Vicky Hamilton
West Jefferson
Summary
Highly motivated healthcare professional who is successful at building positive team dynamics to accomplish aggressive goals. I am in search of an open, communicative culture where employees feel empowered to contribute to the company’s success. I am known for high productivity, efficient task completion and my ability to put team above self. I specialize in team leadership, conflict resolution, and obtaining results with compassion and integrity.
Overview
17
17
years of professional experience
Work History
Billing and Governmental Follow-up Supervisor
UNC Health Appalachian
01.2024 - Current
- Plan, organize, and direct department activities and personnel including developing and monitoring key KPI's
- Oversaw daily operations of the department, ensuring smooth workflow and timely completion of tasks.
- Applied strong leadership talents and problem-solving skills to maintain team efficiency and organize workflows.
- Help establish standards of performance by overseeing staff productivity and quality for billing
- Ensures accuracy and timely billing are occurring in accordance with specific payer requirements
- Establishes and monitors auditing and billing office policies and procedures to ensure maximization of productivity for the department
- Coordinates regular team meetings to communicate essential information, updates on procedures, changes in regulations, or any new protocols relevant to the billing department
- Provides a forum for discussing challenges or obstacles encountered in billing processes and encourages collaborative problem-solving among team members
- Facilitates cooperation and motivates team members to accomplish group goals
- Regularly evaluates workload, tasks, and requirements to determine the optimal staffing levels needed to ensure efficient operations
- Responsible for all areas of employee relations, including, but not limited to, corrective action and action plans, and workplace conflict management
- Maintained accurate records of employee performance, attendance, leave requests, and disciplinary actions
Billing and Governmental Follow-up Specialist
UNC Health Appalachian
08.2020 - 12.2023
- Responsible for following up with insurance carriers on aged and unresolved claims
- Research and analyze denied claims for appeal potential
- Reconcile account balances utilizing ERA, EDI transactions, edits, and rejection reports
- Leverage knowledge and expertise in COB/TPL/MSP to gather and review documentation and eligibility information and investigate to determine the proper order of benefits when multiple forms of coverage are available
- Resolve primacy issues
- Identify and report any trends in denied claims
- Responsible for training and onboarding coworkers
- Analyze monthly data for claims process improvements
- Streamlined follow-up processes for increased efficiency and effectiveness in handling denied or delayed claims.
Utilization Review Coordinator | Inpatient Behavioral Health
UNC Health Appalachian
07.2015 - 08.2020
- Coordinated the tasks involved in the utilization review, prior authorization, and revenue cycle management processes for the Behavioral Health service line
- Training and educating all staff in the requirements of insurance companies for prior and recurrent authorization to justify the service provided to the patient
- Develop and implement action plans for increased departmental revenue
- Provide support to the billing department with management of denials
- Identify trends for denied claims and develop new processes to eliminate recurring issues for denials
- Provides support to the Provider Enrollment department to help expedite the credentialing process with insurance companies
- Collaborated with a state agency on grant-funded contract
- Reviewed and evaluated patient information to determine appropriate level of care and services required
- Conducted utilization review activities including concurrent reviews, retrospective reviews, and discharge planning
- Served as a trusted resource for clinical staff seeking guidance on appropriate levels of care, alternate treatment options, or clarification on insurance coverage requirements.
- Assisted leadership in setting annual objectives for the Utilization Review Department based on organizational priorities.
Office Manager | Outpatient Behavioral Health
UNC Health - Appalachian Regional Healthcare System
08.2010 - 07.2015
- Maintained provider schedules
- Charge/payment entry and charge reconciliation
- Health information management for medical records
- Greeted patients and performed vital signs when required
- Analyzed monthly survey data for improvement opportunities in patient experience
- Handled sensitive information with discretion, maintaining confidentiality of company documents and PHI.
- Enhanced team productivity by delegating tasks effectively and overseeing daily workflow.
- Streamlined office operations by implementing efficient filing systems and organizational strategies.
Accounts Receivable Manager
Total Health Integrated Services
01.2008 - 11.2009
- Directed activities of insurance billing and reimbursement to obtain optimum efficiency of operations to maximize revenue
- Executed daily operations of filing claims, posting payments, and analyzing, correcting, and refiling denied claims for payment
- Designed and implemented a patient payment plan policy to maximize patient account resolution
- Coordinated activities of front office personnel, providers, and management staff to provide more efficient billing processes and policies to decrease A/R
- Provided daily, weekly, and monthly financial reports for the organization
Education
BS - Healthcare Management
Western Governors University
01.2021
AS - Nursing
Wilkes Community College
01.2000
Skills
- Detail oriented
- Exceptional critical thinking
- Productivity and quality standards
- Motivated initiative-taker
- Communicating with impact
- Passion for results
- Leading people through change
- Training and mentoring
- Excel experienced
- Epic Billing experience
Timeline
Billing and Governmental Follow-up Supervisor
UNC Health Appalachian
01.2024 - Current
Billing and Governmental Follow-up Specialist
UNC Health Appalachian
08.2020 - 12.2023
Utilization Review Coordinator | Inpatient Behavioral Health
UNC Health Appalachian
07.2015 - 08.2020
Office Manager | Outpatient Behavioral Health
UNC Health - Appalachian Regional Healthcare System
08.2010 - 07.2015
Accounts Receivable Manager
Total Health Integrated Services
01.2008 - 11.2009
AS - Nursing
Wilkes Community College
BS - Healthcare Management
Western Governors University
Similar Profiles
Beverly BowenBeverly Bowen
PharmD at Appalachian Regional Health UNC Health AppalachianPharmD at Appalachian Regional Health UNC Health Appalachian
Melonie FormwaltMelonie Formwalt
Lactation Consultant /Childbirth Educator at UNC Health -AppalachianLactation Consultant /Childbirth Educator at UNC Health -Appalachian
Eryn HartleyEryn Hartley
Certified Clinical Medical Assistant at UNC Health AppalachianCertified Clinical Medical Assistant at UNC Health Appalachian