Summary
Overview
Work History
Education
Skills
Accomplishments
Languages
Work Availability
Work Preference
Quote
Software
Interests
Timeline
Hi, I’m

CHERYL NILES

Medical claims Research/Collections
SPRING,TX
CHERYL NILES

Summary

Dynamic and detail-oriented Administrative Specialist with over 20 years of experience delivering comprehensive administrative support in fast-paced environments. Proven expertise in managing office operations, coordinating schedules, overseeing communications, and ensuring seamless day-to-day activities. Proficient in office management systems, document preparation, and project coordination, with strong skills in revenue cycle management that include claims processing, billing reconciliation, and financial workflow optimization. Recognized for a proactive approach to problem-solving, the ability to streamline processes, and a commitment to maintaining confidentiality while fostering positive relationships with clients, vendors, and team members to achieve organizational goals.

Research professional with solid foundation in data analysis, scientific methodologies, and project management. Demonstrates strong teamwork and adaptability, ensuring consistent delivery of impactful results. Skilled in quantitative and qualitative research, critical thinking, and problem-solving. Known for reliability and effective collaboration under changing conditions.

Overview

11
years of professional experience

Work History

WellPath/HCS

Claims Research Specialist-Supervisor
02.2020 - 06.2025

Job overview

  • Supervising and leading a team of claims research specialists, providing guidance, training and performance feedback.
  • Work closely with other departments to resolve complex claims issues.
  • Provided regular reports and resolution progress to upper management.
  • Handled escalated claim issues, including disputes with clients or other parties, and working towards a resolution.

Amsurg Central Billing

Insurance/Patient Collector
05.2018 - 02.2020

Job overview

  • Follow-up on open balances listed on monthly AR reports.
  • Verify balances to turnover to the designated collection agency.
  • Review credit balances for refund request.
  • Generate correspondence to payers and patients regarding appeals, payments and authorizations.

Medix

Patient Account Representative
11.2017 - 04.2018

Job overview

  • Collection follow-up on unpaid or denied claims.
  • Perform insurance verification.
  • Oversaw client account management; processed payments, resolved billing disputes, and identified delinquent accounts.

Xtend Healthcare/Navient

Customer Service Representative- Team Lead
05.2014 - 09.2017

Job overview

  • Analyzed customer insurance policies, coverages, benefits, and eligibility to accurately answer questions and process claims.
  • Developed extensive knowledge of medical terminology, medical billing guidelines, ICD-10, ICD-9, and CPT codes.
  • Resolved escalated conflicts by identifying root cause of issues and implementing appropriate corrective actions.

Education

Hyde Park Academy
Chicago, IL

No Degree from Business Administration
06-1983

University Overview

High School Diploma

Westwood College
Woodridge, IL

No Degree from Medical Assistant
05-2011

University Overview

  • Dean's List May and October 2010
  • President's List August 2010
  • 3.93 GPA



Skills

  • Strong background in customer support
  • Medical office support
  • Expertise in verifying health insurance
  • Awareness of HIPAA guidelines
  • Adept at utilizing computer tools
  • Cultivating business relationships
  • Skilled in resolving conflicts
  • Effective troubleshooting skills
  • Adaptable to new challenges
  • Consistent reliability
  • Skilled in using Microsoft Office tools
  • Skilled in document formatting with Microsoft Word
  • Excel data organization
  • Appellate advocacy experience
  • Experienced in optimizing Windows system performance
  • Health information systems management
  • Experience in third-party administrative processes
  • Experienced in Salesforce utilization

Accomplishments

Accomplishments
  • Supervised team of 6 staff members.
  • Achieved 60% of reduced repeat calls through effectively helping with recognizing .call trends and adding the answers to repeat questions on calls to the automated recording when a call came in and having the team advise all providers to utilize the provider portal which is where most of the answers to common questions could answered.

Languages

English
Native or Bilingual
Availability
See my work availability
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tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Work Preference

Work Type

Full Time

Location Preference

On-SiteRemoteHybrid

Important To Me

Work-life balanceFlexible work hoursCompany CulturePersonal development programsTeam Building / Company RetreatsCareer advancementWork from home optionHealthcare benefitsPaid time off401k matchStock Options / Equity / Profit SharingPaid sick leave

Quote

You have to participate in your own rescue.

Software

Real Med , Salesforce, El dorado, EMR, EHR, Microsoft office, Word, Excel

Interests

Professional Development-Currently vetting schools for Billing & Coding Certification Volunteering at the Houston Food Bank preparing food packages for distribution to families, participating in Walks for Alzheimer and Breast Cancer

Timeline

Claims Research Specialist-Supervisor
WellPath/HCS
02.2020 - 06.2025
Insurance/Patient Collector
Amsurg Central Billing
05.2018 - 02.2020
Patient Account Representative
Medix
11.2017 - 04.2018
Customer Service Representative- Team Lead
Xtend Healthcare/Navient
05.2014 - 09.2017
Hyde Park Academy
No Degree from Business Administration
Westwood College
No Degree from Medical Assistant