Cheryl Modester

Dallas, TX

Professional Summary

• Experienced Customer Service Professional with billing and insurance experience from Steward Healthcare, Post Acute Medical, and Conifer Health.

• Communicate via phone calls to payers regarding payments, under paid and/or claims not paying according to the current contract on file.

• Excellent written and verbal communication skills with the ability to work with customers to quickly come to resolutions.

• Proficient in Microsoft Office Suite, EPIC, Xclaim, and proprietary systems.

• Familiar with various insurance carriers: Medicare, Medicaid, Workmans Comp, BCBS, and Commerical Carriers

(HMO, PPO, EPO, etc).

Professional Experience

Post Acute Medical Inpatient Rehab May 2022 – Oct 2023 AR Collector/Billing Specialist

• Respond to government and commercial payer’s correspondence concerning Inpatient Rehabilitation Facility claims.

• Aggressively work aged accounts t to expedite cash, and/or A/R.

• Communicate via phone calls to payers regarding payments, under paid and/or claims not paying according to the current contract on file.

• Meet corporate goals monthly concerning billing and collections. Review denied claims for no authorizations as well as review payer guidelines, co-payment and pricing per payer policy. Submit financial and/or clinical appeals.

• Request and Review medical records for review so r claims that were denied can be overturned and paid accordingly.

Steward Healthcare May 2019 – May 2020

Billing Specialist

• Prepares and submits clean claims to insurance companies either electronically or by paper in an accurate, timely and compliant manner.

• Collects and verifies all documentation necessary for timely billing of patient accounts, including requesting and collecting medical records and other documents ensuring the acceptance of the claim.

• Works all reports related to billing, such as worklists, hold reports, and rejection reports to ensure claims are submitted timely and accurately, per billing guidelines.

• Processes claims for secondary insurance carriers, attaching all required documentation to ensure claims are filed to appropriate payers.

• Understands all payer guidelines related to claim submission; is knowledgeable and proficient with payer websites and other useful resources pertaining to the billing function.

• Focuses daily on complying with policies, processes and department guidelines for billing and claim edit resolution.

• Maintains strict confidentiality and adheres to all HIPAA guidelines/regulations. Alliance RX Walgreens Prime Nov 2017 – Feb 2019

Insurance Verifications Specialist

• Utilizes all available resources to obtain and enter insurance coverage information for ordered services into a patient's file.

• Verifies patient insurance coverage of medications, administration supplies and related pharmacy services through proper investigation into either major medical benefits (including Medicare) or pharmacy benefits.

• Initiate the prior authorization and notify practitioner offices.

• Completes Major Medical Verification.

• Provides notification of urgent orders to the Group Supervisor and communicates with other departments when an urgent need for filling a prescription or delivery is necessary.

• Places outbound calls to patients or physicians’ offices to obtain additional information needed to process the script or to notify of delay in processing script. Conifer Health Solutions Sept 2014 – July 2017

Patient Account Representative

• Outbound calls to various insurance carriers: Commercial (BCBS, Aetna, Humana, etc) timely follow-up on all accounts assigned, account documentations, daily calls to payers to obtain payment resolution and account status information, scanned account correspondence and incoming documents to system, account payments, patient letters, refund requests, customer disputes, research and resolve invoices.

• Worked 50+ accounts daily, update patient account information to ensure timely payment, reconsiderations for in/out of network claims of member insurance benefit amounts for higher allowable amount, insurance verifications of member benefits, validation of claims and electronic billing of member benefits, validation of claims and electronic billing, appeals/denials, medicaid/medicare, self-pay after insurance. Education & Certifications

Mansfield Business College

Accounting Certificate, GPA 3.0

Business and Management Center High School

High School Diploma

Contact this candidate