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Haylie Wolf
Deforest,WI
Work Preference
Summary
Healthcare revenue cycle professional with extensive expertise in medical billing and claims denial resolution. Proven track record in optimizing cash flow by conducting thorough account analysis and resolving complex billing discrepancies. Committed to maintaining high standards of accuracy and confidentiality while driving operational efficiency.
Overview
12
12
years of professional experience
Work History
Patient Financial Associate I
Abbott Cancer Diagnostic
Madison, WI
03.2023 - 08.2026
- Resolved escalated claim rejections, complex denials, and underpayments for commercial, Medicare, Medicaid, and third-party payors by analyzing Explanations of Benefits/Payments (EOBs/EOPs) and submitting detailed, medical-record-backed appeals.
- Pre-Adjudication Claim Auditing: Conduct front-end pre-adjudication reviews and error detection across high-volume billing queues, correcting billing discrepancies to optimize first-pass payment rates and minimize recurring rejections.
- Aged A/R Recovery: Manage high-dollar and aged accounts receivable (A/R) portfolios, conducting proactive multi-channel follow-ups via payor portals and direct representative outreach to accelerate cash flow and significantly shorten days in A/R.
- Systems & Patient Access Expertise: Navigate Epic EHR, clearinghouse platforms, and external payor portals to verify complex insurance coverage, correct patient/guarantor demographic records, and resolve prior authorization discrepancies.
- Identified recurring billing errors and payor rejection trends during interdepartmental reviews, collaborating with senior staff to refine claim edits and standardize documentation workflows, enhancing overall clean claim rates.
- Achieved high accuracy ratings on internal quality audits while ensuring compliance with HIPAA privacy rules, state and federal billing regulations, and corporate Quality Management System (QMS) guidelines.
- (Remote)
Medical Claim Adjuster
Dean Health Plan
Madison, WI
07.2021 - 03.2023
- Adjudicated complex medical claims by evaluating clinical documentation and policy coverage to approve, adjust, or deny reimbursement in accordance with plan benefits.
- Researched high-complexity and disputed claim accounts, executing claim reversals, adjustments, and re-processing to resolve discrepancies.
- Audited medical bills for billing errors, unbundled procedures, and non-covered services, ensuring plan integrity and cost efficiency.
- Processed claims across internal software systems including MetaVance, SDS, and Essette, tracking daily volumes and productivity metrics in SharePoint.
- Evaluated provider network participation, referral authorizations, and primary/secondary payor coordination to establish accurate reimbursement rates.
- Ensured strict adherence to state and federal insurance mandates and internal operating policies.
Claims Support Specialist
Dean Health Plan
Madison, WI
10.2019 - 07.2021
- Processed high-volume medical claims in MetaVance with high accuracy to maintain steady intake flow
- Interpreted insurance policies and benefit riders to ensure accurate claims setup and proper coverage application
- Audited source documents in SDS and Essette to correct data errors and route claims to appropriate queues
- Managed digital document indexing and verification, ensuring accurate records to support efficient claims processing
- Investigated claimant statements and medical records to verify billing codes and identify inconsistent charges for payer review.
Advanced Resident Care Technician
Central Wisconsin Center
Madison, WI
04.2014 - 10.2019
- Delivered direct care and behavioral support to residents with IDD, reducing crisis incidents and improving daily functioning
- Implemented communication and behavioral strategies from interdisciplinary plans to support residents' progress toward care goals
- Maintained electronic care logs and behavior records to enhance trend tracking and inform care adjustments
Education
High School Diploma -
Poynette High School
Poynette, WiSkills
- Medical Billing, Claim Processing, Accounts Receivable, Denial Resolution, Account Reconciliation, HIPAA Compliance, Records Management, Quality Assurance, Problem Solving, Attention to Detail, Data Analysis, Data Accuracy, Conflict Resolution, Critical Thinking, Healthcare Administration, Team Collaboration, Time Management, Patient Advocacy, Insurance Verification, Data Entry, Financial Reporting, Customer Service
- Claims adjudication
- Pre-adjudication auditing
- A/R management
- EHR navigation
EDUCATION & PROFESSIONAL DEVELOPMENT TRAINING
- Healthcare & Revenue Cycle Training
- Revenue Cycle & Patient Financial Services
- Medical Billing & Claims Processing
- Claims Denial & Resolution
- HIPPA & Confidentiality
- Healthcare Systems & Computers Application
- Customer Service& Professional Communication
- Workplace Quality & Compliance