CHANDRA C. WOLFOLK
Westland,MI
Summary
To receive an opportunity to discuss a challenging and responsible position where I can enhance my education and experience to our benefit.
Professional in healthcare industry, bringing valuable experience in authorization management and compliance. Known for delivering reliable and timely authorizations while maintaining robust communication with healthcare teams. Consistently focused on collaborative efforts and achieving results, ensuring organizational goals are met. Skilled in problem-solving and adaptable to changing requirements.
Overview
19
19
years of professional experience
Work History
Revenue Authorization Specialist II
Integrate Health Associates-IHA/Trinity Health
08.2022 - Current
- The Revenue Specialist improves complaint handling, accurate billing, and charge capture at the point of service to decrease costly back-end work and improve cash flow.
- Implements and promotes consistent revenue integrity practices in regard to compliance in coding, billing, and proper documentation.
- Optimizes reimbursement, working in partnership with departments to further develop the revenue stream and documentation processes.
- Analyzes and assists with the correction of billing and coding errors identified by working denials.
- Monitors detailed revenue volumes via claim edits, late charges, and bad adjustments to provide real-time notification of unusual variances.
- Works with the site operations team to provide feedback regarding proper revenue cycle processes and workflows.
- Assists or advises departments regarding the resolution of errors that prevent timely, accurate, and compliant claims submittal.
- Manages regulatory content, simplifying the complex reimbursement environment through the promotion and support of consistent operational efficiencies.
- Helps departments maximize revenue when CPT codes for new technologies and services, or changes in the payment rates for these and other established services, occur.
- Essential Job Functions:
- Uses internal and external resources to create timely and thorough action plans related to a focused area of the revenue cycle (i.e. Charge entry or copays.
- Work Charge Review, Hospital, Office, and Newborn Workqueues.
- Responsible for helping to communicate denials and provide feedback regarding how to reduce denials and improve processes.
- Submit a request for retro authorizations.
- Meet the weekly quota of working 120 accounts a day.
- Assume ownership of the assigned task, prioritize work with or without leader input, and move projects to completion in a timely manner.
- Participates in revenue-targeted projects and addresses opportunities and barriers as they arise.
- Provides regular project updates to customers and leadership, especially when there are delays or challenges.
- Attends additional training, performs research, and engages in e-learning to stay current on best practices and new practice management technology and functionality as it becomes available.
- Documents lessons learned to develop payer, coding, and/or billing playbooks for all specialties.
- Assist with special projects as needed.
- Assist in training new staff.
- Processed patient authorization requests efficiently to ensure timely access to healthcare services.
Payment Posting
Trinity Senior Living Community
03.2021 - 08.2022
- Payment posting from Waystar online payment system for Assisted and Independent living facilities for 6 Ryan Homes and 4 Villages.
- Lockbox payments
- Account adjustments to adjust room & board charges, ancillary charges and miscellaneous fees.
- Mid-month statement processing for Ryan homes
- Month-end statement processing for Village homes
- Month-end close for Ryan and Villages
- Weekly account balancing to bank and Waystar
- Email communication with 10 Business Office Managers
- Daily team meetings
- Reimbursement rule overrides
- Job Functions:
Billing and Collections Representative
Trinity Senior Living Community
09.2017 - 03.2021
- Responsible for reviewing, researching, and processing claims in a timely and efficient manner.
- Take calls from residents and families regarding billing statements
- Make calls to hospitals and other skilled nursing facilities regarding admission, discharge and observation stays and dates.
- Monthly AR aging reviews of all my facilities.
- Communication with Business Office Managers re monthly claim errors or changes needed.
- Complete request for UB04, Insurance remittance advice.
- Monthly billing of Medicare claims for SNF care.
- Call on denied claims.
- Attend weekly team meetings.
- Medicare part B claims coding
- Contact MDS on coding errors.
- Send quarterly credit balance reports to Medicare.
- Performs account adjustments or write-offs as needed in accordance with the 'Write-Off' policy.
- Research credit balances caused by payment posting and prepares appropriate documentation and tasks.
- Help team-members and supervisor with other billing tasks as needed for audits, etc.
- Maintains complete knowledge of and complies with all relevant insurance, CPT coding and diagnosis guidelines.
- Job Functions:
Medical Billing Specialist (Hospitalist Team)
Integrated Health Associates-IHA/Trinity Health
06.2016 - 08.2017
- Maintains complete knowledge of and complies with all relevant insurance, CPT coding and diagnosis guidelines.
- Reviews and (when necessary) corrects charges entered in the Practice Management System.
- Reviews, monitors and performs follow up on insurance accounts receivable resulting from AR reports, tasks, insurance rejections and correspondence from insurance, practice and patients. Maintain department goal 3-2-2.
- Researches credit balances caused by payment posting and prepares appropriate documentation and tasks.
- Performs account adjustments or write-offs as needed in accordance with the 'Write-Off' policy.
- Assists with Inpatient/Outpatient Hospital Charges.
- Resource for team members for work process and other questions; trains new and existing staff on IHA policy and procedures that directly relate to the AR billing function; acts as support to Business Services Manager/Supervisor in their absence as directed.
- Attends regularly scheduled meetings.
- Help export charges for exporting team when needed
- Run monthly AR and aging report.
- Job Functions:
Patient Business Associate Pharmacy department- Transplant Department
University of Michigan Health System
05.2013 - 05.2016
- Obtain detailed prescription benefit information including but not limited to: retail & mail order co-pays, network pharmacies, plan formulary, prior authorization requirements, and all necessary information to adjudicate a claim.
- Create excel spreadsheets to track renewal of patient assistance programs and grants.
- Counsel patients regarding their coverage benefits and insurance nuances.
- Evaluate patients medication, insurance, and financial picture and educate them regarding the resources available through various channels (insurance, drug manufacturers, charity care.
- Obtain prior authorization and/or appeals for all medications filled by Specialty Pharmacy.
- Collect and assist patients with the necessary documentation needed to apply for extra help. Charity care, drug assistance, Medicaid, and any other qualifying insurance or program. Maintain regular contact with patients to ensure smooth and timely transition into these programs.
- Teach patient education classes for pre and post-transplant patients.
- Help facilitate patient enrollment or transition to other pharmacies when UMHS is a non-participating pharmacy to ensure uninterrupted medication treatment.
- Maintain complete and up to date notes in OTIS, QS1, Mi-chart, Excel and Thera-Doc
- Stay abreast of current insurance, PAP and medication resource requirements.
- Billing issues- PBM obtain correct billing information and update all systems, re-bill requests
- Correct COB issues
- Monthly Statements
- Collection calls
- All other duties as assigned
- Job Functions:
Specialty Pharmacy Senior Billing Specialist- Transplant Department
University of Michigan Health System
12.2009 - 05.2013
- Manage and reconcile patient accounts in both QS1 and System One.
- Coordinate and process all Medicare part B billing that is being handled by the Transplant Pharmacy.
- Coordinate and process all specialty billing that is being handled by the clearing house.
- Coordinate and process all non-traditional processes such as, paper billing 1500 claim forms, CSHS, and BCBS transplant riders.
- Process payments to patient accounts in QS1 and System One.
- Process monthly account statements.
- Monitor patients who are pending Medicare eligibility and re-bill appropriate charges.
- Coordinate with third party payers, patients, and financial coordinator to resolve billing inquiries and problems.
- Regularly review patient accounts and contact appropriate financial coordinator when patients have outstanding balances or insurance company denies payment due to termination of coverage.
- Document billing/patient account related issues in Otis and/or QS1, excel spreadsheets
- Train other billing specialist
- Call on claim rejections
- Work with PFC on COB issues
- Post co-pays, deductibles, co-insurances to patient A/R
- All other duties as assigned
- Job Functions:
Transplant Department- Patient Services Associate
University of Michigan Health System
11.2008 - 12.2009
- Provide support to Transplant Coordinators, nurses and doctors by arranging all aspects of evaluation process of living donors and patients awaiting transplantation.
- Obtain clinical information needed to accurately perform a transplant evaluation, routine evaluation testing of candidates following the consult appointment.
- Maintain current demographics and other medical information on patients awaiting transplantation.
- Assist in the weekly evaluation clinic, including placing patients in rooms and preparing paperwork for clinicians.
- Triage patient calls, accurately relay information to the Transplant Coordinator in a timely manner.
- Prepare and mail out Tissue Typing kits for recipients/ Prepare and mail out kits to donors.
- Help prepare clinic charts for combined clinic visits as needed.
- Job Functions:
Outpatient Service Assistant - Briarwood Medical Group
University of Michigan Health System
04.2007 - 11.2008
- Reconcile clinic cash collections daily
- Schedule new and return visits for providers/patients consultation in Other clinics, diagnostic tests.
- Reception
- Instruct patients on preparations needed for appointments
- Answer multi-line phone system in a call center environment
- Complete financial documents including cash handling
- Assist with prior authorizations for patient prescriptions
- Retrieve documents and results from Careweb at patients request
- Job Functions:
Education
No Degree - Health Information Technology
Schoolcraft Community College
Livonia, MI01.2017
Medical Front Office Assistant and Billing Program
New Horizons Learning Center
Livonia, MI08.2006
High School Diploma - undefined
Ypsilanti High School
Ypsilanti, MI01.1996
No Degree - Medical Coding
Schoolcraft College
Livonia, MI12-2026
Skills
- Epic
- Outlook
- Teams
- Microsoft Word
- Excel
- OTIS
- QS1
- Thera-Doc and Fastrack
- Mi-Chart
- Nextgen
- Powerchart
- Ebridge
- Netsmart vision
- ESolutions
- TRAC
- Insurance provider sites
- Claims management
- Insurance verification
- Data entry proficiency
- HIPAA compliance
- Prior authorization processing
- Medical coding
- Appointment scheduling
- Documentation and paperwork
- Microsoft office
- Documentation and reporting
- Effective communication skills
- Policy interpretation
- Application review
- Proficiency in Epic
- Outlook
- Teams
- Microsoft Word
- Excel
- OTIS
- QS1
- Thera-Doc and Fastrack
- Mi-Chart
- Nextgen
- Powerchart
- Ebridge
- Netsmart vision
- ESolutions
- TRAC
- Insurance provider sites
- Claims management
- Insurance verification
- Data entry proficiency
- HIPAA compliance
- Prior authorization processing
- Medical coding
- Appointment scheduling
- Documentation and paperwork
- Microsoft office
- Government relations
- Disability awareness
- Verbal communication
- Data entry
- Record keeping
- Benefits administration
- Applicant support and service
- Advocacy and counseling
- Confidentiality
- Income verification
- Interviewing techniques
- Medicaid
- Recordkeeping and data input
- Eligibility procedures
- Public assistance programs
- Application assessment
- Authorizations
- Teamwork and collaboration
- Time management
- Problem-solving
- Attention to detail
- Problem-solving abilities
- Multitasking Abilities
- Critical thinking
- Organizational skills
Timeline
Revenue Authorization Specialist II
Integrate Health Associates-IHA/Trinity Health
08.2022 - Current
Payment Posting
Trinity Senior Living Community
03.2021 - 08.2022
Billing and Collections Representative
Trinity Senior Living Community
09.2017 - 03.2021
Medical Billing Specialist (Hospitalist Team)
Integrated Health Associates-IHA/Trinity Health
06.2016 - 08.2017
Patient Business Associate Pharmacy department- Transplant Department
University of Michigan Health System
05.2013 - 05.2016
Specialty Pharmacy Senior Billing Specialist- Transplant Department
University of Michigan Health System
12.2009 - 05.2013
Transplant Department- Patient Services Associate
University of Michigan Health System
11.2008 - 12.2009
Outpatient Service Assistant - Briarwood Medical Group
University of Michigan Health System
04.2007 - 11.2008
Medical Front Office Assistant and Billing Program
New Horizons Learning Center
High School Diploma - undefined
Ypsilanti High School
No Degree - Health Information Technology
Schoolcraft Community College
No Degree - Medical Coding
Schoolcraft College