streamline financial operations. Recognized for exceptional communication skills and meticulous attention to detail.
Overview
28
28
years of professional experience
Work History
Patient Account Representative
SSM Health Good Samaritan Hospital
Mt. Vernon
12.1997 - 12.2023
- Contacted insurance companies to check status of claim payments.
- Verified accuracy of medical coding for services rendered by healthcare providers.
- Updated existing patient files with relevant information such as changes in address or contact information.
- Applied organizational policies and complied with regulations for patient privacy.
- Completed month-end and year-end closings, kept records audit-ready and monitored timely recording of accounting transactions.
- Wrote appeal letters to insurance companies for denial of claims.
- Resolved inquiries from patients, families and external payers.
- Collaborated with relevant parties to resolve billing issues, insurance claims and patient payments.
- Maintained detailed notes on all patient interactions for future reference purposes.
- Processed refunds, disbursements, and payments.
- Answered customer questions regarding account discrepancies or problems.
- Conducted follow-up calls with patients to ensure that accounts were up to date and properly documented.
- Monitored overdue accounts using automated information systems.
- Generated detailed reports outlining billing, flagged items, and other important data.
- Assisted in resolving patient complaints related to account balances, insurance coverage, and payment plans.
- Initiated collection activities on delinquent accounts while adhering to HIPAA guidelines and regulations.
- Responded promptly to customer inquiries via telephone or email in a professional manner.
- Provided customer service to patients regarding billing inquiries and account information.
- Used excellent verbal skills to engage customers in conversation and effectively determine needs and requirements.
- Interacted with other departments within the organization such as finance, accounting, IT, and Human Resources when necessary.
- Worked closely with delinquent account holders to collect and reconcile accounts through approved channels.
- Reviewed EOBs statements submitted by insurance companies for accuracy against provider's charges.
- Processed payments from patients and maintained accurate records of all transactions.
- Reconciled payments received against outstanding invoices ensuring proper posting of credits and debits.
- Researched discrepancies in patient accounts to determine appropriate resolution.
- Analyzed claims denials from third party payers and identified potential solutions for reimbursement.
- Ensured compliance with company policies concerning the privacy of confidential health information.
- Investigated billing discrepancies and implemented effective solutions to resolve concerns and prevent future problems.
- Received payments and posted amounts to customer accounts.
- Reviewed flagged items daily and resolved issues.
- Located new addresses of delinquent customers through research, contacting credit bureaus or by questioning neighbors.
- Resolved any issues arising from incorrect or incomplete documentation relating to a particular claim.
- Communicated frequently with healthcare providers regarding payment status updates on their claims submitted.
- Compared statements against patient files.
- Maintained confidentiality of patient information in compliance with HIPAA regulations.
- Submitted electronic bills following facility and legal compliance standards.
- Submitted appeals on behalf of patients when appropriate based on findings from research conducted into denied claims.
- Conducted testing of software and systems to ensure quality and reliability.
- Provided excellent service and attention to customers when face-to-face or through phone conversations.
- Recognized by management for providing exceptional customer service.
- Demonstrated strong problem-solving skills, resolving issues efficiently and effectively.
- Operated equipment and machinery according to safety guidelines.
- Utilized various software and tools to streamline processes and optimize performance.
- Contributed innovative ideas and solutions to enhance team performance and outcomes.
- Worked with cross-functional teams to achieve goals.
- Collaborated closely with team members to achieve project objectives and meet deadlines.
- Worked effectively in team environments to make the workplace more productive.
- Assisted with customer requests and answered questions to improve satisfaction.
- Worked successfully with diverse group of coworkers to accomplish goals and address issues related to our products and services.
Receptionist
Re/Max Looking Forward
Mt. Vernon
06.1996 - 12.1997
- Greeted visitors entering establishment to determine nature and purpose of visit.
- Developed and maintained a filing system for essential documents, improving office organization.
- Scheduled and confirmed appointments, managing a complex calendar for multiple staff members.
- Updated and recorded customer or client information to maintain accounts.
- Processed payments and updated accounts to reflect balance changes.
- Updated daily log book with information about visitors entering the premises.
- Managed all incoming mail distribution, courier services, faxes, and photocopying documents as requested.
- Managed company database and ensured the accuracy of contact information.
- Conducted initial screening of incoming calls to determine urgency and directed them accordingly.
- Greeted customers, answered general questions and directed to appropriate locations.
- Supplied callers with office address and directions, employee email addresses and phone extensions.
- Served visitors by greeting, welcoming and directing to appropriate personnel.
- Performed data entry tasks into various computer systems accurately and promptly.
- Scheduled appointments for clients, customers, and other visitors.
- Maintained daily calendars, set appointments with clients and planned daily office events.
- Composed and prepared routine correspondence, letters and reports with job-related software.
- Maintained business office inventory and equipment by checking stock for needed supplies.
- Compiled data from various sources into organized reports for management review.
- Delivered administrative support to team members by making copies, sending faxes, organizing documents and rearranging schedules.
- Monitored reception area to provide consistently safe, hazard-free environment for customers.
- Protected clients' rights by maintaining confidentiality of personal and financial information.
- Sorted incoming mail and directed to correct personnel each day.
- Performed clerical duties such as filing, photocopying, transcribing, and faxing.
- Assisted with special projects assigned by management when required.
- Scheduled and confirmed appointments and meetings for management team.
- Utilized office equipment such as printers, copiers, and fax machines, ensuring they were in good working order.
- Scheduled and confirmed appointments.
- Answered incoming calls, took messages, and transferred calls to appropriate departments or personnel.
- Maintained an organized filing system of confidential client information in accordance with company policy.
- Handled mail distribution, including sorting and forwarding incoming mail and preparing outgoing mail.
- Ensured cleanliness and organization of the reception area to maintain a professional atmosphere.
Education
High School Diploma -
Mt. Vernon Township High School
Mt. Vernon, IL05-1997
Skills
- Claim processing
- Medical coding
- Patient privacy
- Financial reporting
- Account reconciliation
- Customer service
- Billing inquiries
- Insurance verification
- Problem solving
- Data entry
- Regulatory compliance
- Communication skills
- Documentation accuracy
- HIPAA
- Medical billing
- Payment processing
- Data entry proficiency
- Collections experience
- Follow-up skills
- Verbal and written communication
- File coordination
- Medical terminology knowledge
- Strong empathy
- HIPAA compliance
- Medical terminology
- Excellent judgment
- Insurance billing
- Healthcare industry
- Team collaboration
- Medical Billing Understanding
- Database maintenance
- Aging reports analysis
- Adaptability and flexibility
- Update accounts
- Updating customer accounts
- Decision-making
- Billing documentation
- Task prioritization
- Creative problem solving
- Confidentiality maintenance
- Prioritization skills
- Telephone etiquette
- Organization skills
References
References available upon request.
Timeline
Patient Account Representative
SSM Health Good Samaritan Hospital
12.1997 - 12.2023
Receptionist
Re/Max Looking Forward
06.1996 - 12.1997
High School Diploma -
Mt. Vernon Township High School
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