Summary
Overview
Work History
Skills
Certification
Personal Information
References
Additionalinformation
Timeline
Generic

Charity D Elsten

Elwood,Indiana

Summary

Self-directed Medical Claims Analyst knowledgeable in customer service practices, payment processing and medical billing. Collects and validates patient demographics, prepares medical charts and conducts insurance verification. Detail-oriented team player comfortable working independently. Committed to achieving company objectives and providing excellent assistance to patients.

Overview

19
19
years of professional experience
1
1
Certification

Work History

AR Claims Review

Anesthesia Services LTD
08.2024 - Current
  • Maintained compliance with industry regulations by meticulously reviewing all relevant documents during the claims process.
  • Evaluated complex cases using critical thinking skills, effectively identifying discrepancies requiring further investigation or escalation as necessary.
  • Identified insurance coverage limitations with thorough examinations of claims documentation and related records.
  • Researched claims and incident information to deliver solutions and resolve problems.
  • Negotiated claims payer settlement agreements to resolve disputes
  • Maintained strict confidentiality with all personal data as per company guidelines.
  • Conducted day-to-day administrative tasks to maintain information files and process paperwork.
  • Directed claims negotiations and supported successful litigations for advanced issues.
  • Ensured accurate payments by meticulously reviewing medical records, invoices, and supporting documentation.
  • Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
  • Researched and resolved complex medical claims issues to support timely processing.
  • Verified patient insurance coverage and benefits for medical claims.
  • Monitored and updated claims status in claims processing system.
  • Evaluated medical claims for accuracy and completeness and researched missing data.
  • Responded to correspondence from insurance companies.
  • Followed up on denied claims to verify timely patient payment and resolution.
  • Identified and resolved discrepancies between patient information and claims data.
  • Generated, posted and attached information to claim files.
  • Prepared insurance claim forms or related documents and reviewed for completeness.
  • Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.

Revenue Cycle Claims Analyst

Indiana University Health
12.2018 - 09.2023
  • Responsible for managing patient accounts and resolving payment issues
  • Applied insurance payments and contractual discounts to patient accounts.
  • Managed high-volume caseloads, prioritizing tasks to ensure timely completion of all claims.
  • Demonstrated a high level of accuracy and attention to detail in reviewing claim documentation for approval or denial decisions.
  • Conducted thorough investigations into each claim, gathering relevant data and documentation to support decision-making processes.
  • Examined claims forms and other records to determine insurance coverage.
  • Verified insurance of patients to determine eligibility.
  • Communicated with insurance providers to resolve denied claims and resubmitted.
  • Managed appeals process for denied claims, resulting in successful reimbursements from insurance companies.
  • Ensured timely payments from insurance providers through submission of accurate and complete claims.
  • Reduced claim denials by meticulously reviewing patient insurance information and coding practices.
  • Enhanced revenue collections for the medical practice with diligent follow-ups on unpaid claims.
  • Accurately entered patient demographic and billing information in billing system to enable tracking history and maintain accurate records.
  • Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers.
  • Maintained up-to-date knowledge of billing software and healthcare regulations, contributing to department's compliance and efficiency.

Patient Account Representative

Community Health Network- Business Office
05.2015 - 09.2017
  • I was hired for new position created to review, correct, rebill or write off retroactive medical claims for facilities.
  • Verified insurance of patients to determine eligibility.
  • Communicated with insurance providers to resolve denied claims and resubmitted.
  • Managed appeals process for denied claims, resulting in successful reimbursements from insurance companies.
  • Filed and updated patient information and medical records.

Surgery Scheduler

Community Health Network- Castleton Ob/Gyn
05.2013 - 05.2015
  • Managed patient information in an efficient and confidential manner
  • Educated patients on pre-surgery requirements, such as fasting protocols or medication adjustments, resulting in fewer complications on the day of the procedure.
  • Handled urgent requests effectively, prioritizing cases requiring immediate attention while also balancing routine surgery demands appropriately.
  • Expertly managed planning, scheduling, and coordination of outpatient procedures.
  • Verified insurance coverage and obtained pre-authorizations.
  • Maintained strict confidentiality in handling sensitive patient information, adhering to HIPAA guidelines and clinic policies.
  • Obtained pre-authorizations and pre-certifications ahead of scheduled surgeries.
  • Resolved scheduling conflicts to maintain high-quality patient services.
  • Answered telephone calls to offer office information, answer questions, and direct calls to staff.
  • Acted as a liaison between patients, insurance carriers, and the surgical team to secure necessary authorizations for timely procedures.
  • Ensured optimal patient care by maintaining detailed records of medical histories, insurance information, and surgical consents.
  • Enhanced patient satisfaction by providing clear explanations of surgical procedures and addressing concerns promptly.
  • Reduced surgery cancellations with thorough pre-operative assessments and communication with patients.
  • Minimized patient wait times through effective management of daily surgery schedules.
  • Maintained accurate records for billing purposes, ensuring proper reimbursement from insurance carriers and patients alike.
  • Enhanced patient experience by efficiently scheduling and confirming surgical appointments.
  • Increased operational efficiency, managing surgery schedules to accommodate urgent cases without major disruptions.
  • Streamlined insurance verification processes, ensuring all procedures were approved and properly documented.
  • Assisted with medical coding and billing tasks.
  • Performed various administrative tasks by filing, copying and faxing documents.

Patient Account Coordinator

Community Health Network- Castleton Ob/Gyn
07.2005 - 07.2013
  • Accurately entering patient information to process medical claims in a timely manner
  • Expertly analyzing and verifying accuracy of medical claims
  • Resolving any discrepancies or inconsistencies in medical claims
  • Submitting claims to all relevant parties for appropriate payment
  • Providing prompt follow-up to ensure the timely processing of all claims
  • Monitoring and tracking unpaid/denied claims
  • Utilizing excellent customer service and communication skills to resolve customer inquiries
  • Experience with analyzing and reconciling claims to ensure accuracy and compliance for facility claims
  • Proficient in claims processing and payment systems, medical coding, and patient accounts
  • Knowledge of insurance billing policies, claims processing, and government and private reimbursement guidelines
  • Experienced in managing and working denied claims and appeals by researching and responding to payers
  • Responsible for timely and accurate billing of medical claims
  • Research and respond to customer inquiries
  • Follow up on unpaid claims and investigate for payment
  • Keep detailed records of all claims data
  • Maintain up-to-date knowledge of insurance policies and procedures
  • Communicated with patients, doctors, and other medical staff to ensure the accuracy of patient records and surgical appointments
  • Entered patient data into the computer system and retrieved information as needed
  • Generated monthly financial reports and patient account statements
  • Led the daily operations of the patient accounts department
  • Performed collections on past due accounts and implemented payment plans
  • Resolved customer inquiries in a timely manner
  • Built and maintained relationships with insurance companies to ensure accurate and timely payment
  • Negotiated payment arrangements with delinquent account holders, ultimately reducing bad debt write-offs for the organization.
  • Reduced errors in claim submissions, ensuring thorough verification of patient information and coverage details.
  • Increased accuracy in payment postings by carefully reviewing remittance advices and applying adjustments as needed.
  • Enhanced revenue collection by diligently monitoring outstanding accounts and initiating timely followups.
  • Developed comprehensive knowledge of multiple insurance plans, allowing for efficient navigation of varying requirements and processes.
  • Provided exceptional customer service while addressing complex billing questions from patients or their representatives over phone or email communications.
  • Assisted in training new staff members on department procedures, contributing to a cohesive work environment.
  • Facilitated clear communication between patients, healthcare providers, and insurance companies to resolve discrepancies and maintain positive relationships.
  • Streamlined the billing process for increased efficiency with thorough review of insurance claims and accurate data entry.
  • Maintained strict confidentiality when handling sensitive patient information, adhering to HIPAA guidelines at all times.
  • Improved patient satisfaction by efficiently handling account inquiries and resolving billing issues.
  • Prepared accurate and timely reports on account activity for management review, enabling informed decisionmaking.
  • Posted payments and processed refunds.
  • Electronically submitted bills according to compliance guidelines.
  • Contacted patients after insurance was calculated to obtain payments.
  • Responded to patient, family and external payer inquiries.
  • Utilized computer programs to create invoices, letters and other documents.
  • Responded to customer inquiries and provided detailed account information.
  • Maintained accurate records of customer accounts, payments and payment plans.
  • Monitored customer accounts for payment delinquency and initiated collection efforts.
  • Contacted customers to discuss past-due accounts and negotiated payment plans.
  • Generated and distributed monthly customer statements.

Skills

  • Medical billing
  • Claims processing
  • Medical coding
  • Patient accounts management
  • Insurance billing policies
  • Customer service
  • Communication skills
  • Claims reconciliation
  • Problem-solving

Certification

Certified Professional Coder, 07/01/17, Not currently certified

Personal Information

Title: Medical Biller/Claims Analyst

References

  • Amanda Nalley, Previous coworker, 12/01/17 - 09/30/23
  • Kimberly Montgomery, Previous Manager, 04/01/01 - 09/30/17

Additionalinformation

Over twenty years experience in the medical billing field working on different systems such as Epic, Cerner, SMS, MedMetrix, MefiSoft.

Timeline

AR Claims Review

Anesthesia Services LTD
08.2024 - Current

Revenue Cycle Claims Analyst

Indiana University Health
12.2018 - 09.2023

Patient Account Representative

Community Health Network- Business Office
05.2015 - 09.2017

Surgery Scheduler

Community Health Network- Castleton Ob/Gyn
05.2013 - 05.2015

Patient Account Coordinator

Community Health Network- Castleton Ob/Gyn
07.2005 - 07.2013
Certified Professional Coder, 07/01/17, Not currently certified

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Charity D Elsten