Senior Reimbursement Specialist with Data-Driven Focus

IRIS P. WALKER

Email: ************@*****.*** Phone: 919-***-****

OBJECTIVE

Seeking a role where I can apply my expertise, analytical skills, and collaborative strengths to deliver high-quality support and measurable value while continuing to grow professionally.

PROFESSIONAL EXPERIENCE

United BioSource, King of Prussia, PA (Nov 2024–Feb 2025)

Senior Reimbursement Specialist

Conduct benefit investigations and verify insurance benefits for patients and physicians’ offices; submit prior authorizations and manage recertification for extended treatments.

Accurately enter and maintain data in client databases, ensuring completeness for case status determination.

Participate in conference calls with Client Sales Representatives, Management, and physician offices to discuss case status and funding.

Coordinate product orders, shipments, and therapy initiation with pharmacies and patients.

Respond to incoming calls from patients, insurance companies, physicians, sales reps, pharmacies, and homecare agencies; serve as a single contact for assigned prescribers.

Identify and report events as required by REMS; recognize adverse events and escalate to appropriate team members.

Educate stakeholders on program requirements and facilitate referrals. Ensure compliance with safety and environmental procedures.

Utilized client database and digital tools to track outstanding items and monitor workflow, optimizing case management through data-driven insights.

Collaborated with cross-functional teams to ensure timely communication and resolution of patient cases, leveraging digital platforms for enhanced efficiency.

Its Fashion/Cato Fashions, Garner, NC (Aug 2022-Oct 2024)

Assistant Store Manager

Recruit, hire, train, and supervise associates in manager’s absence; review performance and provide feedback.

Supervise sales operations and manage retail goods and services, including money drop procedures.

Schedule and train staff, collaborate on team goals, and process merchandise and vendor shipments.

Resolve customer complaints and grievances, ensuring a positive shopping experience.

Perform open/close procedures and bank deposits.

Employed digital scheduling and inventory management systems to streamline operations and improve team productivity.

Utilized digital retail management tools to enhance inventory tracking and customer service responsiveness.

Aerotek, Morrisville, NC (Dec 2019–Apr 2020)

Reimbursement Case Manager / Medical Claims Representative

Expert in reimbursement and medical/pharmacy benefits investigations; resolved billing and authorization issues.

Maintained credentialing systems and coordinated documentation for provider credentialing.

Processed appeals, maintained records, and ensured compliance with payers including Medicare, Medicaid, VA, and DoD.

Handled data entry, insurance verification, and patient assistance.

Leveraged electronic health record (EHR) systems and claims processing platforms for efficient case management and documentation.

Applied data analytics to identify patterns in claim denials and optimize reimbursement strategies.

Wake Spine and Pain Specialists, Cary, NC (Aug 2018–Dec 2019)

AR Billing Specialist

Resolved Medicare and commercial account balances; followed up on insurance denials and appeals.

Verified insurance, obtained authorizations, estimated bills, and established payment plans.

Processed bi-monthly payments, mailed statements, and responded to patient inquiries.

Documented account actions and collaborated with team to achieve goals.

Utilized billing software to automate payment processing and track claim status, improving workflow efficiency.

Intermedix/RDMG, Raleigh, NC (Feb 2009–June 2018)

AR Billing Specialist

Resolved A/R balances, followed up on denied claims, validated billing codes, and submitted corrected claims.

Handled online claim submissions and resolved secondary balances.

Obtained medical records for appeals and documented patient account actions.

Assisted clinics with registration, insurance verification, and new employee training.

Integrated digital claim submission processes and electronic communication with payers to reduce processing time.

Medical Edge Healthcare Group/RDMG, Raleigh, NC (Jun 2006–Feb 2009)

Customer Service Representative

Resolved billing inquiries, updated account demographics, submitted insurance claims, and processed payments.

Performed account adjustments and documented corrective actions.

Utilized customer relationship management (CRM) tools to track patient communications and improve service delivery.

US Oncology, Raleigh, NC (Jan 2006–Apr 2006)

Patient Accounts Representative

Processed payments, resolved insurance balances, updated patient demographics, and submitted electronic claims.

Managed Medicaid, self-pay, payment plan, and indigent accounts.

Generated Excel reports to monitor account aging and optimizing collections.

Oncology Hematology West PC, Papillion, NE (2001–2005)

Coordinator Payments & Refunds / Patient Accounts Representative

Bergan Mercy Hospital, Omaha, NE (1998–2001)

Medical Secretary – Cardiology Associates

Bellevue Family Practice (1992–1998)

Medical Receptionist

EDUCATION

Metro Community College, Omaha, NE – Certified Medical Terminology (1993)

Nebraska College of Business (Hamilton College), Omaha, NE – Certificate Computer Office Skills (1991)

RELEVANT COURSEWORK

CPT Coding Directives, ICD-10 Correct Medical Coding Directive, ICD-10 Diagnosis Coding for the Physician Office

Reimbursement Strategies for Medical Oncology, Medical Oncology Reimbursement Made Easy, Mastering the Basics of Medical Oncology Coding

Winning Strategies for Oncology Reimbursement, Oncology, Coding, Reimbursement and Compliance Update

Hospital Inpatient & Outpatient, Stop Burnout Stress Management for Caregivers, Principles of Medical Record Documentation

COMPUTER SKILLS

Microsoft Office (Excel, Word, Outlook, Word Perfect), 10 key by Touch, + Medic/Mysis, Tiger Medic, Group cast/ IDX Billing system, Flowcast, Allscripts, Emdeon, Payerpath, In-Contact Phone System, Eclinical Billing system, Claim Remedy clearinghouse, Chartfinder Medical records, Ring Central Call System, Max Agent, Zoom, UltiPro, Salesforce, Eagleforce, FiveNine,Genesys Cloud

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