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
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
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
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
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