Gretchen Heiss
Margate,FL
Summary
Medical professional with extensive experience in processing medical claims, including claim review, adjudication, and resolution. Known for strong focus on collaboration and achieving results, adapting seamlessly to changing needs. Possesses key skills such as attention to detail, excellent communication, and problem-solving abilities.
Overview
12
12
years of professional experience
Work History
Medical Claims Processor
MASA Holdings, Inc.
09.2023 - 09.2024
- Facilitated the successful transition from paper-based claims processing to a digital platform, ensuring accuracy and efficiency throughout the implementation process
- Collaborated in testing and refining workflow implementations to optimize system functionality and improve team efficiency during the transition
- Supported claims processing and collaborated with team members to ensure seamless workflow operations
- Streamlined the setup and processing of new claims, maintaining accuracy and efficiency in documentation
- Managed a personal queue of assigned medical claims, consistently meeting and exceeding performance targets
- Verified insurance coverage and maintained detailed, accurate records in compliance with regulatory standards
- Interacted effectively with providers and clients to gather additional documentation, ensuring prompt claim resolutions
- Evaluated and indemnified providers and clients according to policy provisions and insurance regulations
- Delivered exceptional support to members, providers, and internal departments through various communication channels, including phone, email, and chat
- Demonstrated meticulous attention to detail, empathy, and active listening skills to enhance client satisfaction and team collaboration
Weather Catastrophe Claims Associate
Alacrity Solutions
06.2022 - 08.2023
- Consistently surpassed daily call volume targets while maintaining average call handling time within company benchmarks, ensuring privacy and confidentiality of insured members' information in strict compliance with regulations
- Handled a high volume of inbound calls from property policyholders, providing clear mitigation expectations, and efficiently processing First Notice of Loss (FNOL) calls with empathy and professionalism to ensure timely resolutions
- Explained coverage of loss to policyholders, assist with coordinating emergency repairs, and arranging additional living accommodations to ensure comprehensive support during the claims process
- Effectively deescalated customer complaint calls by fostering a positive, hassle-free experience through active listening, empathy, professionalism, and timely follow-up to ensure resolution
- Documented all actions and conversations while updating client demographics in the insurance carrier's claim management system, ensuring accurate and comprehensive records
- Demonstrated a strong ability to adapt to changing priorities, maintaining efficiency and focus while addressing dynamic organizational needs
Claims Specialist- Property Field Inspection
Pilot Catastrophe Services
08.2021 - 02.2022
- Consistently achieved fast turnaround times in evaluating claims, ensuring timely settlements for policyholders
- Traveled to loss sites to conduct comprehensive investigations, analyze coverage, and prepare detailed repair estimates, ensuring accurate assessments and efficient claim resolutions
- Maintained meticulous claim files with comprehensive records, ensuring compliance with audit and regulatory requirements
- Delivered exceptional service to policyholders by explaining coverages, addressing concerns, and guiding them through the claims process with empathy and professionalism
- Indemnified or denied coverage for insured clients based on policy provisions, as well as state and county regulations, ensuring accurate and compliant claim resolutions
Billing and Collections Specialist
Senior Nannies Home Health
05.2019 - 08.2021
- Reduced outstanding receivables by 25% within six months through diligent follow-up on unpaid claims and effective denial management strategies
- Identified and corrected inaccurate fee schedule rates within the financial system, ensuring accurate billing and compliance with payer guidelines
- Verified coverage submitted to the Veterans Administration and Long Term Insurance carriers
- Submitted and tracked Assignment of Benefits (AOB) to Long-Term Insurance carriers, ensuring claims were released promptly upon AOB updates in the carrier's system
- Verified and monitored elimination periods, ensuring accurate tracking and collection of self-pay amounts during this timeframe
- Collected and posted payments for self-pay accounts, ensuring accurate ledger updates and maintaining meticulous financial records
- Collaborated with credit card companies to resolve disputed transactions, providing necessary documentation to substantiate reimbursements owed to my employer and ensuring prompt resolution
- Collaborated with physician offices to expedite medical record requests and obtain signed Plan of Care forms, ensuring accurate and timely documentation to support efficient workflows
Billing Manager
Clearlyderm Dermatology
08.2017 - 02.2018
- Developed comprehensive billing guidelines, standardizing procedures across department and reducing variability in outcomes.
- Reviewed billing problems, researched issues, and resolved concerns.
- Conducted regular analysis of billing department performance, identifying trends and areas for improvement to inform strategic planning.
- Worked with customers to develop payment plans and bring accounts current.
- Maintained up-to-date knowledge of industry regulations, ensuring billing department's compliance and protecting company from potential fines.
- Streamlined billing process, significantly reducing errors and enhancing client satisfaction by implementing automated system for invoice generation.
- Enhanced client satisfaction levels by ensuring timely delivery of accurate invoices and addressing concerns professionally.
- Reduced errors and discrepancies in invoicing by closely monitoring billing data and conducting regular audits.
- Improved transparency with clients through development of clear, concise billing statements, reducing inquiries and increasing customer satisfaction.
- Maintained up-to-date knowledge of industry regulations and compliance requirements, ensuring the department remained compliant at all times.
- Enhanced customer service, resolving billing disputes swiftly and maintaining positive relationships with clients.
- Collaborated with cross-functional teams to resolve billing-related issues swiftly, minimizing negative impacts on overall operations.
- Implemented policies that improved accounts receivable collections, resulting in reduced outstanding balances and increased cash flow.
- Conducted periodic reviews of existing processes to identify areas of potential cost savings or efficiency improvements.
- Developed comprehensive training materials for new hires to quickly acclimate them to company procedures and software systems.
- Trained and mentored staff on procedures, compliance requirements, and collections techniques.
- Established performance metrics for evaluating staff effectiveness, leading to continuous improvement initiatives within the department.
- Improved financial accuracy with meticulous auditing of accounts, ensuring compliance with financial standards and regulations.
- Boosted cash flow with effective billing strategies, closely monitoring aging reports and prioritizing high-value accounts for collection efforts.
Cental Business Office Supervisor
Eye Physicians of Forida
04.2012 - 06.2016
Education
No Degree -
Broward Community College
North CampusSkills
- Customer Engagement
- Ethical Conduct in Professional Settings
- Healthcare Terminology
- Insurance Claims Management
- Clear Communication
- Data-Driven Decision Making
- Analytical Problem-Solving
Timeline
Medical Claims Processor
MASA Holdings, Inc.
09.2023 - 09.2024
Weather Catastrophe Claims Associate
Alacrity Solutions
06.2022 - 08.2023
Claims Specialist- Property Field Inspection
Pilot Catastrophe Services
08.2021 - 02.2022
Billing and Collections Specialist
Senior Nannies Home Health
05.2019 - 08.2021
Billing Manager
Clearlyderm Dermatology
08.2017 - 02.2018
Cental Business Office Supervisor
Eye Physicians of Forida
04.2012 - 06.2016
No Degree -
Broward Community College
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