Jaime Godwin
Standish,ME
Summary
Experienced PFS Claims Specialist-Mainecare offering 25 years of healthcare and customer service experience. Highly effective time management, conflict resolution and communication skills. Dependable in serving diverse needs of patients through active communication and responsive engagement with healthcare services and policymakers. Skilled at analyzing case files and databases to speed up inquiry response times and guide information through appropriate personnel channels. Maintains highest standards of ethics, professionalism and regulatory compliance to ease common stressors and de-escalate potential conflicts.
Overview
29
29
years of professional experience
Work History
PFS Claims Specialist Mainecare
OptumInsight
03.2023 - Current
- Managed a high volume of claims effectively by prioritizing tasks and maintaining excellent organizational skills.
- Settled complex claims fairly by applying critical thinking, negotiation skills, and detailed knowledge of insurance policies.
- Handled high-pressure situations with professionalism and composure, consistently achieving positive outcomes for both clients and the organization.
- Collaborated with cross-functional teams to optimize claims handling procedures, resulting in improved productivity.
- Reduced claim processing errors by conducting thorough investigations and accurately interpreting policy details.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Checked documentation for accuracy and validity on updated systems.
- Generated, posted and attached information to claim files.
- Maintained confidentiality of patient finances, records, and health statuses.
Senior Patient Account Representative
Northern Light Laboratory
05.2000 - 03.2023
- Worked with outside entities to resolve issues with billing, claims and payments.
- Contacted patients after insurance was calculated to obtain payments.
- Electronically submitted bills according to compliance guidelines.
- Reconciled statements with patient records.
- Monitored flags and resolved urgent items with accuracy and efficiency.
- Responded to patient, family and external payer inquiries.
- Utilized computer programs to create invoices, letters and other documents.
- Verified patient insurance eligibility and entered patient information into system.
- Provided excellent customer service to patients and medical staff.
- Processed payments using cash and credit cards, maintaining accurate records of transactions.
- Facilitated communication between patients and various departments and staff.
- Followed document protocols to safeguard confidentiality of patient records.
- Engaged with patients to provide critical information.
- Responded to inquiries by directing calls to appropriate personnel.
- Helped address client complaints through timely corrective actions and appropriate referrals.
- Resolved customer complaints using established follow-up procedures.
- Worked with outside entities to resolve issues with billing, claims and payments
Collections Specialist
Maine Lubrication Services
04.1996 - 05.2000
- Delivered exceptional customer service on collection calls and maintained calm and professional demeanor.
- Processed payments and applied to customer balances.
- Negotiated to collect balance in full.
- Researched accounts and completed due diligence to resolve collection problems.
- Counseled debtors on payment options and arranged installment agreements.
- Achieved performance goals on consistent basis.
- Contacted customers to discuss past-due accounts and negotiated payment plans.
- Monitored customer accounts for payment delinquency and initiated collection efforts.
- Worked with customer to create debt repayment plan based on current financial condition.
- Located customers with overdue accounts and solicited payment in compliance with fair debt collection practices.
- Maintained accurate records of customer accounts, payments and payment plans.
- Listened to customers and negotiated solutions that met creditor and debtor needs.
- Entered client details and notes into system for interdepartmental access and review.
- Established relationships with customers to encourage payment of delinquent accounts.
- Maintained high volume of calls and met demands of busy and productive group.
Education
Associate of Applied Science - Medical Assisting
Andover College
South Portland, ME06.1996
Skills
- Patient Account Management
- Coding Expertise
- Deadline Compliance
- Denial Appeals Process
- Insurance Authorizations
- Account Resolutions
- Collections
- Electronic Health Records Systems
- Microsoft Office
- Administrative Support
- Excellent Judgment
- Correcting Errors
- Patient Medical Record Software
- Reliability and Dedication
- Accounts Payable and Accounts Receivable
- Office Operations
- Pleasant Telephone Demeanor
- Medical Billing
- Punctual and Hardworking
- Medical Terminology
- Verbal and Written Communication
- Inquiry Requests
- Credit Accounts
- Overdue Balance Detection
- Insurance Information Collection
- AR Aging Reports
- Verifying Eligibility
- Team Collaboration
- Organization and Time Management
- Insurance Billing
- Patient Reimbursements
- Payment Processing
- HCPCS Compliance
- Insurance Collaboration
- Demographics Information
- Customer Satisfaction
- Workers Compensation
- Software Applications
- Professional Development
- Outbound Calling
- Diagnostic Codes
- Reviewing Patient Information
- Time Management
- Federal Laws
- Medical Records Retrieval
- Continuous Improvement Process
- HIPAA Understanding
- Patient Care
- Organizational Skills
Timeline
PFS Claims Specialist Mainecare
OptumInsight
03.2023 - Current
Senior Patient Account Representative
Northern Light Laboratory
05.2000 - 03.2023
Collections Specialist
Maine Lubrication Services
04.1996 - 05.2000
Associate of Applied Science - Medical Assisting
Andover College
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