Lenette Oliver
Maryland Heights,MO
Overview
24
24
years of professional experience
Work History
Patient Account Representative
BJC Healthcare
St Louis, USA
12.2022 - Current
- Managed collections for outstanding balances using established procedures.
- Analyzed claims denials from third party payers and identified potential solutions for reimbursement.
- Researched discrepancies in patient accounts to determine appropriate resolution.
- Reviewed EOBs statements submitted by insurance companies for accuracy against provider's charges.
- Reconciled payments received against outstanding invoices ensuring proper posting of credits and debits.
Provider Reimbursement Specialist
United Healthcare/Optum
St Louis, USA
04.2018 - 05.2024
- Developed programs, policies and strategies to ensure that contracted rates and reimbursement policies were analyzed and applied accurately for company affiliates according to state and federal regulations
- Reviewed claim disputes to verify correct pricing and analyzed claim inquiry data to determine root cause of errors
- Recommended system changes and training and process improvements in efforts to prioritize accuracy, improve efficiency and avoid future errors
- Assisted company affiliates with initial deployment and ongoing support of systems and processes to leverage national network rates and policies
- Reduced frequency of underpaid providers claims by catching errors, which allowed providers to receive compensation in a timely manner
Claims Processor/Rapid Resolution Expert
United Healthcare
St Louis, USA
04.2006 - 04.2018
- Served as go-to person for team members as a result of being a self-starter, which boosted team morale, support and collaboration
- Provided expertise and general claims support by reviewing, researching, processing, and adjusting claims, resulting in payment accuracy for provider
- Analyzed and identified trends to provide reports as necessary, in efforts to reduce rework for providers. Claims are auto adjudicated upon first submission
- Consistently met established productivity, schedule adherence and quality standards
Customer Service Representative
United Healthcare
St Louis, USA
12.2001 - 04.2006
- Identified provider needs by answering questions and resolving issues regarding benefits and eligibility, billing and payments, clinical authorizations, explanation of benefits, and behavioral health
- Successfully asked key questions regarding claims, identified claim payment goals and ensured codes and ID numbers were correct for billing and coding
Education
High School Diploma -
Hazelwood East High School
St Louis, MO06-1988
Skills
- Data analysis
- Claims processing
- Healthcare regulations
- Medicare guidelines
- Medicaid guidelines
- Managed care contracts
- Healthcare reimbursement policies
- Access healthcare
- Microsoft Excel
- Microsoft Word
- Structured Query Language
- EPIC
Digital Tools
- Access Healthcare
- Microsoft Excel
- Microsoft Word
- Structured Query Language
- EPIC
Timeline
Patient Account Representative
BJC Healthcare
12.2022 - Current
Provider Reimbursement Specialist
United Healthcare/Optum
04.2018 - 05.2024
Claims Processor/Rapid Resolution Expert
United Healthcare
04.2006 - 04.2018
Customer Service Representative
United Healthcare
12.2001 - 04.2006
High School Diploma -
Hazelwood East High School