Janice Freund
Raleigh,NC
Summary
Patient Access Representative with expertise in verifying insurance benefits and managing Medicare plans. Improved collections processes by analyzing revenue cycle data and implementing workflow enhancements, resulting in decreased client complaints. Delivered accurate patient registration and insurance verification while maintaining compliance with regulatory guidelines.
Overview
1
1
Certification
29
29
years of professional experience
Work History
Billing, Customer Service Specialist
Prisma Health
Columbia, SC
02.2025 - Current
- Handled 50 plus calls daily regarding patient billing inquiries across Columbia, Greenville, and Tennessee markets, resolving discrepancies and collecting outstanding balances to enhance cash flow.
- Review accounts to determine insurance coverage, correcting inaccurate information to reduce claim denials.
- Educated patients on insurance responsibilities, which led to increased enrollment in payment plans and financial assistance programs, improving patient access to care.
- Analyzed revenue cycle data to identify trends in denials, non-payments, and overpayments, supporting improved collections and minimizing recoupments.
- Worked remotely to manage tasks and communications efficiently.
Patient Access Representative/Financial Clearance
WakeMed Raleigh Campus
Raleigh, NC
06.2020 - 09.2024
- In this patient-facing role, ensure end-to-end patient registration processes are completed within a fast-paced emergency room setting, and the women's pavilion and birthing center. Complete and collect data related to pre-registration and registration of outpatients and inpatients to ensure seamless departmental operations.
- Processed privileged patient health information (obtained current insurance verification and authorization, coded visits using accurate ICD and CPT codes), balanced daily receipts, and responded to billing questions.
- Completed front desk and administrative processes to meet patient needs as the initial point of entry to the hospital through final discharge.
- Maintained compliance with organizational policies and procedures.
- Managed medical records, verified benefits, and coordinated services with internal departments and external insurance carriers.
- Noteworthy Accomplishment: Successfully decreased the number of client and member complaints by identifying sources of dissatisfaction and implementing new workflow processes to transform operations; efforts resulted in an increase in customer retention by 20%.
- Noteworthy Accomplishment: Conducted outreach during highly visible RightFax project to ensure the backlog of faxed prior authorization requests was quickly processed; ensure all measures for timeliness, quality, and compliance were met
- Noteworthy Accomplishment: Conducted outreach during highly visible RightFax project to ensure the backlog of faxed prior authorization requests was quickly processed; ensuring all measures for timeliness, quality, and compliance were met
Pharmacy Services Coordinator
Blue Cross of North Carolina
Durham, NC
08.2018 - 02.2020
- Promoted to role of increased responsibility based on demonstrated subject matter expertise and consistently high performance.
- Demonstrated advanced problem-solving skills in various scenarios to improve team efficiency., and proven ability to go the extra mile.
- Processed pharmacy authorizations while acquiring clinical data from providers, ensuring compliance with NCQA guidelines and department of insurance standards.
Intake Specialist
Blue Cross of North Carolina
Durham, NC
01.2015 - 08.2018
- Executed daily entry of provider authorizations for outpatient and inpatient admissions into the system, ensuring timely processing.
- Coordinated and prioritized large volume of intake requests received via telephone and electronic submission to streamline workflow.
- In this fast-paced environment, held accountability for daily entry of provider authorizations for outpatient and inpatient admissions, into the system.
- Interpreted and coded medical data accurately, conducting follow-up with providers to confirm and enhance data integrity.
- Remained up to date on medical coding knowledge to meet all company standards.
Provider Services Representative
XEROX CORPORATION, INC
06.2015 - 07.2018
- Represented the company as an initial point of contact in the provider relations domain. Maintained the customer base by supporting both providers and brokers alike to address claims, billing and member eligibility requests.
- Managed inbound inquiries from providers, addressing questions on policies, rates, changes, referrals, and credentialing to ensure clear communication and support.
- Consulted with providers to identify improvement opportunities and effectively communicated additional benefits of the Xerox brand.
- Cultivated strong relationships with providers, aligning their needs with business objectives in healthcare to support long-term growth.
- Worked remotely to support provider relations initiatives.
Appeals Coordinator
UPMC Health Plan
Pittsburgh, PA
01.2012 - 01.2015
- Contributed knowledge to the Medicare Member Complaints and Grievances Department. Oversaw claims appeals process, evaluating data, identifying trends, and conducting quality reviews. Conducted investigations into member and provider reconsiderations, addressing issues related to healthcare fraud.
- Coordinated member appeals and grievance case files for UPMC Health Plan.
- Reviewed medical records, claims, and authorization details for appeal determinations.
- Communicated with members, providers, and internal teams regarding appeal status.
Customer Service Analyst
UPMC Health Plan
Pittsburgh, PA
01.2009 - 01.2012
- Received a promotion to a role with increased responsibility. Assessed member requests, including claims, and conducted research to resolve inquiries.
- Resolved member inquiries regarding eligibility, benefits, and claim status at health plan.
- Reviewed customer records and updated account details in service systems.
- Processed appeals, grievances, and service requests for health plan members.
Customer Service Representative
UPMC Health Plan
Pittsburgh, PA
01.2006 - 01.2009
- Supported members, providers, and brokers by addressing inquiries on eligibility, claims, and billing to ensure clear understanding and resolution.
- Answered member calls regarding health plan benefits and coverage questions.
- Reviewed eligibility details, claims status, and authorization information for members.
- Documented call notes in customer service systems and account records.
Customer Service Representative
UPMC Health Plan
Pittsburgh, PA
01.1998 - 01.2006
- Handled high volume of daily inbound calls, addressing standard and complex health plan inquiries from retirees and commercial members.
- Answered member calls regarding benefits, claims, and eligibility for UPMC Health Plan.
- Documented member interactions in call center systems and case notes.
- Explained health plan coverage, copays, and referral requirements to members.
Education
Associate of Arts - American & English Literature
Slippery Rock University
Accelerated Computer Science Course -
Wake Technical Community College
Skills
- Claims Processing
- Claims analysis
- Denial Management
- Claims Analysis
- Patient intake
- Medical billing
- Insurance verification
- Epic
- Prime Rx
- Provider relations
- Patient coordination
- Documentation management
- Regulatory Compliance
- Office Suite expertise
- Project Management
- Issue resolution
- Cross-team communication
- Medical Terminology
- Claim processing
Personal Information
Availability: can start immediately
Certification
Notary Public
Timeline
Billing, Customer Service Specialist
Prisma Health
02.2025 - Current
Patient Access Representative/Financial Clearance
WakeMed Raleigh Campus
06.2020 - 09.2024
Pharmacy Services Coordinator
Blue Cross of North Carolina
08.2018 - 02.2020
Provider Services Representative
XEROX CORPORATION, INC
06.2015 - 07.2018
Intake Specialist
Blue Cross of North Carolina
01.2015 - 08.2018
Appeals Coordinator
UPMC Health Plan
01.2012 - 01.2015
Customer Service Analyst
UPMC Health Plan
01.2009 - 01.2012
Customer Service Representative
UPMC Health Plan
01.2006 - 01.2009
Customer Service Representative
UPMC Health Plan
01.1998 - 01.2006
Associate of Arts - American & English Literature
Slippery Rock University
Accelerated Computer Science Course -
Wake Technical Community College