Abigail Elu

Collaborated with department leadership to ensure accurate and timely submission of claims information while staying informed on industry trends and reimbursement updates.

Monitored unpaid claims, corrected discrepancies, and managed appeals for denials and underpayments, conducting root cause analysis to prevent recurring insurance issues.

Researched denied claims by reviewing EOBs and Remittance Statements (R&S) and contacting payers to determine denial reasons and appropriate resolution steps.

Processed pediatric facility claims and managed DRG-based reimbursements to ensure accurate hospital payment.

Resolved billing system edits and claim work queue (WQ) errors by partnering with clinical departments, coding teams, and patient registration to ensure timely and accurate corrections.

Identified and tracked recurring claim errors, analyzed reimbursement patterns, and reported inaccurate payment or contractual discrepancies.

Conducted timely follow-up with payers and guarantors, thoroughly documenting account activity, conversations, and resolution outcomes.

Reviewed account details to support appropriate write-offs for inclusive CPT codes based on payer guidelines.

Managed hospital revenue cycle and insurance collections for commercial payers (BCBS, Aetna, UHC) and government programs, including Traditional and Managed Medicaid plans.

Corrected Medicaid claims in electronic billing systems to resolve missing or invalid patient and insurance information in compliance with billing procedures.

Ensured accurate billing and timely submission of both electronic and paper claims.

Verified and coordinated insurance benefits across multiple service lines to support proper claim adjudication.

Monitored claim status, investigated rejections and denials, and documented all related account activities.

Resolved accounts efficiently and accurately to maximize reimbursement while performing detailed investigative review in high-volume, fast-paced environments.

Posted adjustments and processed insurance payments for Medicare, Medicaid, Managed Medicaid, and commercial payers.

Performed follow-up on unpaid insurance accounts identified through aging reports to secure timely reimbursement from Medicare, Medicaid, Managed Care, and commercial insurance carriers.

Contacted insurance companies to verify patient coverage and confirm eligibility prior to claim processing.

Reviewed and analyzed commercial accounts and hospital revenue cycle collections to ensure accurate reimbursement.

Examined claim documentation for missing or incomplete information and corrected errors to prevent delays in payment.

Evaluated denied claims and reported appeal recommendations to management when escalation to the payer level was appropriate.

Scheduled and maintained follow-up activities based on claim status to ensure timely resolution.

Identified and billed secondary insurance carriers to maximize reimbursement.

Reviewed RA/EOB statements carefully and posted payments accurately, maintaining strong attention to detail.

Managed inbound and outbound calls related to patient accounts, insurance verification, and claim follow-up.

Documented account issues thoroughly and provided management with detailed reports and recommended next steps, ensuring continuous follow-up.

Communicated daily with insurance representatives and commercial payers to resolve coordination of benefits and outstanding claims.

Contacted patients when necessary to obtain updated insurance or demographic information to support prompt claim resolution and payment.

Identified and communicated payer trends, including recurring denials related to specific procedures, diagnosis codes, or billing practices.

Consistently met customer service call standards, including service level agreements, handle time, and productivity targets.

Responded to customer inquiries through phone and written communication, researching issues thoroughly and providing clear, accurate resolutions.

Delivered both technical and customer service support by understanding member concerns, assessing each situation carefully, and explaining the most appropriate solution.

Maintained strict compliance with HIPAA regulations in all daily interactions to protect sensitive health information.

Ensured high levels of member satisfaction by providing professional, empathetic, and solution-focused support.

Assisted members with filing grievances and appeals, guiding them through the process and ensuring proper documentation.

Managed a high volume of health insurance–related calls and correspondence while maintaining accuracy and professionalism.

Helped members locate primary care physicians (PCPs) and in-network providers based on their coverage and plan benefits.

Documented all member interactions accurately in the system to ensure proper tracking, follow-up, and compliance with internal policies.

Educated members on their benefits, coverage limitations, and claims processes to help them better understand their health plan and avoid future issues.