Caroline Arveson

• Allina RCM was acquired by UnitedHealth Group (UHG)

• Worked medical claims denials, determined the reason for the denial, appeal, call the payers for status until the claim is at a zero balance.

• Monitored EPIC PB Work Queues (WQs) for, account, claim rejects, resubmit claims, follow-up on claims and coding changes requests.

• Maintained a production standard and accuracy rate of over 95%.

• Submitted, processed, and resolved claim rejections using Claimlogic and EPIC systems.

• Completed the appeal process by electronically retrieving and submitting supporting records.

• Reviewed and resolved outstanding claims.

• Obtained prior and retro authorizations as required.

• Utilized payer websites to check claim status and review denial reasons.

• Communicated with insurance companies to obtain claim status and denial reasons.

• Provided billing support and educational feedback within RCM.

• 9 years' experience working remote and making production standard.

• Completed 11,000 claim in 2023 with a 100% accuracy.

• Company Overview: Acquired by UnitedHealth Group (UHG)
• Worked medical claims denials, determined the reason for the denial, appeal, call the payers for status until the claim is at a zero balance
• Monitored EPIC PB Work Queues (WQs) for, account, claim rejects, resubmit claims, follow-up on claims and coding changes requests
• Maintained a production standard and accuracy rate of over 95%
• Submitted, processed, and resolved claim rejections using Claimlogic and EPIC systems
• Completed the appeal process by electronically retrieving and submitting supporting records
• Reviewed and resolved outstanding claims
• Obtained prior and retro authorizations as required
• Utilized payer websites to check claim status and review denial reasons
• Communicated with insurance companies to obtain claim status and denial reasons
• Provided billing support and educational feedback within RCM
• 9 years' experience working remote and making production standard
• Completed 11,000 claim in 2023 with a 100% accuracy
• Acquired by UnitedHealth Group (UHG)

• Check in, scheduled appointments, completed patient registration, and verified insurance coverage
• Scanned medical records into EPIC and ensured accurate documentation
• Demonstrated positive customer service and quality commitment
• Verified patient information and created provider schedule templates

• Released patient records to patients and insurance providers in compliance with regulations
• Answered phones and managed medical records requests efficiently
• Evaluated authorizations for disclosure compliance

• Reviewed and released claims from EPIC Work Queues (HB)
• Addressed and resolved patient concerns related to claims
• Analyzed accounts to ensure all EPIC follow-up Work Queues were current
• Managed appeals in EPIC Work Queues assigned to me

• Billing Supervisor (when Supervisor is not present) to assist with any questions
• Researched and resolved root causes of claims issues and submitted changes to the system
• Answered questions on CPT, ICD-9, and HCPCS coding
• Audited hospital claims to ensure standard procedures are followed, couch employees with improvements to be more effective and provided feedback and training to staff
• Demonstrated project management skills and researched coding requirements

• Processed transplant patient claims and obtained prior authorizations
• Resolved unpaid accounts by handling appeals to payers
• Coordinated all billing activities for transplant patients
• Secured transplant patients before adding them to the national transplant waiting list