Customer Service Revenue Cycle
Resume:
Michele Schroeder
***(***-****) *********************@*****.***
Detail-oriented and dedicated Customer Service/Billing Specialist with 5+ years of experience in revenue cycle management. Proficient in navigating the complexities of revenue cycle management billing to ensure accurate and efficient reimbursement processes for internal and external professionals and customers. Well-versed in industry-standard software and compliance guidelines, maintaining strict adherence to confidentiality and regulatory requirements. Possesses strong analytical and problem-solving skills, along with excellent communication abilities to facilitate effective collaboration with professionals, and customers in resolving billing issues promptly. Seeking an opportunity to leverage expertise in auditing, cryptocurrency, customer service/billing, and or research to contribute to the financial success of a reputable banking organization.
Work Experience
Patient Account Representative
TRC Staffing 12/2022 - 06/2023
Assigned to Medicare Advantage payors for claim status follow-up.
Assisted with resolving outstanding claims.
Worked to appeal any denials by providing additional/missing information.
Understanding and Knowledge of coordination of benefit and explanation of benefits
Verified documentation and eligibility of benefits.
Understanding and Knowledge of coordination of benefit and explanation of benefits.
Maintained client files.
Stayed up to date on complex insurance regulations.
Performed other administrative support duties as needed.
Insurance Follow Up Denial Specialist
Edward Elmhurst Health Care 08/2021 - 06/2022
Assigned to Commercial and Veterans payors for claim status follow-up.
Assisted with resolving outstanding claims.
Verify documentation and eligibility of benefits
Update insurance information for existing patients
Call to obtain pre-authorization and referrals for recommended services and procedures.
Submit appeals and reconsideration for denials by providing additional/missing information
Inform relevant clinical staff about denials
Stayed up to date on complex insurance regulations
Performed other administrative support duties as needed
Understanding and Knowledge of coordination of benefit and explanation of benefits
Appeals and Grievance Specialist
Annuity Health 03/2018 - 07/2021
Reviewed and appealed denials for all payors.
Researched various sources of information to determine appropriateness of appeal.
Completed various types of denial reviews, appeal, and further action.
Requested appropriate charge corrections for rebilling.
Added prior authorization to claim if missing and submit as corrected claim
Recommended or educated others on proper documentation, payer processes, and policies with a denial prevention strategic focus.
Escalated any discrepancies and issues encountered to supervisors in a timely manner.
Kept up to date on department and organization policies as well as payer and all regulatory and compliance rules and regulations.
Participated in any meetings, phone conferences or webinars as needed in order to properly process denials or expand knowledge regarding the appeal process, changing rules and regulations.
Education
Associate Degree in Applied Science Liberal Arts - Morton College
Skills
Excellent Customer service
Intensive Collection
Insurance Verification, Prior Authorization
Accounts Receivable Specialist
Denial Specialist
Athena, Availity, Centene, Epic, Meditech, Ecare, Onesource
Appeals and Grievance Specialist
Revenue Cycle Management
Advocate Health Care, Copley Memorial, MT Sinai, University of Chicago, ST Anthony Chicago, Innova HealthCare Systems
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