Jennifer Reibert-Wolfe, CRCR

Hospice and Home Health Client 3/2023-12/2023

• Performed all denial and appeal activities for Hospice claims for Medicaid, Medicaid HMO, other government and commercials payers for client with locations in AK, CA, OR, TX and WA.
• Assisted in onboarding new PARs by sharing my engagement knowledge in shadow sessions.
• Identified trends and reported to leadership.
  
  

Regional Healthcare System client 1/2024-present

• Performing all denial and appeal activities for Regional Health System client, open to working all payers, but main work assignment is Medicare/Medicare HMOs and high dollar work pools
• Assist and support in onboarding new PARs by sharing my engagement knowledge in shadow sessions with up to 3 PARs at a time.
• Identified trends and reported to leadership.
• Special projects as assigned by leadership which may involve payer research or engagement issue log research.

• Performed all denial and audit activities for assigned physician revenue cycle client on the Medicare/Commercial/Other Government team
• Contacted insurance companies to determine reasons claims are unpaid; identified trends in denied payments by insurance companies to remediate issues
• Reduced aging accounts receivable balance with timely appeal submissions for denied claims.
• Served as a subject matter expert on denial-related issues within the organization, providing guidance and support to colleagues when needed; led a three week Medicare denial training for no response PARs who were moving to denials team.

• Served as an ambassador for Bluegreen Vacations & Cabela’s by interacting with the community and initiating conversations and providing excellent customer service.

• All aspects of claims follow up for hospice, home health care, IV/infusion and orthopedic providers as a contract employee
• Followed up with insurance companies, reconciled accounts, filed corrected claims, or contacted the patient/guarantor by letter or phone
• Provided effective customer service for all internal and external customers as well as communicating effectively with team members.

• Responsible for coding and billing patient medical encounters for four providers
• Verified accuracy of patient demographic and insurance information
• Completed prescription prior authorization requests and followed up with pharmacies as needed
• Ran weekly patient statements file and uploaded to the vendor after verification of statement accuracy
• Maintained in-house and agency collections, including letters and communications with outside agency
• Answered patient phone calls, emails and in-office questions regarding previous services, future services or general insurance questions.

• Responsible for working clinical denial work queues for all surgical and psychiatric providers according to the EPIC workflow for assigned centers
• Identified the root cause of the denial and reported trends and discrepancies to the follow-up manager
• Properly and thoroughly noted all activity taken on the appropriate account
• Interacted with providers for optimal resolution of the claim denials when needed
• Acted as a resource to the staff of assigned centers, helping to ensure positive patient experiences
• Researched escalated customer service requests to provide resolution of patient questions and concerns.

• Maintained and fostered customer relationships
• Used interpersonal skills and diplomacy with customers and associates
• Educated customers on trends, sales and the benefits of Your Rewards and Love Style Rewards programs
• Merchandised and organized new products as they arrive and proactively manage all areas in zone
• Assisted in cash office: balancing registers and preparing daily deposit
• Prepared change till, balance vault and petty cash to ensure that business needs were met
• Organized paperwork for sales audit
• Processed, packed and shipped orders received through store fulfillment process.

• Initiated and cultivated relationships with Costco members, employees and vendors with the purpose of creating interest in the Costco/Lennox Special Order Program
• Educated members about the features and benefits of Lennox residential HVAC products
• Provided members with information to enhance understanding of the value of the program
• Assisted members with scheduling in-home consultations with Comfort Advisors
• Collaborated with Service Experts and Costco management to ensure a quality, professional experience for all members at all stages of the process.

• Proactively maintained a clean, organized, easy to shop store environment
• Successfully managed daily work flow by remaining adaptable and flexible to business needs
• Provided friendly customer service to all customers by answering questions and connecting customers to sales associates for further assistance.

• Provided customer assistance via telephone or click to chat protocol
• Listened to customer in order to determine best opportunity for one call resolution
• Researched account access issues and took appropriate actions per company guidelines
• Educated customers about the specific guidelines related to the product line they were inquiring on
• Assessed various situations and made the judgment to escalate case to upper level support team.

• Communicated with staff and vendors to assure compliance with procedures
• Contacted staff, vendors, and other agencies to resolve issues
• Analyzed, approved and processed A/P documents
• Audited ProCard statements for accuracy and documentation.

• Customer service to patients, insurance companies, and other parties
• Educated staff about insurance and compliance issues pertinent to the practice
• Accurate coding and processing of health insurance claims
• Verify accuracy on daily banking transactions and monthly A/R accounting
• Perform routine investigation on all outstanding accounts.

• Processed charges and payments for ER/critical care, pediatric, family practice, general surgery clients
• Audited patient accounts in an effort to decrease accounts receivable days outstanding
• Served as a contact for patient questions, comments, disputes; assisted patient understanding of complex billing issues; analyzed patient situations to conclude account issues in a timely and accurate manner
• Enjoyed problem solving insurance denials and coding issues
• Maintained positive working relationship with client contacts.

• Processed charges; posted client receipts of insurance and patient payments in order to ensure timely submission of electronic and paper claims and accurate patient statements
• Served as customer service liaison between our clients and their patients
• Enjoyed assisting clients in understanding and solving issues with their practice's account receivable activity and insurance industry changes applicable to them
• Created financial spreadsheets to facilitate in fee schedule analysis; collected and clarified data from regulatory agencies and payers.