Angie Wilson
Portland
Summary
Healthcare claims analyst with extensive expertise in analyzing and evaluating professional and facility claim submissions, payments, and refunds with precision and efficiency. Proven success in resolving complex claims issues while ensuring adherence to industry standards and regulations. Recognized for reliability and adaptability, consistently enhancing team collaboration and driving process improvements to optimize operational effectiveness. Committed to delivering high-quality results that support organizational goals and enhance patient care outcomes.
Overview
9
9
years of professional experience
Work History
Claims Analyst
Greater Oregon Behavioral Health, Inc.
01.2025 - Current
- Analysis of network provider payments for encounter-only, capitated providers as well as providers paid fee-for-service.
- Proficiency in mental health and substance use disorder coding (CPT, HCPCS, and ICD-10 codes) for both outpatient and inpatient services, including experience with coding for assessments, diagnostic evaluations, case management, peer services, transcranial magnetic stimulation (TMS), systems-based approach to process improvement.
- Knowledge of Center for Medicare and Medicaid Services and the Oregon Health Authority regulations, reporting requirements and guidelines.
- Root cause analysis of over and underpayments, denials, and inaccuracies in data collected for reporting purposes.
- Applying of a systems-based approach to process improvement, working across multiple departments (finance, data analytics, utilization management, compliance and coding auditing) to identify trends and patterns in processing errors.
- Use of pivot tables and vlookup in Excel; beginners level use of Tableau; PowerPoint for provider trainings and presentations, Word and Google Meets for web based meetings.
- Other duties assigned by supervisor, CFO, CEO and Clinical Director.
- Go-to person for all claims-related questions requiring advanced organization and time management skills; ability to communicate effectively with external and internal stakeholders to resolve problems and improve performance.
Medical Billing Manager
Vital Care Urgent Care Center
Battle Ground, Washington
08.2022 - 06.2024
- Coded and billed all urgent and primary care encounters using AthenaOne Health EMR.
- Worked all claim denials, resubmission and appeals for Medicare claims by calling the Medicare Administrative Contractor (MAC) or submitting through the online portal.
- Submitted Medicare Secondary Payor (MSP) forms.
- Worked all commercial and Medicaid claim denials, resubmissions and appeals via phone call or online portals.
- Assisted patients with insurance coverage and eligibility, acting as a liaison by contacting insurance companies if necessary to ensure patients’ needs are met.
- Assisted patients with completing application for Washington Medicaid (Apple Health) and explained the role of Managed Care Organizations (MCOs).
- Maintained accurate records of financial transactions utilizing Athena Health Electronic Health Records (EMR) system.
Behavioral Health Billing Supervisor
Neustart Psychiatry
Salem, Oregon
02.2020 - 04.2022
- Maintained accurate patient data and billing information in electronic health records system, Next gen.
- Submitted all outpatient provider claims electronically to insurance or billed as self-pay.
- Trained staff on behavioral health coding and stayed up to date on changes to policies and guidelines related to billing, and the 2021 E&M coding updates.
- Performed claims research, appeals and related follow-up using medical systems and software.
- Worked all insurance claim denials, including Medicare, Medicaid and commercial insurance claims.
- Assisted patients with applications for Oregon Health Plan and helped complete FMLA paperwork.
- Acted as HIPAA Compliance Officer for the practice, setting guidelines and procedures for compliance.
Health Insurance Member Services Representative (Contract)
NTT Data
Portland, Oregon
10.2019 - 02.2020
- Provide health insurance eligibility, benefits, and claim status information to incoming callers such as subscribers and medical, dental, and/or vision practice personnel.
- Advised patients and providers of prior authorization requirements and non-covered/exclusions to their plan.
- Collaborated with team/coworkers on policy changes, discrepancies, and updates.
- Advised members of appeal rights and reimbursement process for applicable out-of-pocket payments.
- Assisted patients with completing appeal forms and submitting required documents.
- Developed and maintained positive relationships with customers by providing timely, accurate information and solutions to their inquiries or problems.
- Kept records of customer interactions or transactions, recording details of inquiries.
Billing and Credentialing Coordinator (Contract)
Better Care Psychiatry
04.2022 - 08.2022
- Managed all physician billing, payor credentialing and contracting, and collections.
- Worked Medicare, Medicaid and commercial insurance denials, resubmissions and appeals by calling provider services or using the online portals.
- Trained and monitored billing staff on appropriate and optimal billing procedures and federal/state compliance (including HIPAA).
- Managed medical billing processes from insurance verification to payment posting and collections, ensuring accuracy and timeliness of payments and immediate working of claim denials or underpayments.
- Coordinated with various departments to ensure proper coding, documentation, and payment processing.
- Created reports to track outstanding balances and account activity.
- Monitored trends in the healthcare industry related to billing practices and procedures.
- Assisted patients with completing Oregon Medicaid (Oregon Health Plan) applications, Victims of Crime and FMLA paperwork, and assisted veterans with locating additional resources in the area such as housing and food banks.
Account Resolution Specialist
Oregon Billing and Collections, Inc.
Salem, Oregon
03.2017 - 08.2019
- Worked aging A/R for pain management claims, calling insurances and writing appeal letters to resolve payment issues.
- Wrote and submitted appeals for coding-related denials for plastic surgery provider claims.
- Developed and implemented collection strategies to reduce delinquency rates.
- Analyzed customer accounts to identify discrepancies and errors in billing information, tracking progress of unresolved cases until completion, or escalated to higher levels.
- Researched, documented, and resolved complex billing inquiries from patients via phone and email.
- Utilized eClinical Works EMR to review patient demographics and billing information, and to document action taken on accounts.
Education
Bachelor of Science (BS) - Public Health Studies with Concentration in Health Services Administration
Portland State University
Portland, OR06-2026
Associate of Arts Oregon Transfer (AAOT) - undefined
Chemeketa Community College
Salem, OR08-2024
Certification in Professional Medical Billing (CPB) - undefined
American Academy of Professional Coders (AAPC)
02-2022
General Education Diploma (GED) - undefined
Davidson County Department of Education
Nashville, TN03-1997
Skills
- Claims
- Claims analysis
- Interpersonal and written communication
- Policy interpretation
- Proficient in Excel, Word, PowerPoint
- Claim investigation
- Claims history analysis
- Accounting spreadsheets
- Claims trend analysis
- Data privacy initiatives
- Claims processing
- Critical thinking
- Customer service and support
- Team collaboration
- Claim form analysis
- Denied claims identification
- Benefits review
Timeline
Claims Analyst
Greater Oregon Behavioral Health, Inc.
01.2025 - Current
Medical Billing Manager
Vital Care Urgent Care Center
08.2022 - 06.2024
Billing and Credentialing Coordinator (Contract)
Better Care Psychiatry
04.2022 - 08.2022
Behavioral Health Billing Supervisor
Neustart Psychiatry
02.2020 - 04.2022
Health Insurance Member Services Representative (Contract)
NTT Data
10.2019 - 02.2020
Account Resolution Specialist
Oregon Billing and Collections, Inc.
03.2017 - 08.2019
Associate of Arts Oregon Transfer (AAOT) - undefined
Chemeketa Community College
Certification in Professional Medical Billing (CPB) - undefined
American Academy of Professional Coders (AAPC)
General Education Diploma (GED) - undefined
Davidson County Department of Education
Bachelor of Science (BS) - Public Health Studies with Concentration in Health Services Administration
Portland State University