Gabriel Boyd
Clover
Summary
Detail-oriented Healthcare Billing Professional with extensive hands-on experience in EPIC, insurance verification, medical record audits, and end-to-end claims processing. Exceptional skills in HIPAA compliance, data management, documentation accuracy, discrepancy resolution, and revenue cycle support. Proven track record of enhancing claim accuracy, minimizing denials, and fostering effective communication between clinical and administrative teams. Committed to driving operational efficiency and ensuring the highest standards of service within the healthcare billing landscape.
Overview
11
11
years of professional experience
Work History
Billing Follow Up Rep 2
Atrium Healthcare
04.2025 - Current
- Completes claims and documents billing activity according to governmental regulations, agency policies and department guidelines.
- Reviews trends specific to denials, root cause, and A/R impact.
- Reviews insurance credit balances to determine root cause, takes necessary action to resolve account.
- Contacts payer and makes inquiries on account status.
- Processes and researches electronic remittances and bank deposits.
- Works with Specialty Payers and other facilities to ensure compliance and payment. Transfers charges between Patient and Facility accounts as required.
- Escalates problem accounts as needed and leads appeal process.
- Receives, review and takes actions for all communications within the business office.
Sr. Escalations Associate
Wells Fargo
02.2021 - 05.2024
- Independently logs, researches, and responds to escalated or urgent requests regarding life events or complaints that are high visibility, high risk, legal, ethical, and/or regulatory in nature.
- Timely and efficiently process acknowledgment letters, conduct investigative steps to identify high-risk issues, and work with internal partners to resolve complaints.
- Uploading Wells Fargo's response to a customer facing the Regulatory Portal, which requires special handling and/or imaging/uploading documentation to other repositories as required.
- Partner with senior compliance representatives to ensure all cases meet both company and federal guidelines
- Collaborate with various lines of business on overlapping or cross-product complaints to ensure all information is accurate, and provide one resolution.
- Mitigating risk by identifying key information and ensuring that both company and federal compliance guidelines are met.
Sr. Fraud & Claims Operations Representative
Wells Fargo
11.2017 - 01.2021
- Reviewed and examined complex transactions and referrals to prevent and detect fraudulent activities, policy violations, and merchant disputes with low to high risk within the fraud and claims functional area.
- Exercised judgment within defined parameters while developing an understanding of investigative techniques and all facets of portfolios serviced by the division to quickly examine information and determine liability, as well as the impact of each case.
- Provided financial or business evidence, and detailed data detecting patterns, trends, anomalies, and schemes in both transactions and relationships across multiple businesses or products to the more experienced management, as well as specialists working within the team.
- Take appropriate preventative or corrective action to secure customers' online banking accounts, personal information, and relationships.
- Open cases/referrals (UAR, elder abuse, ATO, support, and business referrals) and other claims to facilitate the mitigation of fraudulent activity.
Sr. Claims Benefit Specialist
Connextions
09.2014 - 10.2017
- Performed claim documentation review, verified policy coverage, assessed claim validity, communicated with healthcare providers and policyholders, and ensured accurate and timely claims processing.
- Accurately handling medical claims for reimbursement requires knowledge of medical coding and billing practices, as well as effective communication skills.
- Determined the eligibility and coverage of benefits for each claim based on the patient's insurance plan, policy guidelines, and scope.
- Assessed claims for accuracy, compliance with coding guidelines, medical necessity, and documentation requirements.
- Documents claim information in the company system, assigning appropriate codes, modifiers, and other necessary data elements to ensure accurate tracking, reporting, and processing of claims.
- Conducts reviews and investigations of claims that require additional scrutiny or validation to ensure proper claim resolution.
- Communicates with healthcare providers, patients, or other stakeholders to resolve any discrepancies or issues related to claims.
Education
High School Diploma -
Clover High School
Clover, SC05-2010
Skills
- EPIC
- HIPAA Compliance
- Account Follow-Up
- Data Entry
- Insurance Verification
- Denials
- Submitting Reconsiderations
- Appeals
- Medical Records
- Prior Authorization
- Documentation and Correspondence
- Payment Recovery
- Medical terminology understanding
- Document scanning
Timeline
Billing Follow Up Rep 2
Atrium Healthcare
04.2025 - Current
Sr. Escalations Associate
Wells Fargo
02.2021 - 05.2024
Sr. Fraud & Claims Operations Representative
Wells Fargo
11.2017 - 01.2021
Sr. Claims Benefit Specialist
Connextions
09.2014 - 10.2017
High School Diploma -
Clover High School