Alice Middleton

● Manage high-volume AR follow-up for hospital and physician claims with commercial,
Medicare, Medicaid, and managed care payers.
● Investigate denied, rejected, and underpaid claims by reviewing EOBs, claim edits,
payer policies, and medical documentation.
● Submit corrected claims, appeals, reconsiderations, and supporting documentation to
maximize reimbursement and reduce write-offs.
● Work aging reports and prioritize high-dollar accounts to improve collection rates and
reduce AR days.
● Utilize payer portals including Availity, NaviNet, UHC Provider Portal, and Medicare
portals for claim status and resolution.
● Analyze denial trends and collaborate with internal departments to reduce recurring
claim issues.
● Review eligibility, authorization, coordination of benefits, and coding-related denials to
determine root cause and resolution steps.
● Maintain productivity and quality metrics while consistently meeting departmental
turnaround expectations.
● Assist patients with account questions, insurance explanations, and payment-related
concerns professionally and empathetically.
● Support end-to-end revenue cycle functions while ensuring HIPAA compliance and
accurate account documentation.

● Performed insurance follow-up on outstanding medical claims for physician and facility
accounts.
● Contacted insurance companies to resolve denied, delayed, or unpaid claims and obtain
claim status updates.
● Reviewed EOBs and remittance advice to identify denial reasons and initiate corrective
actions.
● Resolved denials related to authorization, timely filing, eligibility, coding, modifier usage,
COB, and medical necessity.
● Submitted appeals and corrected claims with appropriate documentation to secure
reimbursement.
● Worked multiple payer types including Medicare, Medicaid, BCBS, Aetna, Cigna,
Humana, and UnitedHealthcare.
● Maintained detailed account notes and followed payer guidelines for claim escalation
and reconsideration.

● Collaborated with billing, coding, and patient access teams to resolve claim
discrepancies efficiently.
● Helped reduce outstanding AR balances by consistently resolving aging accounts and
improving payment turnaround times.
● Utilized EMR systems, clearinghouses, and payer portals to track and manage claim
activity.

● Registered patients accurately while collecting demographic, insurance, and
authorization information.
● Verified insurance eligibility, benefits, and coverage prior to patient visits and procedures.
● Assisted patients with scheduling, financial counseling, copay collection, and payment
options.
● Obtained prior authorizations and ensured all required documentation was completed
before services.
● Maintained compliance with HIPAA regulations and hospital registration policies.
● Coordinated with clinical and billing departments to ensure clean claim submission and
minimize registration errors.
● Provided excellent customer service while managing high patient volumes in a
fast-paced healthcare environment.
● Updated patient records and insurance information to improve claim accuracy and
reduce denials.