Heather Winter
Pleasant Hill,IA
Summary
Healthcare billing and claims specialist with extensive experience in claims processing, denial management, payment posting, and AR reconciliation across public and private payers. Handles billing discrepancies, payer follow-up, and month-end reporting with strong accuracy, compliance, and cross-functional coordination.
Overview
1
1
Certification
36
36
years of professional experience
Work History
Billing Specialist
Iowa Orthopedic Center
Des Moines, IA
08.2025 - Current
- Prepared, reviewed, and processed invoices accurately and timely to support financial operations.
- Verify billing information, account details, and payment records.
- Investigated and resolved billing discrepancies and customer account issues to ensure accurate billing.
- Monitored outstanding balances and followed up on overdue payments to maintain cash flow.
- Maintain accurate billing records and documentation.
- Reconcile accounts and assist with month-end reporting.
- Collaborate with other departments to ensure accurate billing and timely payment processing
- Processed rejections from clearinghouse to ensure accurate claims submission.
- Executed special projects and additional duties
- Adjusted denial work logs to ensure accurate tracking of claims issues.
Billing Specialist
Blue Stone Therapy
Urbandale, IA
08.2024 - 08.2025
- Process, audit, and submit high-volume therapy claims to Medicare, Medicaid, and commercial payers.
- Posted payments, denials, and contractual adjustments into billing system, ensuring accuracy and compliance.
- Reconcile daily and monthly AR reports for multiple long-term care facilities.
- Identified trends in payer denials, collaborating with internal teams to address and resolve recurring issues.
- Maintain compliance with HIPAA and internal SOPs during all billing and documentation activities.
- Liaised with payers to resolve complex claim issues, securing accurate reimbursements and enhancing claim processing.
Bill Review Analyst II
CorVel Corporation
West Des Moines, IA
11.2005 - 05.2024
- Identified billing errors and overcharges, saving thousands in excess payments.
- Reviewed and repriced medical bills according to state-specific Workers Compensation fee schedules.
- Applied knowledge of CPT, ICD, and HCPCS codes to validate treatment appropriateness and cost.
- Generated comprehensive audit reports for clients and internal stakeholders to enhance billing accuracy.
- Delivered customer service to providers and clients, clarifying coding and reduction processes to ensure understanding.
- Trained new hires and mentored junior analysts on claims review protocols to strengthen team expertise.
Internal Auditor / Managed Care Contracts
Des Moines Surgery Center West
West Des Moines, IA
05.2004 - 11.2005
- Audited insurance payments to ensure compliance with managed care contracts and fee schedules.
- Investigated underpayments and submitted appeals for reimbursement discrepancies.
- Collaborated with billing and coding teams to ensure accurate claims submissions, reducing denial rates.
- Maintained logs to track payer issues and identify recurring contract violations for timely resolution.
- Prepared month-end reconciliation reports to enhance financial accuracy and support revenue cycle management.
Senior Auditor / Claims Technician
CTI
Des Moines, IA
04.2000 - 03.2004
- Audited medical, dental, and vision claims for accuracy and compliance with plan documents, ensuring adherence to regulatory standards.
- Reviewed eligibility, pre-authorizations, and benefits to validate claims, supporting accurate payment processes.
- Managed complex claims caseload, coordinating escalations with case managers to facilitate timely resolution.
- Supported reinsurance reporting by identifying high-dollar claims and compiling required documentation.
- Handled provider and patient inquiries regarding claim status and adjudication outcomes.
Senior Benefit Analyst
CIGNA Health Care
Clive, IA
09.1990 - 04.2000
- Processed, audited, and approved high-dollar medical claims to ensure compliance with policies and mitigate financial risk.
- Led recovery efforts on overpaid claims through subrogation and coordination of benefits.
- Collaborated with medical directors on complex cases requiring review for medical necessity.
- Developed and maintained Standard Operating Procedures for high-dollar and escalated claims, ensuring consistency and efficiency in processing.
- Mentored team of analysts, facilitating onboarding and training to enhance team capabilities and knowledge retention.
Education
High School Diploma -
Gilbert High School
Gilbert, AZ05-1989
Skills
- Medical billing
- Claims processing
- Claims adjudication
- Denial management
- Payment posting
- Insurance verification
- Billing dispute resolution
- Accounts receivable
- Payer follow up
- Account reconciliation
- Medical billing and collections
- Revenue cycle
- Month-end closing procedures
- Audit procedures
- Claim submission
- Effective communication
- Verbal and written communication
- Attention to detail
- Problem solving
- Time management
- Customer engagement
- Team collaboration
- HIPAA compliance
Certification
- - HIA Designation
- - Certified Fraud Associate
- - Certificate of Completion Eastern Nebraska Anti-Fraud Association
Timeline
Billing Specialist
Iowa Orthopedic Center
08.2025 - Current
Billing Specialist
Blue Stone Therapy
08.2024 - 08.2025
Bill Review Analyst II
CorVel Corporation
11.2005 - 05.2024
Internal Auditor / Managed Care Contracts
Des Moines Surgery Center West
05.2004 - 11.2005
Senior Auditor / Claims Technician
CTI
04.2000 - 03.2004
Senior Benefit Analyst
CIGNA Health Care
09.1990 - 04.2000
High School Diploma -
Gilbert High School