Central Scheduler Claims Processor
Resume:
Laura Rippon
Central Scheduler, Medical Claims Processor, EDI Processor
Joliet, IL 60435
**********@*****.***
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.
Contact this candidate