Donna Wheeler-Burr

Work History

SLIDELL MEMORIAL HOSPITAL

10.2020 - Current

Working denial workqueues to insure proper reimbursement for services. Reviewing denials and resolving issues with the carriers. Assisting other departments with needed information, such as medical records, primary EOBs to complete claim processing, and obtaining archived unposted payments. Using payer websites extensively. Using knowledge of insurance policies in order to request reconsiderations and appeals. Administrator for our organization to approve access for employees to the payers' websites. Identify payer issues and reporting issues to the Director and the appropriate payer. Scanning information into our records system for future reference. Working in EPIC and McKesson systems (Paragon).
Worked with outside entities to resolve issues with billing, claims and payments

OCHSNER HEALTH SYSTEMS

02.2020 - 05.2021

Worked in credit workqueues to issue refunds as needed, transferred payments to appropriate accounts as needed, reviewed websites and contracts for needed information on recoupment requests. Left full-time status in October 2020 and remained as contract employee to clean up old computer system. Worked in EPIC system.

ADVANTAGE RESOURCES

08.2019 - 02.2020

Job location - Slidell Memorial Hospital.
Followed up on outstanding insurance claims, insurance and patient refunds, documented accounts, scanned payments and correspondence into One Content and telephone coverage as needed. Worked in the McKesson system (Paragon). This was a temporary position due to partnership with Ochsner Health Systems.

GUTHRIE CLINIC

01.2006 - 05.2015

Analyzed payments received from insurance companies to ensure payments paid according to contract, requested additional payments as needed, analyzed drug costs on a monthly basis, communicated with insurance representatives and physician staff, and reviewing medical records to insure proper coding. During my tenure at Guthrie Clinic, I was an Insurance Specialist which included filing claims to all commercial, BCBS carriers and Medicare/Medicare Advantage plans, as well as all follow-up on unpaid claims. Helped cashiers with posting payments and working credit balances. I was promoted to Coordinator over the Medicaid billing area with a team of 4 employees. Analyzed remits to verify payments were posted correctly, assisted employees with billing NY & PA Medicaid claims online, worked overpayments and resolved credit balance issues, ensured electronic claims were processed correctly and submitted appropriately, filed appeals to Medicaid, attended training sessions and handled employee time sheets and time off requests. Extensive use of IDX & EPIC systems. This was physician based billing.