Summary
Overview
Work History
Education
Skills
Timeline
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Carrie Zepeda

Chicago

Summary

Dynamic Revenue Cycle Specialist at Insight Medical Genetics, LLC.,

Revenue cycle professional with strong background in billing, and collections processes. Proven ability to enhance team performance and streamline operations to achieve optimal financial results. Known for effective collaboration, adaptability, and reliability. Skilled in revenue cycle management, regulatory compliance, and customer service.

Overview

19
19
years of professional experience

Work History

Government Refund Specialist

Viva USA/HCSC-Blue Cross Blue Shield of IL
02.2022 - 10.2024
  • update provider demographics when requested.
  • increase or decrease the amount owed by the provider to BCBS. .
  • Set up payments to be automatically processed by BCBS for balance due by provider.
  • Provide feedback on common issues to support training initiatives for team members.
  • Adapt quickly to changing policies and tools while maintaining high standards of service quality.
  • Adhered strictly to data privacy regulations while handling sensitive customer and provider information during the refund process, minimizing potential risks or breaches.
  • Developed strong working relationships with colleagues across various departments, facilitating smooth resolution of cross-functional issues involving refunds.
  • Provided excellent customer service, addressing concerns promptly and professionally to maintain high levels of satisfaction.
  • Actively contributed to team discussions on best practices for handling unique or challenging refund scenarios.

Revenue Cycle Specialist / Patient Insurance Spec

Insight Medical Genetics, LLC.
12.2015 - 05.2021
  • Analyzed revenue cycle data to identify trends and enhance billing accuracy.
  • Implemented process improvements that streamlined patient account management workflows.
  • Collaborated with cross-functional teams to resolve billing discrepancies and improve patient satisfaction.
  • Trained junior staff on revenue cycle best practices and software utilization.
  • Developed training materials to support ongoing education in revenue cycle processes.
  • Increased revenue by identifying and resolving billing errors in a timely manner.
  • Trained new team members on revenue cycle best practices, contributing to a more knowledgeable workforce.
  • Enhanced customer satisfaction by promptly addressing and resolving billing disputes.
  • Ensured accurate billing with thorough audits of patient accounts and insurance claims.
  • Reached out to insurance companies to verify coverage.
  • Contacted responsible parties for past due debts.
  • Achieved optimal reimbursement rates by verifying insurance coverage, eligibility, benefits, and authorization prior to service delivery.
  • Coordinated patient payment plans, balancing compassion with firmness to ensure timely payments while preserving positive patient relationships.
  • Identified and resolved payment issues between patients and providers.
  • Assisted patients in understanding complex billing statements, leading to increased trust between patients and healthcare providers.
  • Balanced and reconciled accounts.
  • Provided regular updates on billing status to upper management through detailed reports.
  • Collaborated with cross-functional teams to improve overall financial performance of the organization.
  • Reduced outstanding account balances by implementing effective collection strategies.
  • Improved patient satisfaction by providing clear, concise explanations of billing procedures and insurance coverage.
  • Played key role in transition to new billing system, ensuring smooth conversion with minimal disruption to operations.
  • Enhanced revenue collection efficiency with robust follow-up procedures on delinquent accounts.
  • Streamlined billing processes, significantly reducing errors in patient invoices by meticulously auditing and correcting discrepancies.
  • Triaged incoming calls to ensure prompt service
  • Reviewed insurance coverage, benefits and policies with clients to assess their insurance
    inquiries.
  • Balanced and prepared monthly statements
  • Processed refund request
  • Maintained HIPAA compliance
  • Nominated and received employee of the year award

Senior Patient Care Representative

Dental Works Office,
08.2014 - 12.2015
  • Managed daily front office activities.
  • Triaged patient inquiries.
  • Verified patient insurance eligibility and entered patient information into system.
  • Greeted and assisted patients with check-in procedures.
  • Processed payments using cash and credit cards, maintaining accurate records of transactions.
  • Compiled and maintained patient medical records to keep information complete and up-to-date.
  • Maintained office supply orders.
  • Assisted with other clerical duties as required.
  • Facilitated communication between patients and healthcare providers, ensuring clarity of information shared.
  • Supported insurance verification processes by gathering necessary documentation from patients and insurers in a timely manner.
  • Conducted pre-appointment confirmation calls to reduce no-shows and improve appointment scheduling.
  • Promoted a positive and welcoming environment by providing exceptional customer service to all patients, visitors, and staff members.
  • Managed sensitive patient information while maintaining strict confidentiality according to HIPAA regulations.
  • Stayed calm under pressure to and successfully dealt with difficult situations.
  • Answered incoming calls, scheduled appointments and filed medical records.

INTAKE/UTILIZATION COORDINATOR -TEAM LEAD

Medical Cost Management
05.2005 - 03.2014
  • Managed and triaged over 75 daily incoming
    calls.
  • Verified ICD9 and CPT codes using code manuals and policy resources to assure that pre-certification request were accurate.
  • Clarified pre-certification process and procedures according to individual health plan, medical benefits, policies and procedures for
    members, physicians, Medical office staff, contract providers and outside agencies.
  • Obtained clinical information pertaining to the specific request for certification.
  • Worked with the Clinical Services Team, Medical Director and Providers to ensure referrals are completed in accordance to
    Utilization Review Accreditation commission policies and procedures.
  • Responsible for adhering to requirements when processing certifications based on group plan specific preferences, including
    reviewing, verifying and processing assigned pre-certification requests for Inpatient, Outpatient and High-Tech Diagnostic Care.
  • Assisted Clinics in obtaining pre-certification for emergency admits, and for patients needing same day clinic visits/hospital
    admit/procedure.
  • Adhered to strictest confidentiality and to all HIPAA guidelines/regulations.
  • Prepared and maintained training manuals for new staff members and trained new employees of the Utilization Review
    Department.

Education

High School Diploma -

Thomas Kelly College Preparatory High School
Chicago, IL

Skills

  • Patience and tolerance
  • Compliance awareness
  • Dispute resolution
  • Customer service
  • Problem-solving
  • Attention to detail
  • Time management
  • Problem-solving abilities
  • Multitasking
  • Reliability
  • Excellent communication
  • Organizational skills

Timeline

Government Refund Specialist

Viva USA/HCSC-Blue Cross Blue Shield of IL
02.2022 - 10.2024

Revenue Cycle Specialist / Patient Insurance Spec

Insight Medical Genetics, LLC.
12.2015 - 05.2021

Senior Patient Care Representative

Dental Works Office,
08.2014 - 12.2015

INTAKE/UTILIZATION COORDINATOR -TEAM LEAD

Medical Cost Management
05.2005 - 03.2014

High School Diploma -

Thomas Kelly College Preparatory High School

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Carrie Zepeda