Kelli Vaughn

Research, patient accounts and resolve account issues, using supporting information to determine appropriate next step.

Review and manage appeals and investigate account details to support resolution.

Train staff on job responsibilities, workflows, and department procedures.

Help manage daily work, and support team workflow.

Participate in interview and prospective employees.

Perform quality assurance review and provide employee re-education when improvement is needed.

• Verified patient demographic information and insurance coverage to ensure accurate claims submission.
• Interpreted Explanation of Benefits statements from insurance companies for denied or underpaid claims.
• Identified, researched and resolved payment discrepancies with Medicare and Medicaid carriers.
• Collected payments on past due accounts by making calls to patients, insurance companies, and other third-party payers.
• Developed an effective collection strategy in order to maximize cash flow while minimizing bad debt write offs.
• Sent out monthly billing statements to clients who had outstanding balances due.
• Audited accounts receivable aging reports for accuracy and completeness of data entry into collections software program.
• Analyzed account trends and identified areas needing improvement in overall collections process.
• Maintained up-to-date knowledge of Medicare and Medicaid regulations related to reimbursement policies.
• Provided customer service support via telephone or email regarding billing inquiries.
• Reviewed medical records to determine if additional documentation was needed for claim resolution.
• Attended continuing education courses as required by law or company policy in order to stay current on industry trends.
• Performed research on unpaid claims involving complex issues such as coordination of benefits, Medicare Secondary Payer rules.
• Researched eligibility status changes in order to ensure timely filing of claims with insurers.
• Adhered strictly to HIPAA guidelines when handling confidential patient information.
• Followed up promptly on all pending items until final resolution was achieved.
• Answered phone calls and responded to questions and concerns.
• Reviewed claims for coding accuracy.
• Researched and rectified account discrepancies.
• Flagged return claims and dealt with insufficient payments.
• Took billing calls, questions and concerns from patients and third party carriers.
• Processed claims and forwarded information to Medicare, Medicaid and commercial insurance companies.
• Identified discrepancies and carrier issues regarding billing and reimbursements.
• Corrected, completed and processed claims for payer codes.
• Used excellent verbal skills to engage customers in conversation and effectively determine needs and requirements.
• Answered customer questions regarding account discrepancies or problems.
• Accepted and processed customer payments and applied toward account balances.
• Recorded information about status of collection efforts.
• Investigated billing discrepancies and implemented effective solutions to resolve concerns and prevent future problems.
• Contacted insurance companies to check status of claim payments.
• Wrote appeal letters to insurance companies for denial of claims.

• Maintained up-to-date records of all managed care contracts and related correspondence.
• Processed prior authorizations from insurance companies for medical services.
• Provided excellent customer service to members, both in person and over the phone.
• Resolved complex member inquiries and escalated issues as appropriate.
• Answered incoming calls promptly and professionally.
• Performed research on member requests using various online databases.
• Maintained accurate records of all transactions and interactions with members.
• Monitored compliance with applicable laws, regulations and internal policies.
• Identified areas of improvement within departmental processes.
• Trained new employees on job duties related to Member Service Representative position.
• Answered member questions about products and services.
• Helped members resolve account problems and navigate internal systems to handle routine needs.
• Consulted with customers regarding needs and addressed concerns.
• Enhanced member relationships by providing excellent service during each interaction.
• Achieved goals for member experience, transaction accuracy and product cross-sell, resulting in consistent growth.
• Engaged in conversation with customers to understand needs, resolve issues and answer product questions.
• Promoted high customer satisfaction by resolving problems with knowledgeable and friendly service.
• Kept records of customer interactions or transactions, thoroughly recording details of inquiries.
• Enhanced productivity and customer service levels by anticipating needs and delivering outstanding support.
• Reviewed and processed medical and dental claims to ensure accuracy of information.
• Verified eligibility, benefits, authorization requirements for services rendered.
• Resolved discrepancies between provider's billings and insurance contracts.
• Analyzed patient accounts to identify underpayments or overpayments.
• Applied knowledge of insurance plans, regulations and guidelines in adjudicating claims.
• Investigated, researched and responded to customer inquiries regarding billing issues.
• Continuously monitored changes in industry standards related to health care reimbursement practices.
• Processed claims according to established quality and production standards and made corrections and adjustments to solve problems.