Ashley Houchens
Saint Joseph,IL
Summary
Proven Claims Specialist at Carle Health, adept in medical billing and fostering provider relations, enhanced claim processing efficiency by implementing best practices. Excelled in customer service, consistently exceeding billing targets, demonstrating exceptional attention to detail and multitasking abilities. Achieved a high level of accuracy in ICD-10 coding, contributing significantly to the financial stability of the healthcare facility.
Overview
12
12
years of professional experience
Work History
Claims Specialist
Carle Health
10.2021 - 06.2023
- Followed up with insurance providers on unresolved issues.
- Responded to correspondence from insurance companies.
- Used administrative guidelines as resource or to answer questions when processing medical claims.
- Reviewed provider coding information to report services and verify correctness.
- Monitored and updated claims status in claims processing system.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
- Verified patient insurance coverage and benefits for medical claims.
- Managed large volume of medical claims on daily basis.
- Coordinated with contracting department to resolve payer issues.
- Maintained confidentiality of patient finances, records, and health statuses.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Processed and recorded new policies and claims.
- Prepared insurance claim forms or related documents and reviewed for completeness.
- Responded to inquiries by answering questions, providing information and directing customers to appropriate resources.
- Reviewed insurance and claims documents to verify required information and secure any missing data for settlements.
- Contributed to the overall financial stability of the healthcare facility by consistently meeting or exceeding billing and collection targets.
- Maintained accurate patient records by diligently updating databases and following strict documentation guidelines.
- Utilized advanced knowledge of ICD-10 codes to accurately process complex medical claims.
- Managed high volume of claims, consistently meeting deadlines without compromising accuracy or quality.
- Developed strong relationships with healthcare providers to facilitate efficient information exchange regarding patient eligibility and benefits coverage.
- Expedited claim resolution times with proactive communication between patients, providers, and insurance companies.
- Collaborated with interdisciplinary teams to ensure smooth processing and accurate reimbursement of medical claims.
- Submitted electronic/paper claims documentation for timely filing.
- Improved claim processing efficiency by streamlining workflows and implementing best practices.
- Reduced errors in claims submissions through meticulous attention to detail and thorough review processes.
- Researched and resolved complex medical claims issues to support timely processing.
- Evaluated medical claims for accuracy and completeness and researched missing data.
Surgery Scheduling Specialist
Carle Health
10.2011 - 10.2021
- Developed strong client relationships through consistent communication and attentive service.
- Mentored junior team members, fostering professional growth through guidance on best practices in the industry.
- Oversaw daily operations of a busy office environment, ensuring tasks were completed efficiently and accurately.
- Followed all company policies and procedures to deliver quality work.
- Earned recognition as a top performer consistently exceeding targets throughout my tenure as a specialist in the field.
- Answered telephone calls to offer office information, answer questions, and direct calls to staff.
- Improved patient satisfaction by efficiently scheduling appointments and managing patient records.
- Coordinated patient scheduling, check-in, check-out.
- Gathered forms and copied insurance cards to collect patient information for billing and insurance filing.
- Expedited claims processing by accurately updating ICD-10 codes in accordance with changes in diagnosis or treatment plans from physicians'' notes.
- Promoted excellent customer service experience through prompt responses to voicemails and emails, addressing patient inquiries or concerns.
- Updated patient information and insurance details for accurate electronic medical records.
- Facilitated seamless coordination of appointments with specialists or diagnostic testing centers for comprehensive patient care services.
- Adhered to strict HIPAA guidelines to protect patient privacy.
- Registered patients and completed associated paperwork for accurate records.
- Prepared patient charts by gathering and organizing medical records ahead of appointments.
- Used EPIC EMR to schedule appointments for doctor visits and procedures.
- Provided prompt, polite and professional in-person and telephone customer service.
- Obtained pre-authorization from insurance companies ahead of medical services.
- Assisted physicians in providing high-quality care, completing insurance forms and handling referrals promptly.
- Maintained a clean reception area conducive to a professional atmosphere while adhering to safety guidelines during the COVID-19 pandemic.
- Collaborated effectively with interdisciplinary teams to optimize patient care plans based on individual needs and preferences.
- Maintained strict compliance with HIPAA regulations, ensuring the confidentiality of sensitive patient information.
- Placed new supply orders, managed inventory and restocked clerical spaces.
Education
High School Diploma -
St Joseph-Ogden High School
Saint Joseph, IL05.2000
Skills
- Medical Billing
- Insurance Verification
- Provider Relations
- Payment posting
- Medicaid knowledge
- Medical Coding
- Interpersonal abilities
- Claims Processing
- HIPAA knowledge
- EOB Analysis
- Claim Denials Management
- Medicare Expertise
- Claim Appeals Handling
- Medical software navigation
- Healthcare compliance
- ICD-10 Proficiency
- Medical Terminology
- Telephone Etiquette
- Organizational abilities
- Knowledgeable in EPIC EMR
- Customer Service
- HIPAA
- Medical record review
- Attention to Detail
- Multitasking Abilities
Timeline
Claims Specialist
Carle Health
10.2021 - 06.2023
Surgery Scheduling Specialist
Carle Health
10.2011 - 10.2021
High School Diploma -
St Joseph-Ogden High School