LAUREN REINBOLD
Bay City,MI
Summary
Detail-oriented, motivated professional with experience in Medicare Advantage & Medicare Plus Blue, which includes prior authorizations, claim troubleshooting, and high-volume provider support. Seeking a Physician Biller role where I can apply my knowledge of insurance guidelines, CMS regulations, and claims processing to improve accuracy and reduce denials.
Overview
2
2
years of professional experience
Work History
BCBSM Medicare Advantage Contractor - CSR1, CSR2, Help Desk
Morley Company
06.2023 - Current
- Process Medicare Advantage claims including benefits verification, prior authorizations, and provider inquiries.
- Troubleshoot denied claims and provide resolution pathways to agents, providers, and billers.
- Assist with appeal correspondence and ensure accurate documentation for resubmissions.
- Support high-volume provider calls while meeting call-time and quality metrics.
- Review clinical editing codes and modifiers for accuracy before processing.
- Escalate complex cases and coordinate with appropriate departments to reach resolutions.
Education
Delta Community College
01.2018
Kent Career Technical Center
01.2007
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Rockford High School
05.2006
Skills
- Medical Billing & Coding Skills
- Clinical Edits and Appeals
- Medicare & BCBSM guidelines
- CMS regulations
- Prior authorizations
- Claim processing
- EOB review
- Appeal submissions
- CPT / ICD-10 familiarity
- High-volume inbound/outbound call handling
- Care management platforms & portals
- Technical & Software
- CRM / call management systems
- Microsoft Office Suite
- Professional Skills
- Customer service
- Verbal & Written Communication
- Conflict resolution
- Problem solving
- Documentation and Annotation Accuracy
- Patience & Empathy
- Friendly, positive attitude
- Teamwork and collaboration
Timeline
BCBSM Medicare Advantage Contractor - CSR1, CSR2, Help Desk
Morley Company
06.2023 - Current
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Rockford High School
Delta Community College
Kent Career Technical Center