Anita Frederick
Tupelo
Summary
Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy. Excellent communicator and dependable team player with strong understanding of insurance industry.
Overview
35
35
years of professional experience
Work History
Payor Relations Representative
NMHS
Tupelo
06.2019 - 07.2023
- Identified and worked to resolve contracted and non-contracted payer issues concerning claims, contract interpretation, utilization management, eligibility, and general operational issues.
- Maintained all levels of communication with providers, informing them of any operational, procedures and payer contractual changes and routinely provided updates.
- Provided payer education to a variety of NMHS stakeholders.
- Resolved complex provider payer issues
- Monitored collection of all payer information received; followed up on missing items and/or incomplete forms per the NMHS policy and procedure
- Reviewed rate sheets or contracts to assure All Payor had them loaded properly.
- Reviewed legal documents and contracts to determine potential conflicts and disputes.
Payment Resolution Specialist
NMHS
Tupelo
03.2017 - 05.2019
- Reviewed legal documents and contracts to determine potential conflicts and disputes.
- Researched and resolved routine and complex issues.
- Acted as subject matter expert, answering internal and external questions and inquiries.
- Managed time efficiently in order to complete all tasks within deadlines.
- Processed eligibility and benefits verification.
- Resolved discrepancies in insurance payments by collaborating with carriers.
Assistant Office Manager/Insurance Specialist
Aurora Spine Center, INC
Tupelo, MS
06.1988 - 12.2016
- Oversaw office inventory activities by ordering, stocking and shipment receiving.
- Filed paperwork, sorted, and delivered mail and maintained office organization.
- Updated and maintained employee attendance records.
- Maintained accurate records of customer payments.
- Generated monthly billing and posting reports for management review.
- Monitored outstanding invoices and performed collections duties.
- Reconciled accounts receivable to general ledger.
- Produced and mailed monthly statements to customers and assisted with related requests for information and clarification.
- Handled account payments and provided information regarding outstanding balances.
- Correctly coded and billed professional medical claims.
- Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
- Maintained payer fee schedules
Education
Associate of Applied Science -
Itawamba Community College
Fulton, MS05.1988
Skills
- Claims Information Gathering
- Analytical and Critical Thinking
- Microsoft Word and Excel
- Maintaining Compliance
- Insurance Knowledge
- Benefits Verifications
Timeline
Payor Relations Representative
NMHS
06.2019 - 07.2023
Payment Resolution Specialist
NMHS
03.2017 - 05.2019
Assistant Office Manager/Insurance Specialist
Aurora Spine Center, INC
06.1988 - 12.2016
Associate of Applied Science -
Itawamba Community College