Laura Buckley

Pharmacy Insurance Verification & Reimbursement Specialist

• Conducted in-depth reviews of insurance policies and medical claims to determine patient eligibility, coverage limits, and plan benefits across major medical carriers, PBM's, government healthcare programs (Medicare, Medicaid), and specialty pharmacies such as (Accredo, Centerwell, CVS, Optum, BioPlus).
• Initiated appropriate Appeal actions required to prepare and submit documentation needed to resolve the denial or non-payment of a claim.
• Clearly communicated insurance coverage details and financial responsibilities to patients, ensuring understanding of complex benefit structures.
• Maintained and updated electronic patient records with accurate insurance and authorization data in compliance with HIPAA regulations.
• Interpreted prescriptions, prior authorizations, and medical documentation to ensure clarity and alignment with insurance requirements.
• Accurately analyzed and transcribed ICD-9, ICD-10, CPT, and HCPCS codes for medical claims processing and reimbursement.
• Partnered with the medical coding team to verify correct coding and reduce claim denials and payment delays.
• Initiated and followed up on prior authorization requests and Appeals with insurance providers for medications, procedures, and therapies, ensuring timely patient access to treatment.
• Implemented process improvements that reduced claim rejection rates through careful analysis of error patterns.
• Mentored junior team members in best practices for claim submissions, fostering a culture of continuous improvement.
• Reduced claim denial rates by thoroughly reviewing documentation before submission to insurance providers.

Billing & Collections Specialist – PIP/WC (DME & Pharmacy Claims)

• Managed end-to-end billing and collections for Personal Injury Protection (PIP) and Workers’ Compensation (WC) claims related to Durable Medical Equipment (DME) and pharmaceutical supplies.
• Oversaw DME billing operations, including intake, authorizations, Appeals, and procurement of purchase orders, ensuring efficient workflow and timely reimbursement.
• Communicated directly with insurance adjusters, attorneys, and claim representatives, significantly reducing turnaround times and expediting claim resolution.
• Achieved 30–60 day collection rates while consistently meeting or exceeding monthly revenue targets, reducing aged receivables by 80%.
• Conducted proactive follow-up on outstanding claims through work queues, resolving issues and securing over $150,000 in collections.
• Drafted and submitted appeals for denied or underpaid claims, successfully overturning adverse insurance decisions.
• Negotiated payment terms for DME supplies with patients, adjusters, and legal representatives—maintaining alignment with company contractual agreements.
• Delivered high-quality customer service, enhancing satisfaction by professionally engaging with patients, insurers, physicians, and clinical teams.
• Ensured strict compliance with HIPAA, Medicare, CHAP, and internal corporate policies, supporting regulatory readiness and audit standards.

Skilled Nursing Facility Billing & Collections Specialist

• Billed and successfully collected over $1.25 million in reimbursements for Skilled Nursing Facility (SNF) services.
• Processed and submitted 300–350 claims bi-monthly and monthly through Medicare Part A & B, Medicaid, and secondary co-insurance payers.
• Consistently met weekly, bi-weekly, and month-end billing and submission deadlines, maintaining accuracy and compliance with payer requirements.
• Resolved all third-party payer correspondence—including remittance advices, Explanations of Benefits (EOBs), and denial letters—within a 30-day resolution window to minimize delays in payment.
• Conducted proactive follow-ups on outstanding claims within the 30–60 day standard billing cycle, ensuring timely collections and reduced aged accounts.
• Streamlined the billing process, reducing errors and increasing overall productivity.
• Negotiated to collect balance in full.

Hospital Medicaid Authorization, Accounts Receivable & Collections Specialist

• Reviewed and confirmed Medicaid eligibility for hospital emergency room visits, ensuring accurate patient coverage and reducing claim rejections.
• Prepared, billed, and successfully collected over $543,750 in Medicaid reimbursements for ER claims.
• Transmitted 125+ clean claims weekly using billing software, managing both electronic submissions and paper claim processing to meet payer requirements.
• Verified patient eligibility and benefits for hospitalizations, procedures, and treatments using NaviNet and payer web portals.
• Conducted timely follow-ups on unpaid claims within a 30-day billing cycle, expediting reimbursements and reducing accounts receivable aging.
• Audited incoming insurance payments to ensure accuracy and compliance with payer contracts and negotiated discounts.
• Supported hospital provider credentialing and enrollment, preparing required documentation for seamless onboarding and regulatory compliance.
• Collected, coded, and entered all hospital-related services and charges with precision, ensuring complete and accurate claim submission.

Skilled Nursing Facility Billing & Collections.

• Billed and collected Medicare Part A & B and Co-Insurance. Transmitted 500 claims biweekly using billing software including electronic and paper claim processing.
• Meet weekly, bi-weekly and month-end claim submission deadlines. Responsible for maintaining low A/R and bad debt for assigned payors.
• Resolve rejected claims from the claim's clearinghouse daily.
• Prepared and submitted reports in regard to insurance billing as required.
• Stayed in compliance with all state, federal, and government agencies.
• Performed all other duties as assigned.

Office Manager & Medical Billing, Collections, Authorization Specialist

• Billed and collected payments across all payer types, including Medicare Part A & B, Medicaid, Commercial Insurance, Managed Care, Workers' Compensation, and Auto/PIP claims.
• Analyzed Explanation of Benefits (EOBs) and insurance correspondence to identify, appeal, and resolve claim denials on a daily basis, improving revenue recovery.
• Accurately posted co-payments, patient payments, and insurance reimbursements (both paper and electronic) while reconciling transactions and preparing daily deposit summaries.
• Handled the full patient billing cycle, including statement generation, claims processing, transaction posting, and data entry in compliance with payer guidelines.
• Generated and analyzed detailed financial reports including write-offs, payment types, credit balances, and reconciliation audits to support revenue integrity and compliance.
• Completed bi-weekly payroll for 8 employees.