Laura Rippon

Central Scheduler, Medical Claims Processor, EDI Processor

Joliet, IL 60435

adw7ux@r.postjobfree.com

+1-815-***-****

Authorized to work in the US for any employer

Work Experience:

Radiologist Scheduler

Duly Healthcare

March 2023 to Present

INBOUND SCHEDULING CALL CENTER for scheduling tests such as MRI'S, CT SCANS

Central Scheduler

R1 RCM - Joliet, IL

June 2019 to March 2023

INBOUND SCHEDULING CALL CENTER for scheduling tests such as MRI'S, CT SCANS, OTHER DIAGNOSTIC TESTS to be done for 4 different hospital facilities, verifying insurance, running medical necessity for medicare patients, while meeting KPI requirements.

EDI PROCESSOR

DuPage Medical Group - Downers Grove, IL

January 2019 to June 2019

Processing error rejections from the payor within Epic before they were released or fixing rejected claims that got to the payor and were rejected, scrubbing the claims as well.

Follow-up Insurace Specialist

RevMD Partners - Lombard, IL

November 2018 to January 2019

Working on a AR off of a in house system.

Following up on claims that haven't been paid on and using multiple systems such Quadax, Availity, Meditech and different web portals for different sorts of health plans.

Medical Claims Processor

APEX HEALTHCARE - Naperville, IL

December 2016 to October 2018

• Retrieved data from Meditech system and accurately entered the information into Medisoft.

• Created claims to be billed to health plans using Medisoft.

• Verified member's eligibility and claim status through different web portals including Availity.

• Reviewed and completed Aging Revenue reports.

• Posted claim payments using the Medisoft program. Medicaid Claims Analyst

Apex Healthcare

2014 to 2016

• Utilized 3M Encoder software for inpatient and outpatient claims to ensure DRG's would go through the Illinois State calculator.

• Analyzed claims to make certain health plan guidelines and procedures were completed so that proper payment was received. This included completing member eligibility, obtaining authorizations and making sure add-ons, percentages and per-diems were calculated correctly for both inpatient and outpatient dates of service.

• Answered inbound calls from members and providers regarding claim statuses, member eligibility and PCP changes.

• Resolved claim issues in order to process them through the claims analyst department.

Utilization Management Representative

Apex Healthcare

2007 to 2009

• Called hospitals to obtain patient discharge dates and clinical reviews and entered the information into the Apex's database for a nurse to review.

• Entered incoming referral requests into health plan system for outpatient procedures to be reviewed.

• Received inbound calls from providers requesting referral status and referral authorization approval codes.

• Completed daily reports using D-Base to correct errors on EOB's and payments.

• Created EOB report using the Visual program for claims analysts to review and make corrections to EOBs as needed.

• Processed final payments and created payment checks using D-Base. Education

High school or equivalent

Lockport Township High School East

Skills

• CUSTOMER SERVICE (5 years)

• MEDISOFT (2 years)

• MEDITECH (10+ years)

• Microsoft Outlook (7 years)

• Organizational Skills (10+ years)

• Billing (2 years)

• Outlook

• Typing (10+ years)

• Word (10+ years)

• EDI

• Medical Scheduling (3 years)

• EPIC

• Insurance Verification (4 years)

• EMR Systems (10+ years)

• ICD-10

• Medical Coding

• Genesys Cloud (2 years)

• One Source (5 years)

Additional Information

Skills

• Software: EPIC, 3M Encoder, Availity, Health Plan Portal, Google Sheets, Internet Explorer, MD- Online, Medi (State of Illinois Web portal), Medisoft, Meditech, Microsoft Excel, Outlook, Word and Softident, QUADAX, EMR, Gensys, Activefax, Teams

• Dedicated, detailed, efficient, excellent customer service, great communicator, innovative, punctual, organized, responsive, works well with others.

• Proficient in various types of coding software.

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