Jennifer Halterman

Methodical Revenue Cycle Specialist with strong attention to detail and in-depth understanding of billing procedures and Revenue Cycle Management. Excellent planning and problem solving abilities. Bringing 20 plus years of related experience to a dynamic position with room for career growth.

• Identified and resolved problems through root cause analysis ad research between 20-40 accounts per day.
• Gathers and submits documents within a timely manner based on established deadlines, draft appeals and demands to insurance companies to ensure timely resolution and payment of claims, as well as discusses verbally over the phone with insurance companies to get denials overturned and paid.
• Performs contractual analysis on paid claims to ensure that client hospitals are reimbursed accurately and according to contract, and to ensure payment integrity. Researches claims, reviews medical policies, prepares and reviews documentation. Prepares and submits appeal letters,
• Exceeded performance targets consistently by prioritizing workload effectively and managing time efficiently during periods of high call volume or complex caseloads.
• Participated actively in ongoing professional development opportunities to stay current on industry best practices and enhance personal skillset.
• Maintained detailed records of all interactions and resolutions for future reference and analysis purposes, improving overall efficiency in handling similar cases down the road.
• Analyzed root causes of recurring issues to implement preventive measures, reducing the number of future complaints.
• Contributed to a positive team culture by offering support and encouragement to peers, fostering a collaborative and high-performing work environment.
• Developed tailored strategies for dispute resolution, resulting in successful outcomes and increased client retention rates.
• Coordinated with internal departments as needed to gather information on each individual case, facilitating a more accurate and timely response.
• Collaborated effectively with cross-functional teams to provide comprehensive solutions for clients'' concerns.
• Assisted colleagues in navigating challenging situations by sharing expertise and offering guidance when requested or needed.
• Devised and implemented dispute resolution processes for companies, enabling fast resolution of disputes.

• Created new customer files in Pentagon ERP System, producing invoices in Pentagon for new and recurring State and Government clients based on contractual obligations while meeting daily, weekly and month end deadline. Reviewed and tracked key details of contracts to ensure correct billing to customer. Researched disputed invoices, issued credits as needed. Reviewed all contracts for billing customers and ensured billing documents met internal and customer requirements. Researched and validated underpayments/overpayments. Processed RMA adjustments, refunds, and incoming payments daily through Pentagon.
• Work in conjunction with and support for the Project Manager, and Accounts Payable to ensure billing, invoicing is accurate per contract and submit invoices monthly or daily as required by each program. Processed segment activity invoices. Answered and resolved all questions, issued credit memo’s needed based on customer contract.
• Reviewed daily and process all expenses reports paid, trip, crew related expenses, monthly expenses, crew training. Ensured proper reimbursement to crew and company through SAP Concur software verifying billable, non-billable, chargeable, non-chargeable based on contract. Processed fuel receipt packet report daily. Confirmed fuel allocated to the correct program, tail number and price per gallon based on contracted rates and then bill to correct project. Reconciled flight activity and work orders, verify labor, materials, outside services on work order and import to invoice.
• Applied cash, check, wire, AHC, payments received daily. Created and distributed AR Aging weekly. Compiled necessary accruals monthly, and post in general ledger. Assigned proper Department and G-L codes to each charge for import into Pentagon for Customer Invoices.

• Managed collection of insurance and patient payments, processed revenue, bad debt adjustments, billed patients self-pay, followed up on denied / underpaid claims via Brightree Solutions. Ensured accurately coded equipment requests for prior auth based on diagnosis ICD 10, HCPC, LCD’s as per CMS regulations and payer specific guidelines and documentation in patient’s medical chart. Contacted facilities and physician’s offices for documentation needed. Identified issues, tracked trends, analyzed root causes and applied counter measures to resolve prior auth issues so claims were not held up in the revenue cycle.
• Daily worked prebill edit report and reviewed held claims report. Followed up on all accounts for unpaid, underpaid claim lines and denied claims assigned via Brightree to resolve outstanding issues. Pursued additional payment from payers for underpaid claims. Made calls to patients and physicians to follow up on denied auths or additional information needed to complete auth process. Identified potential trends with the prior auth process in regards to Commercial payers, Managed Care plans, Medicare Advantage plans, Medicaid PPO’s & HMO’s. Processed all adjustments, credit memo’s, contractual adjustments and refunds to all payers.
• Obtained prior authorizations via Navinet, Emdeon, manually and through various other insurer sites. Reviewed & filed documents in the electronic medical record. Obtained all documents needed to resolve denials. Ensured documentation available for quality assurance review & audits for Managed care, Medicaid HMO’s, Commercial, Third-party payers. Examined EMR’s to ensure documentation reflects need for equipment ordered, provided, met compliance guidelines and payer requirements. Various forms of EHR access used, Medforce, Webextender, EPIC. Documented all actions taken in account notes.

• Improved claim resolution times by efficiently managing a high volume of appeals and coordinating with various departments.
• Contributed to ongoing process improvement initiatives within the department by proactively identifying inefficiencies and proposing actionable solutions.
• Maintained strict confidentiality of sensitive patient information; ensuring compliance with HIPAA regulations at all times.
• Developed customized appeal letters tailored to each case''s unique circumstances, increasing the likelihood of successful outcomes.
• Composed technical denial arguments for redetermination and reconsideration, including both written and via telephone responses utilizing federal and state guidelines and LCD guidelines. Prepared appeals to send to ALJ for telephone and on the record hearings. Notified Billing Manager of denial/audit results, root cause of denials or unfavorable audits. ADR’s, CERTS, RAC’s, ZPICS, SMERCS, UPICs, etc.
• Audited/ analyzed payer policy requirements, Medicare regulatory monitoring obligations, interpreted CMS regulations, CMS transmittals, outpatient payment systems, LCD’s, NCD’s, DME services for clean claims submission coded properly based on ICD 10, HCPC, & LCD’s. Ensured compliance with documentation.
• Investigated and identified reasons for insurance denials. Analyzed, tracked trends, identified root cause through continuous improvement practices, applied counter measures and resolved appeals denials by payer. Recommended the best course of action for favorable outcome and process changes needed.
• Reviewed and understood all contracts, Federal, State, commercial, third party. Responsible for resolving all underpaid claims, overpaid claims and denied claims. Appealed all claims as required through payer appeals process.
• Assembled and responded to incoming audits from government and non-government agencies. Arranged audit, secured documentation, validated for accurate coding, executed completion of audit, appealed unfavorable audits to Administrative Law Judge. Evaluated appropriate language for letters, prepared and responded to appeals and grievances following up until denial resolved for Medicare, Medicaid, Commercial and Managed Care Plans. (Over 5,000 audits completed) Notified Billing Manager of denial/audit results, root cause and countermeasures resulting in process improvements.

• Conducted performance evaluations for staff members, identifying areas of improvement and guiding professional development plans.
• Collaborated with other departments to achieve organizational goals, fostering teamwork across various functions.
• Resolved conflicts among team members promptly, maintaining a harmonious working environment conducive to productivity.
• Demonstrated commitment to the organization''s core values, leading by example and fostering a culture of excellence.
• Identified operational inefficiencies and implemented corrective measures to increase effectiveness.
• Cultivated strong relationships with key clients or stakeholders through consistent communication and excellent service delivery.
• Maintained billing and understanding all insurance regulations, insurance billing, processing revenue and bad debt adjustments, billing patient’s portion, followed up on unpaid, denied claims. Coded DME claims, ICD 9/10 codes, HCPC, reviewed LCD’s, NCD’s ensuring requirements met. Monitored all requests for revenue recovery both Government and private payer requests.
• Electronically & manually billed Medicare, Medicaid, Managed Care, and other third-party claims. Daily review pre-bill of all insurers to ensure clean claims on the front end with no edits or rejections. Actively supervised operation of retail sales showroom.
• Completed, responded to all incoming audits government, non-government agencies, compiled documentation, verified medical documentation for accurate coding, tracked data, and appealed unfavorable audits. Appealed denials to ALJ level of Appeals. ADR, CERT, RAC’s, ZPICS, IOG, etc.
• Interpreted, translated, clarified payer contracts to ensure up-to-date knowledge of all payer billing requirements to support serviced billed, including required medical documentation based on billing compliance rules Medicare, Medicaid, Managed Care, Commercial Payers. Actively processed, filed, and reconciled Medicare, Medicaid, Managed Care, Commercial, HMO claims. Decreased DSO 86%, maintained best DSO in organization.