Janet McCleary
Tucson,AZ
Overview
9
9
years of professional experience
Work History
Recovery Specialist
Revecore
06.2023 - 11.2023
- Contact insurance companies to explain and resolve underpayments and arrange for payment or adjustment processing on behalf of client
- Follow up on claims in a timely fashion
- Document information in appropriate client systems, including completion of call logs
- Prepare and submit correspondence such as letters, emails, online inquiries, appeals, adjustments, reports and payment posting
- Maintain regular contact with necessary parties, including payors, clients, managers regarding claims status, discrepancies and/or adjustments
- Working in hospital databases
- Exceeding production standards of 20 accounts per hour
- Secured recoveries in the hundreds of thousands of dollars for hospitals
- Complying with HIPPAA and PHI policies
Senior Collections Specialist
St. Mary's NDS
02.2023 - 05.2023
- Monitored accounts to identify overdue payments.
- Negotiated to collect balance in full.
- Increased company revenue.
- Kept accurate records and reporting on collection activity.
- Worked with payors to resolve overdue collections accounts.
Claims Representative
Elevate PFS Formerly MedData
11.2021 - 12.2022
- Assisted hospitals and medical providers in resolving Workers’ Comp claims by obtaining injury details and insurance information from hospitals, employers, patients and from other sources.
- Submitted insurance bills and documentation to Workers’ Comp insurance carriers while reaching and exceeding quality and production goals
- Reviewed payments and denials for potential appeal.
- Wrote and submitted billing appeals to insurance carriers
- Worked within specialized department where hospital revenue was increased by 5%
- Communicated with insurance carriers, employers, attorneys and patients during claims adjudication process
- Ensured hospital and/or medical providers received appropriate payment on submitted bills and denied claims
- Resolved 150 patient cases per week, increasing company revenue
- Verified insurance coverage information
- Maintained strong knowledge of basic medical terminology to better understand services and procedures
- Posted payments to accounts and maintained records
- Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt
WC Senior Integrated Service Specialist
Coventry Healthcare, DBA Mitchell Genex
12.2015 - 01.2021
- Reviewed legal disputes involving Workers’ Compensation professional and hospital bills
- Prevented legal disputes from going to trial and increased revenue by saving company money on legal fees
- Resolved 100 legal dispute accounts per week
- Researched resubmitted/corrected claims to ensure correct payment
- Researched Usual and Customary/state fee schedule, PPO and OON contract issues
- Resolved client issues timely and accurately
- Communicated with customers/clients via telephone and email to resolve issues
- Trained extensively on HIPPA and PHI
Integrated Service Specialist
Coventry Healthcare
12.2014 - 12.2015
- Processed Workers’ Compensation claims for the VIP team
- Answered incoming calls from claims adjustors
- Researched fee schedule and PPO/OON pricing for Workers’ Compensation claims
- Performed bill review of both CMS-1500 and UB04 bills
- Mentored colleagues.
Education
Bachelor of Arts - History
University of Arizona
Tucson, AZSkills
- Claims Processing
- MS Excel/Word
- OneDrive
- MS Teams
- CMS-1500 and UB04 claims
- Claims adjusting
- Cerner
- Availity
- Epic
- CMS
- HIPPA
- Hospital Revenue Cycle
- Insurance Follow-up
- Explanation of Benefits (EOBs)
- State fee schedule/U&C pricing
- PPO/OON pricing
Timeline
Recovery Specialist
Revecore
06.2023 - 11.2023
Senior Collections Specialist
St. Mary's NDS
02.2023 - 05.2023
Claims Representative
Elevate PFS Formerly MedData
11.2021 - 12.2022
WC Senior Integrated Service Specialist
Coventry Healthcare, DBA Mitchell Genex
12.2015 - 01.2021
Integrated Service Specialist
Coventry Healthcare
12.2014 - 12.2015
Bachelor of Arts - History
University of Arizona
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