Lani Cluke
Temecula,CA
Summary
Accounts Receivable Specialist with over ten years’ experience in business-to-business credit and collections, medical insurance reimbursement, and customer service. Contributed to creation of improved process flow resulting in reducing aging in multi-million dollar accounts by40%. Accomplished collection goal by collecting over $12 million in receivables in a30 day period. Works effectively with executive management as well as distributors and teammates.
Dedicated and adaptable professional with a proactive attitude and the ability to learn quickly. Strong work ethic and effective communication skills. Eager to contribute to a dynamic team and support organizational goals.
Overview
11
11
years of professional experience
Work History
Revenue Cycle Management Specialist II-Commercial Appeals
Neogenomics Laboratories, Inc
Carlsbad, CA
12.2021 - Current
- Reconcile medical claims for the purpose of collecting revenue
- Work with the patient, client and/or Third Party insurance bills, and may work on one or more of these processes daily
- Focus efforts on increasing cash and reducing bad debt
- Analyze payer issues and resolve AR to increase cash collections
- Subject Matter Expert on AR collections related to Neo procedures and systems
- Assists management with developing training and QC
- Identifies payer trends and brings to Lead and management attention for resolution
- Complete refunds/adjustments to customer accounts, while providing necessary back-up information to maintain accuracy
- Contact Third Party carriers to follow up on denied and un-responded claims
- Evaluate and respond to all aspects of written billing inquiries from the patient or their representative in order to resolve billing issues
- Handle patient indigence and bankruptcy claims
- May have contact with insurance carriers, clients, patients and/or other outside sources
- Regular research involving both the internet and billing systems
- Maintain compliance and HIPAA standards at all time
- Meet or exceed daily production standards
- Ability to work on various other projects as needed
Billing Specialist
Airspace
Carlsbad, CA
02.2021 - 11.2021
- Respond to external customers and internal managers regarding invoices and collections to ensure accuracy
- Research information to provide accurate and timely solutions to internal clients and customers, resolve disputes and escalate when necessary
- Prepare invoices and ensure the accuracy of invoices by working closely with operations & customer success teams
- Review customer set-up to ensure completeness and accuracy of information collected, including credit limits
- Follow procedures for issuing credit memo and refunds
- Review and manage aging reports and ensure customers have up to date invoices & statements
- Help improve policies & procedures around the AR function
Reimbursement Specialist (Home Infusion)
NuFactor, Inc
Temecula, CA
01.2020 - 09.2020
- Submit and/or follow-up on payer claims
- This may include primary, secondary, tertiary claims and/or patient statements
- Verify accuracy of payments according to the payer's fee schedule
- Possess a basic understanding and ability to audit accounts receivables: analysis of payments, contractual discounts and/or adjustments, bad debt, recoupments, refunds and the credit/debit function
- Draft professional, concise cover letters, appeals and correspondence
- This may include provider dispute forms, re-openings, reconsiderations, and various levels of appeals as necessary during the collection process
- Resolution of credit balances
- This may include revenue adjustments, balance transfers, recoupments and/or refunds
- Clearly and accurately document all collection efforts within the AR system
- Complete and submit monthly claim status reports
- Promptly inform management of reimbursement rates, changes, and/or issues which may directly affect Nufactor receivables
- Maintain reimbursement records in compliance with Nufactor policies and procedures
Accounts Receivable Specialist III /Credit and Collections
Dexcom, Inc
San Diego, CA
11.2017 - 11.2019
- Review customer accounts and correspond with consumers and businesses regarding past due invoices and over/short payments via email, mail and telephone
- Create credit/debit memos to correct invoices previously billed as requested
- Process refunds/disputes for medical insurance payments, cash transactions and rga
- Maintains documentation and procedures in accordance to company policy
- B2B Collections
- Reviewing distributor contracts for terms and credit limits
- Manages credit hold accounts
- Generates daily DSO/Aging Report
- Perform account reconciliation and coordinate discrepancies
- Ensure withholding tax certificates are collected from any customers who are required by local tax laws to withhold amounts from their remittances and build up and document filing system
- Order Management
- Send invoices, past due statements and statements of accounts to clients on a timely basis
- Provide billing proof to clients when requested
- Coordinate dispute orders and invoices to sales and/or account managers
- Reviews and monitors work of collections staff offshore (Manila)
- Works closely with business units, Sales, Corporate Tax, Customer Service and Accounting
Program Specialist II/HCV Case Manager
Covance
San Diego, CA
05.2015 - 10.2015
- Respond to inbound calls from customers, identify how best to assist the caller, document calls in appropriate
- Database, and handle/escalate calls per PSPs
- Ensure that the appropriate reimbursement steps have been taken for the patient such as the insurance
- Verification, prior authorization process, claim, PAP screening, SP Triage etc
- Understands what the reimbursement or financial barriers the patient is facing and then can work on their behalf to remove it
Customer Service Rep/Spine
Integra Life Sciences
Vista, CA
08.2013 - 08.2014
- Responsible for proper documentation and implementation of all order types received by phone, fax or other sources
- Responsible for proper documentation of inquiries and complaints
- Check available inventory, provide delivery information on open orders and inquiries
- Process customer, vendor and other requests for catalogs, price sheets, samples and copies of invoices
- Answers all customer order related questions
- Mails out catalogs, invoices and other miscellaneous items requested by customers
Education
Some College (No Degree) - General Studies
Palomar College
San Marcos, CASkills
- B2B, Aging Reports, Debt Collection, Accounts Receivable, Balance Accounts, Medical Device, Finance, Issue Resolution, Account Reconciliation, Billing, Communication, HIPAA Compliant, Training
- Oracle, Apex, Salesforce, Tableau, Emdeon, Cisco, CMS -1500 Data Management ICD10, Microsoft Office (Excel, Word and Outlook), Medforce, CPR, Sharepoint, Waystar
- Multitasking
- Customer relations
- Adaptability
- Continuous improvement
- Relationship building
- Analytical thinking
- Time management abilities
- Quantitative skills
- Analytical skills
- Written communication
- Self motivation
- Conflict resolution
- Decision-making
- Interpersonal skills
- Teamwork
- Process improvement
- Task prioritization
- Reliability
- Team collaboration
- Issue research
- Problem-solving
- Adaptability and flexibility
- Professional demeanor
- Goal setting
- Team leadership
- Team building
- Organizational skills
- Attention to detail
- Problem-solving aptitude
- Teamwork and collaboration
- Excellent communication
- Time management
- Multitasking Abilities
- Workflow optimization
Timeline
Revenue Cycle Management Specialist II-Commercial Appeals
Neogenomics Laboratories, Inc
12.2021 - Current
Billing Specialist
Airspace
02.2021 - 11.2021
Reimbursement Specialist (Home Infusion)
NuFactor, Inc
01.2020 - 09.2020
Accounts Receivable Specialist III /Credit and Collections
Dexcom, Inc
11.2017 - 11.2019
Program Specialist II/HCV Case Manager
Covance
05.2015 - 10.2015
Customer Service Rep/Spine
Integra Life Sciences
08.2013 - 08.2014
Some College (No Degree) - General Studies
Palomar College
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