Kewana Brownson
Wendell
Summary
Detail-oriented Revenue Cycle Specialist with strong claims processing, precertification, and insurance verification skills. Proven track record in HIPAA compliance and denial management.
Overview
14
14
years of professional experience
Work History
Revenue Cycle Specialist
Mayo Clinic
Jacksonville
11.2022 - Current
- Communicated with insurance providers to verify patient coverage.
- Clarified coverage details and billing requirements through communication with insurance providers.
- Determined precertification requirements for insurance coverage by reviewing patient files.
- Submitted precertification requests to insurance companies using electronic systems.
- Communicated with patients regarding their precertification status and requirements.
- Maintained detailed records of all precertification activities and communications.
- Kept knowledge of insurance policies, procedures, regulations, and guidelines up to date.
- Researched discrepancies on unpaid invoices and reconciled them.
Precertification Specialist
Midtown Pain&spine
Raleigh
04.2019 - 11.2022
- Compiled and submitted precertification requests for review by payers in accordance with established timelines.
- Verified insurance eligibility, coverage levels, and benefit parameters prior to submission of precertification requests.
- Reviewed patient medical records to assess medical necessity for requested services, ensuring compliance with authorization criteria.
- Answered provider inquiries regarding preauthorization requirements and processes to facilitate timely approvals.
- Evaluated clinical criteria against existing health plan guidelines to determine authorization status.
- Processed appeals when necessary following denial or rejection of claims due to lack of proper authorization.
- Analyzed trends in claims denials or rejections due to lack of proper authorization, identifying areas for process improvement.
- Maintained detailed documentation of all activities related to the precertification process.
- Resolved any discrepancies identified during the precertification process.
- Investigated payer policies to ensure compliance with service and diagnosis requirements.
- Ensured compliance with all HIPAA regulations pertaining to protected health information.
- Adhered to applicable laws, regulations, policies, and procedures governing the healthcare industry.
- Attended meetings with providers regarding their utilization management needs.
Lpn/Medical Assistant
Duke Spine and pain Management
Raleigh
01.2012 - 04.2019
- Administered medications and treatments, ensuring compliance with healthcare provider prescriptions.
- Monitored patient vital signs, promptly reporting changes to nursing staff for timely intervention.
- Provided patient care in accordance with physicians' orders and nursing standards of practice.
- Performed physical assessments, including vital signs and health history documentation.
- Assisted with daily living activities to enhance patient comfort and care.
- Educated patients and families on health management and discharge instructions to promote adherence and recovery.
- Maintained a clean and safe environment for patients and staff members.
Education
LPN - Practical Nursing
Wilson Community College
Wilson, NC12-2012
Medical Assistant - Medical Assisting
Gwinnett College
GA08-2010
Skills
- Claims processing
- Insurance verification
- Precertification
- Denial management
- Medical necessity
- Healthcare billing practices
- HIPAA compliance
- Electronic health records
- Medical coding
- Health insurance knowledge
- Patient care techniques
- Utilization management
Timeline
Revenue Cycle Specialist
Mayo Clinic
11.2022 - Current
Precertification Specialist
Midtown Pain&spine
04.2019 - 11.2022
Lpn/Medical Assistant
Duke Spine and pain Management
01.2012 - 04.2019
LPN - Practical Nursing
Wilson Community College
Medical Assistant - Medical Assisting
Gwinnett College