Carol McGruder

Credit Collections Representative

Children's National Hospital

Washington, D.C

01.2005 - Current

Account Management, Client Relations, Receive denial correspondence from insurance companies via email or payment posting process
When claims are not being paid, maybe electronic or paper format, evaluate the type of denial using codes and prioritize the number of claims
Proactively follow up on submitted claims to determine payment issues through telephone or web contact in a timely manner
Manage a large volume of denials to maximize reimbursement
Administer and maintain company financial documentation and generate correspondence concerning claims and appeal process
Research reason for denial and collect more information and documentation, review system records to identify source of denial and health Information to collect necessary information and documents referral and authorizations for the appeal process
Review demographics, insurance and charge entries to assure correct input and system compliance
Monitor error trends to determine if it's a staff or system issue and I report to the Management
Perform Special projects that are given for follow up with the insurance
Continuously validate and verify information needed for decision making or documentation
May follow-up with parent if insurance has paid the patient, and for any other information needed to have the claim processed and paid
Prioritize work to facilitate payment of higher account balances
Identify and report trends in denial and appeal claims, inform manager, and work closely to identify appeal and follow-up strategy for getting the claims processed and paid
Assist co-coworkers when they need help
And recommend adjustments for write-offs over my limit to the manager as appropriate and attach documentation needed for processing the adjustments.

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