Lorrie Owen
Avondale,AZ
Summary
Dynamic Sr. Claims Analyst with extensive experience at TriWest Healthcare Alliance, specializing in claims analysis and regulatory compliance. Proven ability to implement process improvements, enhancing operational efficiency and accuracy. Recognized for critical thinking skills and a commitment to professionalism, driving effective strategic decisions within the organization. Seasoned Senior Claims Analyst with wide-ranging experience in managing and executing complex claims processes. Possess strong analytical skills, adept at interpreting policy language and determining coverage. Proven track record of effectively communicating claim resolutions to stakeholders while adhering to regulatory compliance protocols. Demonstrated ability to improve efficiency and accuracy in claims processing and settlement procedures.
Overview
23
23
years of professional experience
1
1
Appeals Negotiator
Work History
Sr. Claims Analyst
TriWest Healthcare Alliance
Phoenix, AZ
10.2019 - Current
- Working in Provider Written Correspondence to address Medical Provider claims for professional and facility claims for multiple specialties
- Identifying reimbursement trends and communicating to management to be addressed
- Working in the role as claims liaison for the IVF program
- Contacting providers and veterans regarding claims issues for resolution
- Addressing claims and authorization issues as identified by the VA
- Resolving claims appeals directed to Legal Department and providing directions to PGBA directly with instructions on claim resolution
- Running reports as needed to address claim issues
- Assisting peers with processing questions, providing training as requested
- Assisted on re-writing the new claim correspondence
Reimbursement Specialist
CVS Health
Phoenix, AZ
07.2017 - 10.2019
- Maintained and updated collections to maximize reimbursement
- Compiled and tracked outstanding balances owed to the DME client
- Meticulously identified and rectified inconsistencies, deficiencies, and discrepancies in medical documentation pertaining to Medicare LCD's to allow for correction of the claims to maximize reimbursement
- Researched HCPCS, CPT and ICD-10 coding discrepancies for compliance and reimbursement accuracy
- Maintained strict patient and client confidentiality
- Submitted electronic/paper claims documentation for timely filing, using Change Healthcare
- Confidently and adeptly handled claim denials and/or appeals
- Examined patients' insurance coverage, deductibles, possible insurance carrier payments and remaining balances not covered under their policies when applicable
- Actively maintained current working knowledge of CPT and ICD-10 coding principles, government regulation, protocols, and third-party requirements regarding billing
- Reviewed and resolved claim issues captured in CEDI/CLAIMS edits and the clearing house
- Thoroughly researched newly identified diagnoses and/or medical procedures to expand skills and knowledge
Account Resolution Specialist
Healthcare Excellence Institute
Phoenix, AZ
04.2016 - 07.2017
- Working of Hospital claims for insurance payers, including Medicare Part A and Part B claims
- Billing and collection of in-patient and out-patient claims
- Writing appeals letters to the insurance companies
- Submitting re-openings and re-determinations to Medicare
- Working in Connex for NGS Medicare as well as DDE
- Working in Emdeon for billing and submission of claims
- Experience with Meditech and Epic Software systems
- Precisely completed appropriate claims paperwork, documentation, and system entry
- Conscientiously reviewed medical record information to identify appropriate coding based on CMS HCC categories
- Interacted with providers and other medical professionals regarding billing and documentation policies, procedures, and regulations
- Confidently and adeptly handled claim denials and/or appeals
Account Specialist
THE CORE INSTITUTE
Phoenix, AZ
06.2015 - 04.2016
- Working the Durable Medical Equipment accounts
- Ensured the accuracy of public information and materials
- Actively maintained up-to-date knowledge of applicable state and Federal laws and regulations
- Implemented standards and methods to measure the effectiveness of agency activities
- Worked the aged accounts to resolution
- Dealt with and resolved the Auto and Worker's compensation claims for the Arizona and Michigan Markets
Reimbursement Specialist
TOCA
Phoenix, AZ
05.2013 - 06.2015
- Researched and resolved billing and claim problems
- Reducing outstanding A/R for 2012 to current
- Monitored new trends and procedures as they applied to Medicare and CMS
- Diligently monitored claims and Accounts Receivable to confirm proper resolution
- Verified that CPT and ICD codes used, were in compliance with established policies for NCCI edits and MUE's per CMS guidelines
- Kept abreast of advances in medicine, computerized diagnostic and treatment equipment, data processing technology, government regulations, health insurance changes and financing options
- Maintained accounts receivable documentation electronically and on paper
- Working with Medicare, Worker's Compensation, Liens, Medicare Replacement Plans
Reimbursement Specialist-Contractor
McKesson Health Solutions (Remex Staffing)
Scottsdale, AZ
09.2012 - 05.2013
- Demonstrated analytical and problem-solving ability by addressing barriers to receiving and validating accurate HCC information
- Carefully reviewed medical records for accuracy and completion as required by insurance companies
- Strictly followed all federal and state guidelines for release of information
- Acquired insurance authorizations for procedures and tests ordered by the attending physician
- Completed registration quickly and cordially for all new patients
- Demonstrated knowledge of HIPAA Privacy and Security Regulations by appropriately handling patient information
- Analyzed and interpreted patient medical and surgical records to determine billable services
- Remained up to date with all insurance requirements, including the details of patient financial responsibilities, fee-for-service and managed care plans
- Efficiently performed insurance verification and pre-certification and pre-authorization functions
- Ensured the accuracy of public information and materials
Reimbursement Specialist
Paradise Valley Family Care
Phoenix, AZ
11.2007 - 09.2012
- Manage and Collections of all patient and insurance claims for busy family practice with laboratory, x-ray, and physical medicine modalities as the only collector in the business office
- Work practice Accounts Receivables for both patient and insurance balances
- Post payments and adjustments
- Intake and approval for Industrial claims
- Management of all payment arrangements for patients
- Review of denied and underpaid insurance claims for optimum reimbursement
- Intake and triage of Motor Vehicle Accident patients
- Prepping and filing of third-party liens
- Working with attorneys and third-party adjusters to negotiate settlement of claims
- Verification of insurance plans
- Coverage for front office as needed
- Back up to poster as needed
- Ensured the accuracy of patient information and billing
- Actively maintained up-to-date knowledge of applicable state and Federal laws and regulations
- Demonstrated analytical and problem-solving ability by addressing barriers to receiving and validating accurate HCC information
- Carefully reviewed medical records for accuracy and completion as required by insurance companies additional diagnosis codes based on specific clinical findings (laboratory, radiology and, pathology reports as well as clinical studies) in support of existing diagnoses
Patient Service Manager
WALGREEN'S HOME CARE
Phoenix, AZ
08.2005 - 02.2007
- DME Company Supervision and Management of 55 employees
- Managed Centralized Admissions/Call Center, Billing Department for Arizona region of National DME Provider
- Successfully obtained objective of answering 80% of calls received in 20 seconds
- Implemented new procedures for monitoring calls, to provide training and education, to increase professionalism of employees, and increase customer satisfaction
- Implemented new procedures for auditing of patient files, to achieve compliance with Medicare, Medicaid, and JCHAO requirements
- Implemented an employee morale committee to increase employee participation and satisfaction, as well as decrease employee turnover
- Implemented adherence to policies and procedures, using employee rewards and recognition, progressive discipline, performance reviews, and one on one monthly review
- Implemented employee goals for incoming calls, with goals for number of calls, patient satisfaction, and quality of call
- Set goals for orders processed, ensuring insurance demographics
- Provided thorough supervision for day-to-day operations of facility in accordance with set policies and guidelines
- Organized and led weekly personnel meetings with team members
- Diligently monitored the QA (Quality Assurance) program to improve performance and maintain high standards of care
- Organized and led weekly personnel meetings with team members
- Observed strict confidentiality and safeguarded all patient-related information
Supervisor
CORAM HEALTHCARE HOME INFUSION COMPANY
Phoenix, AZ
04.2004 - 08.2005
- Oversaw Government billing of $2.5 million per month in account receivables
- Supervised Cash Application Department for average weekly deposits of $1.5 million
- Reduced unapplied as well as unidentified cash
- Successfully resolved large backlog of refunds
- Reorganized cash application department from a data-entry department to a cash resolution department
- Carefully selected, developed and retained qualified staff, as well as trained new staff annually
- Created annual goals, objectives and budget and made recommendations to reduce costs
- Directed the installation of improved work methods and procedures to achieve agency objectives
- Provided thorough supervision for day-to-day operations of facility in accordance with set policies and guidelines
Lead/Supervisor
INSIGHT DIAGNOSTIC IMAGING
Phoenix, AZ
11.2002 - 03.2004
- Radiology Corporation Supervision and Management of seven employees
- Managed the day-to-day workflow for collections department of a National Medical Company
- Responsible for maximum reimbursement
- Directly responsible for managing staff to successfully resolve A/R greater than 120 days and bring the DSO to Corporate guidelines
- Successfully met cash goals monthly, above Corporate Guidelines
- Daily auditing of employee's production to ensure completion of company goals
- Cross-trained in other departments, including coding and billing
- Analyzed accounts for maximum reimbursement
- Assigned Daily and Monthly goals
- Strictly followed all federal and state guidelines for release of information
- Thoroughly investigated past due invoices and minimized number of unpaid accounts
- Posted charges, payments and adjustments
- Submitted refund requests for claims paid in error
- Carefully prepared, reviewed and submitted patient statements
- Ensured timely and accurate charge submission through electronic charge capture, including the billing and account receivables (BAR) system and clearing house
- Meticulously tracked and resolved underpayments
- Remained up to date with all insurance requirements, including the details of patient financial responsibilities, fee-for-service and managed care plans
- Performed full-cycle medical billing in a fast-paced medical billing company
- Performed quality control of the data entry system to verify that claims and payments were correctly posted
Education
Certificate of Technical Studies - Human Interaction And Communication
NTL Institute
BETHEL, ME03-2005
Some College (No Degree) - Healthcare Administration
Grand Canyon University/University of Phoenix
Phoenix, AZCRCR - Accounts Receivable Management
HFMA
Skills
- Policy Interpretation Proficiency
- Regulatory Compliance Awareness
- Critical thinking abilities
- Continuous Improvement Mindset
- Statistical analysis techniques
- Claims Analysis Expertise
- Professionalism and Integrity
- Insurance industry knowledge
- Claims processing efficiency
- Claims review
- Claims analysis
- Claim investigation
- Claims history analysis
- Advanced data analytics
- Critical thinking
- Policy interpretation proficiency
- Technical writing proficiency
- Strategic Decision-making
- Regulatory compliance awareness
- Claims analysis expertise
- Professionalism and integrity
- Ethical conduct standards
Accomplishments
- Certified Professional Biller, CPT and HCPCS coding HIPAA compliance.
- Reorganized order intake processing system, streamlining processes for faster turn-around for patients to obtain equipment and supplies.
- Restructured department to allow for sole focus on phones, providing better customer service.
- Designed and created new forms and processes, which resulted in, decrease in bad debt adjustments by 50%.
- Successfully restructured documentation-billing department, which decreased un-billed revenue from $1 million to $10,000.
- Reduced A/R aging from an average of 87 days to 63 days in less than 7 months.
- Supervised team of 15 staff members.
Timeline
Sr. Claims Analyst
TriWest Healthcare Alliance
10.2019 - Current
Reimbursement Specialist
CVS Health
07.2017 - 10.2019
Account Resolution Specialist
Healthcare Excellence Institute
04.2016 - 07.2017
Account Specialist
THE CORE INSTITUTE
06.2015 - 04.2016
Reimbursement Specialist
TOCA
05.2013 - 06.2015
Reimbursement Specialist-Contractor
McKesson Health Solutions (Remex Staffing)
09.2012 - 05.2013
Reimbursement Specialist
Paradise Valley Family Care
11.2007 - 09.2012
Patient Service Manager
WALGREEN'S HOME CARE
08.2005 - 02.2007
Supervisor
CORAM HEALTHCARE HOME INFUSION COMPANY
04.2004 - 08.2005
Lead/Supervisor
INSIGHT DIAGNOSTIC IMAGING
11.2002 - 03.2004
Certificate of Technical Studies - Human Interaction And Communication
NTL Institute
Some College (No Degree) - Healthcare Administration
Grand Canyon University/University of Phoenix
CRCR - Accounts Receivable Management
HFMA