Nina Simpson
Kingsport
Summary
Meticulous professional with extensive experience in Medicaid application processing and insurance verification. Proven ability to maintain confidentiality while ensuring accuracy in client records and claims. Dedicated Patient Financial Advocate with over eight years of experience in eligibility determination and medical billing. Known for exceptional attention to detail and strong customer service skills, consistently assisting clients in navigating complex Medicaid processes. Results-driven claims representative with a robust background in medical coding, billing, and eligibility verification. Committed to enhancing client experiences through effective communication and timely resolution of inquiries.
Overview
27
27
years of professional experience
Work History
Patient Financial Advocate
University Of Kentucky Healthcare
Lexington
11.2016 - Current
- Processed Medicaid applications and maintained accurate client records.
- Reviewed eligibility requirements to determine client program qualifications.
- Assisted clients with navigating Medicaid services and benefits information.
- Conversed with people from different cultures daily, providing high level of respect and patience with each interaction.
- Researched discrepancies between application information and other sources of data to determine the correct eligibility determination.
- Maintained confidential case records according to established policies and procedures.
- Assisted applicants with the completion of their applications when needed.
- Responded timely to inquiries from clients regarding their Medicaid applications or benefits.
- Reviewed patient eligibility and verified insurance information promptly.
- Educated patients on Medicaid benefits and billing processes clearly.
- Ensured accuracy of financial data by verifying patient insurance coverage.
- Performed insurance verification, pre-certification and pre-authorization.
Claims Representative
HealthSmart Benefit Solutions
Lexington
01.2016 - 11.2016
- Processed high volume of claims efficiently while upholding quality standards.
- Reviewed and verified documentation for accuracy and compliance with company policies.
- Ensured timely submission of required claimant documentation prior to payment approval.
- Delivered exceptional customer service to insured and claimants throughout claims process.
Medical Billing Specialist
Lifepoint Health
Georgetown
09.2013 - 12.2015
- Processed medical claims accurately using advanced billing software.
- Verified patient insurance information to ensure proper billing procedures.
- Communicated with healthcare providers to resolve billing discrepancies.
- Reviewed and corrected denied claims for timely resubmission.
- Maintained patient confidentiality while handling sensitive billing information.
- Contacted insurance providers to verify insurance information and obtain billing authorization.
- Adhered to HIPAA regulations when handling confidential patient information.
- Completed appeals and filed and submitted claims.
- Maintained current working knowledge of CPT and ICD-10 coding principles, government regulation, protocols and third-party billing requirements.
- Submitted appeals for denied claims when appropriate according to the insurance company's criteria.
- Identified errors and re-filed denied or rejected claims quickly to prevent payment delays.
- Monitored aging accounts receivable balances ensuring timely resolution of outstanding balances.
- Precisely completed appropriate paperwork and system entry regarding claims.
- Reviewed and verified benefits and eligibility with speed and precision.
- Communicated with insurance representatives to complete claims processing or resolve problem claims.
- Reviewed account information to confirm patient and insurance information is accurate and complete.
Patient Account Representative
Wellmont Health System
Kingsport
08.2007 - 09.2013
- Processed claims submissions to ensure timely reimbursements for services rendered.
- Verified accuracy of medical coding for healthcare provider services.
- Reviewed EOB statements against provider charges for accuracy.
- Resolved issues related to incorrect or incomplete claim documentation.
- Submitted appeals for denied claims based on thorough research findings.
- Assisted in resolving patient complaints regarding account balances and insurance coverage.
- Contacted insurance companies to verify claim payment statuses.
- Drafted appeal letters for denied claims submitted to insurance companies.
Executive Assistant
Appalachian Fertility/Fertility Resource Center
Kingsport
03.1998 - 07.2006
- Coordinated scheduling for patient appointments and consultations efficiently.
- Organized patient records ensuring confidentiality and compliance with regulations.
- Facilitated communication between patients and medical staff to enhance service delivery.
- Supported billing processes by verifying insurance information and patient details.
- Maintained office supplies inventory, ordering items as needed to ensure efficiency.
- Answered telephone calls from customers or clients providing assistance where necessary.
- Processed accounts receivable and payable.
- Claims processing and insurance follow-up.
- Processed payroll and 941 tax forms.
Education
High School Diploma -
Elkhorn City High School
Elkhorn City, KY05-1991
Skills
- Medicaid application processing
- Eligibility and insurance verification
- Medical coding & billing
- Claims management & follow-up
- Teamwork, multitasking abilities
- Patient advocacy
Timeline
Patient Financial Advocate
University Of Kentucky Healthcare
11.2016 - Current
Claims Representative
HealthSmart Benefit Solutions
01.2016 - 11.2016
Medical Billing Specialist
Lifepoint Health
09.2013 - 12.2015
Patient Account Representative
Wellmont Health System
08.2007 - 09.2013
Executive Assistant
Appalachian Fertility/Fertility Resource Center
03.1998 - 07.2006
High School Diploma -
Elkhorn City High School
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