Megan Zeugner

Utilization Management

Milwaukee, WI 53214

ad07te@r.postjobfree.com

+1-414-***-****

I am driven, and take pride in my work. All of the positions held have been in a fast paced environment. This experience has allowed me to refine my multitasking skills throughout my career. Adapting well to change allows me to feel confident in well thought thru decisions. Being a peer support comes easily to me, clear communication has always been key. I have been able to use constructive feedback in my personal development in my career. Taking the time to hear the message intended provides an opportunity for me to gain perspective and allow for personal reflection. Ideally, my new position will allow me to utilize all of my skills and experience while also providing professional and personal development.

Work Experience

Reconciliation Specialist

Centene - West Allis, WI

October 2018 to Present

Ensuring timely and accurate prior authorization processing for Utilization Management department. Utilizing clinical Interqual, evidence based criteria, Centene is able to monitor and manage fraud, waste and abuse of medical services. I work directly with the Medical Director to manage and review Physician to Physician discussions for possible overturn of denied services. All work is completed in compliance with the WI Medicaid guidelines. Data collected while monitoring and evaluating prior authorization accuracy allows for leadership to facilitate professional development. Maintaining approval or denial of medical claim payments impacted by authorization errors. Support peer and cross training needs. Organization of interdepartmental collaboration for workflow and policy improvements. Working 100% remote since March 2020.

Contractor

Kforce - Milwaukee, WI

May 2018 to October 2018

Temp to hire with current employer.

Office Manager

AZH Centers - Milwaukee, WI

November 2017 to February 2018

Reception including but not limited to scheduling, phone triage, managing a multi-line phone system, patient insurance verification of coverage and benefits, prior authorization and referral management for Occupational Therapy, Hyperbaric treatments, and vascular testing and procedures. Meeting with patients to discuss insurance coverage providing transparency in billing policies. Billing and coding all face to face office visits, vascular testing and procedures. A/R management; payment posting, patient statement processing, deposit management, month end balancing.

Collections both patient and insurance.

Insurance credentialing.

Joint Commission Accreditation February 2017

Various projects as assigned.

Practice Administrator

Heart & Vascular Institute - Pewaukee, WI

February 2016 to November 2017

Working with vendors negotiation contracts.

Reviewing and approving orders and invoices for cost savings and accuracy. Coordinate staffing.

Managing a staff of 10 clinical employees.

Ensuring employee scheduling meets clinical needs. Support staff with personal and professional development working toward measurable and attainable goals set to improve confidence and skills.

Managing all things related to patient comfort.

Medical Billing Specialist

Waukesha Heart Institute - Waukesha, WI

May 2014 to November 2017

Answering patient and insurance company phone calls regarding claims Patient and insurance payment posting, bank deposit management Reviewing medical records to ensure proper coding prior to claims being sent to insurance companies for payment

Writing written appeals using all available resources to get proper claim payments from insurance companies

Following up on any claim outstanding for more than 45 days Work directly with management to develop workflows thru-out the clinic to streamline patient registration and medical claim billing

Coding all practitioner's charges ensuring all charges are filed accurately, and timely Auto/Casualty Claim Adjustor

American Family Insurance - Madison, WI

November 2013 to May 2014

Communicating directly with insureds and claimants regarding auto/casualty claims Investigating auto/casualty claims & assessing comparative negligence Conducting recorded statements/interviews, determining liability in auto/casualty claims Assessing injury value, settling first and third party bodily injury claims Working with attorneys regarding bodily injury claims Reviewing and paying subrogation demands

Medical Billing Specialist

Wisconsin Heart Group SC - Brookfield, WI

October 2011 to November 2013

Payment posting, charge entry.

Answering patient phone calls regarding their statements, taking patient payments. Working one on one with patients regarding insurance issues. Working 45 and 90 day a/r reports monthly.

Filing appeals with insurance companies using LCD and NCD guidelines for support, with patient medical records.

Following up on all appeals filed with-in 60 days of filing appeal. Scanning documentation into WHG electronic medical record system. Medical Biller and Customer Service

Alliance Staffing - Milwaukee, WI

June 2011 to October 2011

Assigned to a 90 day project for Outsource, a third party billing company Answering patient phone calls regarding their statements, taking and processing phone payments Working a/r 45 and 90 day reports monthly to follow up on all outstanding balances. Writing and filing appeals using LCD and NCD guidelines Senior Call Center Representative

Assurant Health - Milwaukee, WI

March 2006 to June 2011

Have detailed knowledge across 4 product lines.

Supporting a team of 68 call center representatives. Maintaining a Call Quality score of 98% or better for more than 5 years. Communicating daily with supervisor to manage call service levels and CSR development. Resolving escalated issues including Presidential Complaints, and supervisor calls. Providing peer coaching mentoring and aid in CSR development. Education

sciences and healthcare

Nathan Hale High School - West Allis, WI

1995 to 1999

Skills

• Quickbooks

• Front Office

• Utilization Management

• Insurance Verification

• Medical Coding

• Medical Records

• Epic

• Medical Billing

• Medical Terminology

• Microsoft Office (5 years)

• Microsoft Excel (10+ years)

• CPT Coding

• ICD-10

• EMR Systems

Assessments

Medical terminology — Proficient

September 2022

Understanding and using medical terminology

Full results: Proficient

Medical billing — Proficient

September 2022

Understanding the procedures and forms used for medical billing Full results: Proficient

Indeed Assessments provides skills tests that are not indicative of a license or certification, or continued development in any professional field.

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