Jennifer Lubcke
Neptune City,USA
Summary
Dynamic Medical Billing Reimbursement Specialist with extensive experience Specialist/Providers, Insurance Carriers and Attorney Offices, excelling in denial management and claim negotiation. Proven track record of increasing A/R by 200% through strategic appeals handling and compliance with HIPAA regulations. Adept at leveraging strong analytical skills and exceptional customer service to enhance revenue cycle efficiency.
Overview
14
14
years of professional experience
Work History
Medical Billing Reimbursement Specialist
Cohen Howard / CHRMS Revenue Management Solutions
Tinton Falls, NJ
02.2021 - 08.2023
- Review EOBs and claim files for denial resolution and processing claims for additional reimbursement
- Determine claim pathway for additional payment
- Authorizations and work-up for all prior planned procedures when available
- Initiate any negotiations whether pre or post surgery
- Extensive follow up for any trauma cases in a timely manner
- Thorough understanding of denial resolution strategies and payor reimbursement specifics
- Ensure compliance by payors with contractual obligations and Independent dispute resolution
A/R Specialist
Advanced Orthopedics & Sports Medicine
Freehold, NJ
09.2017 - 05.2020
- Responsible for all billing aspects of company
- Reviewing physician next day appointments and review account for accuracy
- Called patients regarding balances and created monthly patient statements
- Posting of Electronic Remittance Advice (ERA), Explanation of Benefits (EOB) and zero ERA's
- Working A/R reports for commercial carriers, using insurance online tools such as Link, Navinet and Availity
- Worked the clearinghouse for corrections/denials and created clean claims
- Created all appeals for underpayment of claims
- Provide accurate information to patients regarding their benefits, billing statements and posting payment
Complaint and Appeals Analyst
Horizon Blue Cross Blue Shield
Wall, NJ
08.2016 - 02.2017
- Manages resolution of complaints and/or appeals that have been escalated to Horizon executives or regulatory entities within prescribed timeframes as mandated by the regulatory entity and per designated quality standards
- Analyze complaints/appeals to determine final disposition for the issues received
- Research, execution and closure of complaints/appeals into Horizon BCBSNJ's unique database as well as national and statewide databases
- Coordinate with other internal departments such as legal, enrollment and billing to ensure complete and accurate resolution for member issues
- Develop timely, customized and accurate correspondence for delivery to relevant parties detailing case and final outcomes
- Authorizes administrative adjustments that may involve claim adjustments in payments that may have a higher threshold of payment
- Compile and calculate rates and/or subsidies to ensure members are being charged correct premiums
- Required to resolve 20-25 appeal letters for correspondence as a final determination per day
Independent Surgical Biller for Craniofacial Reconstructive Surgeon
Kayvon Haghighi, DDS, MD
Red Bank, NJ
11.2013 - 02.2015
- Utilized my vast surgical billing experience to ensure accurate and timely billing
- Initiated all follow up on every account to promise profitability
- Focused on Out of Network payment for ED trauma and worked closely with Major Crimes Unit of Monmouth County, Victims of Violent Crime, as well as all attorneys involved
- Knowledge of all third party responsibilities of payment / RE: PIP, Homeowner's, Worker's Compensation, secondary and tertiary insurance
Surgical Billing Coordinator
Center for Advanced Oral and Maxillofacial Surgery
11.2010 - 01.2014
- Responsible for all billing aspects of company
- Handled all ED trauma and self-pay accounts
- Scheduled surgeries and monthly A/R reports
- Increased yearly dental fees with participating insurance on a yearly basis
- Negotiated all trauma cases and consistently increased income involving Victims of Violent Crimes as necessary, including close communication with Major Crimes Unit of Monmouth County
A/R Recovery Specialist
The Plastic Surgery Center
10.2009 - 11.2010
- Collected monies for ageing claims 6-12 months all relating to trauma/ED
- Enforced all state mandates for the State of NJ, as well as pre-certs, while working closely with in-house attorney
- Submitted all appeals
- Increased A/R 200% consistently from month to month
- Determined 'pattern problems', focusing on incorrect payments
- Attended all insurance seminars and assisted in training
Education
Advanced Career Institute -
Medical and Dental School
05.2016
Skills
- HIPAA compliance
- Denial management
- Revenue cycle management
- Appeals handling
- Policy evaluation
- Eligibility verification
- Prior Authorization/Precertification
- Claim Negotiation
- Policy analysis
- ICD-10 coding
- Microsoft office
- Claims processing
- Medical billing
- Medical Billing
- Medical Records
- Medicare Experience
- Medical coding
- Microsoft Word
- Customer service
- EMR Systems
Areas Of Expertise
- Out of Network ED Surgery Reimbursement
- Medical/Dental CPT and ICD-9/10
- Medical Law by State
- Negotiations
- Attorney Client Relationship
- Pattern Problems
- DOBI Appeals
- Victim of Violent Crime Resolvement
Personal Information
Authorized To Work: US
Timeline
Medical Billing Reimbursement Specialist
Cohen Howard / CHRMS Revenue Management Solutions
02.2021 - 08.2023
A/R Specialist
Advanced Orthopedics & Sports Medicine
09.2017 - 05.2020
Complaint and Appeals Analyst
Horizon Blue Cross Blue Shield
08.2016 - 02.2017
Independent Surgical Biller for Craniofacial Reconstructive Surgeon
Kayvon Haghighi, DDS, MD
11.2013 - 02.2015
Surgical Billing Coordinator
Center for Advanced Oral and Maxillofacial Surgery
11.2010 - 01.2014
A/R Recovery Specialist
The Plastic Surgery Center
10.2009 - 11.2010
Advanced Career Institute -
Medical and Dental School
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