Janet Boutelle
Raleigh,NC
Summary
Results-driven financial account representative with extensive experience at Wakemed Hospital, specializing in resolving billing discrepancies and optimizing claims processing. Proven ability to apply insurance benefits effectively while promoting team collaboration. Expertise in managing complex claims and ensuring compliance, consistently achieving timely resolutions and enhancing client satisfaction.
Overview
24
24
years of professional experience
Work History
Financial Account Representative
Wakemed Hospital
Raleigh , NC
06.2013 - Current
- Managed patient financial inquiries and resolved billing discrepancies efficiently.
- Collaborated with healthcare providers to verify insurance eligibility and coverage details.
- Communicated regularly with external payers to facilitate timely claims resolution.
- Participated in training sessions to stay up-to-date on industry trends and best practices.
- Coordinated with internal departments to resolve issues quickly and effectively.
Medical Claims Processor
Interactive Medical Systems
Raleigh , NC
05.2001 - 06.2013
- Reviewed and processed insurance claims for accuracy and compliance standards.
- Communicated with clients to gather necessary documentation for claim processing.
- Investigated claim discrepancies by analyzing supporting documents and records.
- Collaborated with team members to streamline claims processing workflows.
- Updated claims database with relevant information and status changes regularly.
- Assisted in training new staff on claims processing procedures and software tools.
- Resolved client inquiries regarding claim status and provided timely updates.
- Processed a high volume of incoming claims in accordance with established policies and procedures.
- Verified claim data correctness in preparation for processing.
- Processed claims according to established quality and production standards and made corrections and adjustments to solve problems.
- Assisted customers via telephone inquiries related to their specific claim status or general questions about the company's services.
- Analyzed contracts and claim systems to apply appropriate benefit amounts.
- Provided technical guidance and training to new staff members regarding claim processing procedures.
- Coordinated benefits with medical insurance plans and Medicare providers.
- Resolved complex issues associated with denied or underpaid claims through negotiation with payers.
- Managed escalated customer complaints pertaining to denied or delayed payments in a timely manner.
- Reviewed history records to determine benefit eligibility for services.
- Reconciled payment discrepancies between provider statements and remittance advice from payers.
Education
Associate of Science - Business Administration
University of Pheonix
On Line06-2005
Skills
- Follow up on commercial and government claims
- Reconciling billing errors
- Applying correct insurance contractual benefits
- Advanced written and verbal communication skill
- Team collaboration
- Provide information to Insurance
- Vast knowledge in TPA practices and policies
Affiliations
- Enjoy Crafts of all kinds and developing an on line store
- Volunteering for homelessness
- Volunteer work with abused women
Timeline
Financial Account Representative
Wakemed Hospital
06.2013 - Current
Medical Claims Processor
Interactive Medical Systems
05.2001 - 06.2013
Associate of Science - Business Administration
University of Pheonix
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