Summary
Overview
Work History
Education
Skills
Mad Scientist Award
Timeline
Generic

Judith Pfeifer

Osage,Iowa

Summary

Dynamic Medicaid Claims Specialist with proven expertise at ElevatePFS in claims investigation and processing. Adept at resolving complex payer issues and training new employees, while fostering strong communication across departments. Recognized for achieving financial targets through meticulous documentation review and timely submission of corrected claims.

Overview

16
16
years of professional experience

Work History

Claim Specialist, Medicaid - EOB

ElevatePFS
08.2019 - Current
  • Reviewed insurance and claims documents to verify required information and secure any missing data for settlements.
  • Evaluated and settled complex insurance claims in strict timeframes.
  • Worked with claims adjusters and examiners to expedite processing in alignment with procedures.
  • Processed and recorded new policies and claims.
  • Coordinated with contracting department to resolve payer issues.
  • Communicated effectively with staff members of operations, finance and clinical departments.
  • Calculated adjustments, premiums and refunds.
  • Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
  • Call insurance companies as needed to determine next steps to get claim to process
  • Contact patients when we need more information to get claims to process

Medicaid Billing Specialist

MercyOne North Iowa
08.2009 - 08.2019
  • Created improved filing system to maintain secure client data.
  • Processed payment via telephone and in person with focus on accuracy and efficiency.
  • Audited and corrected billing and posting documents for accuracy.
  • Reconciled accounts receivable to general ledger.
  • Used data entry skills to accurately document and input statements.
  • Skilled at working independently and collaboratively in a team environment.
  • Developed strong communication and organizational skills through working on group projects.
  • Worked on Medicare, Commercial payers, helicopter, organ donor and plastic surgery claims.

Remedial Service Provider

Seeds For Growth
03.2009 - 08.2009
  • Verified client adherence to service contracts via close monitoring.
  • Assisted clients in finding various opportunities for success.
  • Worked with clients to maximize individual success.
  • Helped clients with dealing with mental health issues, ensuring high levels of satisfaction and loyalty.
  • Developed effective improvement plans in alignment with goals and specifications.
  • Generated reports detailing findings and recommendations.
  • Cultivated positive relationships with families to create a more positive environment.

Education

Associate of Arts - Medical Administration

Hawkeye Community College
Waterloo, IA
05-2006

Bachelor of Science - Elementary Education

Upper Iowa University
Fayette, IA
05-1995

Skills

  • Claims investigation
  • Claims processing
  • Documentation review
  • Claims
  • Performed monthly Q&As
  • Communicate well with leaderships and co-workers
  • Trained new employees
  • Attended client conference calls
  • Assisted other medicaid representatives if they need help on getting claims to pay
  • Work medicaid denials
  • Submit corrected claims in a timely manner
  • Assist other medicaid departments to get claims out the door and accounts worked in a timely manner

Mad Scientist Award

Mad Scientist Award was for:

Able to analyze even the most complex problem and find a solution.


Team Trainer Award:

Certificate for training new employees


Kudus Award:

For stepping in to assist with special projects including audits, answering staff questions, and training as needed with no hesitation. She is greatly appreciated!

Timeline

Claim Specialist, Medicaid - EOB

ElevatePFS
08.2019 - Current

Medicaid Billing Specialist

MercyOne North Iowa
08.2009 - 08.2019

Remedial Service Provider

Seeds For Growth
03.2009 - 08.2009

Associate of Arts - Medical Administration

Hawkeye Community College

Bachelor of Science - Elementary Education

Upper Iowa University

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