Barbara Peavy
Douglasville,GA
Summary
Experienced Reimbursement Specialist with a proven track record in effectively managing complex reimbursement processes and resolving billing issues. Proficient in handling claims and appeals, ensuring compliance with regulatory requirements and minimizing denials. Strong analytical skills and attention to detail have been instrumental in optimizing reimbursement strategies.
Overview
15
15
years of professional experience
Work History
Reimbursement Specialist
Mimedx Group
08.2013 - 05.2017
- Specialized in providing reimbursement services to physicians office, hospitals, dental providers and ambulatory centers
- Proficient in product knowledge of biological medicine, treatments, coding and reimbursement
- Working knowledge of medical policy guidelines
- Completed benefit and prior authorization requests expediently to insure maximum reimbursement
- Expertise in reimbursement methodologies, coding and medical terminology
- Proficient in private insurance, Medicare, Medicaid
- Managed multiple priorities and deadlines working within all payer sectors and requirements in the United States and Guam
Insurance Specialist
MdnetSolutions
09.2012 - 06.2013
- Managed insurance verification and Prior Authorization for providers specializing in Bariatric Surgery
- Documented medical policy criteria and benefit details for bariatric surgery patients.
- Fostered effective partnerships with top Bariatric providers, contributing to successful outcomes at The Cleveland Clinic Foundation and Loyola University Medical Center.
Long Term Care Insurance Consultant
U.S. Department of Personnel Management
03.2011 - 08.2012
- Company Overview: Sponsored by the U.S
- Supported the Department of Personnel Management in collaboration with Long Term Care Partners and John Hancock.
- Provided consultation expertise for federal government employees in purchasing a long term care insurance plan.
- Certified and recognized as a specialist in Long Term Care Insurance.
- Assisted in long term financial planning in coordination with healthcare needs.
Provider Relations Representative
Kid’s Health First Pediatric Alliance, CHOA
01.2008 - 01.2010
- Served as Liaison for 35 pediatricians and insurance companies to resolve coverage, claims and network issues
- Delivered excellent customer service skills with a working knowledge of complex issues and concepts regarding claims, coverage and exemptions
- Monthly newsletter to network providers regarding trends, coding, contractual and network issues
- Proactively identified and resolved client issues
Coordinator Workers’ Compensation Case Management/ CMA
Coventry Healthcare
01.2006 - 01.2008
- Transcribed oral statements and clinical information from claimant’s, physicians, employers, claims adjusters and attorneys into the injured workers file
- Extensive collaboration of assessment and planning with healthcare providers, attorneys and injured worker’s to facilitate services to meet needs with cost effective outcomes
- Scheduling /Coordinated appointments to providers
- Maintained strict confidentiality of sensitive information
- Dedicated, decisive and action oriented with case management and claims direction
- Proficient in medical terminology
- Managed complex workers’ compensation cases within highly diverse cultures and medical practices
- Set up and organized new claim files
- Worked 'on site' at ACE/USA to coordinate services with Workers’ Compensation Claims Adjusters to facilitate an expedient return to work
- Excellent working relationships with clients such as Delta Airlines and Haliburton
- Telephonic Case Management, average patient load, ninety
- Promoted Delta Health and Wellness programs
Patient and Physician Liaison/ Reimbursement Specialist
Medical Communications Technology, Synergestics
01.2002 - 01.2006
- Executed reimbursement strategies for products within the public and private payor sector
- Effectively established and maintained collaborative key relationships
- Wrote clinical summaries from clinical information extracted from medical records
- Coordinated letters of appeals and medical necessity with designated physician
- Coordinated services with Pharmaceutical Medical Liaison to facilitate education, reimbursement and product set up and delivery to hospitals for Infusion Therapy
- Excellent working relationships with hospitals, genetic physicians and organizations such as the FDA for product commercialization and distribution
- Arranged for special services such as transportation, funding, authorizations and home healthcare
Education
Certified Long Term Care Insurance -
Long Term Care Partners
Worker’s Compensation Claims Adjuster -
Crawford University
Atlanta, GADisability Management for Claims Adjusters and Case Managers -
Coventry Healthcare
Tampa, FLMedical Negotiations and Cost Savings -
Coventry Healthcare
Tampa, FLCertified Recreational Therapy - Social Sciences
Macon University
Medical Terminology -
Coventry Healthcare
Skills
- Appeals handling
- HIPAA compliance
- ICD-10
- Insurance verification
- Excellent communication
- Organizational skills
Timeline
Reimbursement Specialist
Mimedx Group
08.2013 - 05.2017
Insurance Specialist
MdnetSolutions
09.2012 - 06.2013
Long Term Care Insurance Consultant
U.S. Department of Personnel Management
03.2011 - 08.2012
Provider Relations Representative
Kid’s Health First Pediatric Alliance, CHOA
01.2008 - 01.2010
Coordinator Workers’ Compensation Case Management/ CMA
Coventry Healthcare
01.2006 - 01.2008
Patient and Physician Liaison/ Reimbursement Specialist
Medical Communications Technology, Synergestics
01.2002 - 01.2006
Certified Long Term Care Insurance -
Long Term Care Partners
Worker’s Compensation Claims Adjuster -
Crawford University
Disability Management for Claims Adjusters and Case Managers -
Coventry Healthcare
Medical Negotiations and Cost Savings -
Coventry Healthcare
Certified Recreational Therapy - Social Sciences
Macon University
Medical Terminology -
Coventry Healthcare
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