Becoming a leader in management
Louisa Howard
Murrieta,CA
Summary
Dedicated and detail-oriented Remote SR. Reimbursement Specialist with over 30 years of experience in medical billing and accounts management. Expert handling billing inquires, processing Medicare claims, and managing Denied claims to ensure accurate billing and timely resolution. Proven track Record of securing approvals for denied claims, leading to significant financial Recoveries. Committed to enhancing reimbursement experience and streamlining the processes to meet organization needs.
Overview
16
16
years of professional experience
Work History
Program Coordinator
Centene Corporation
07.2023 - 07.2025
- Managed inbound communications from Wellcare members to assess and address their needs.
- Facilitate Case Management support by actively listening to members routing and addressing their needs. Routing them to appropriate care queues based on risk levels.
- Guided members in utilizing their benefits, including assistance in obtaining meal benefits, glucose meters for diabetes management, scales, and blood Pressure cuffs.
- Connected members to community assistance resources for additional needs such as housing utilities, or homecare services.
- Assisted member with billing inquires, directing them to the appropriate departments for resolutions.
- Recommended members for Case Management regarding behavioral health Support and in-home care services.
- Temp
Medical Biller
Sierra Winds Retirement
03.2022 - 05.2022
- Executed monthly billing operations, focusing on private pay accounts for long-term health center services.
- Processed Medicare Part A and B billing for skilled nursing care.
- Managed billing for laboratory tests, pharmacy services, x-ray, therapy charges, and room and board fees.
- Participated in daily briefings to discuss admits, treatments, and patient discharges.
- Utilized MyUnity, Excel, Windows, and Outlook systems for billing operations.
- Provided customer service to residents for bill inquires and account adjustments.
- Community
Intake Coordinator
Soleo Health-Pharmaceutical Strategies
01.2022 - 03.2022
- Served as an intake Coordinator for infusion services.
- Verified insurance benefits for infusion treatments and communicated financial responsibilities to patients.
- Documented patient acknowledgements in accounts to ensure understanding of potential out-of-pocket expenses post
- Employment systems CPR+, Excel, Windows, and Outlook for operational task
- Temp
Denial and Appeal Specialist
Great Elm Healthcare
06.2020 - 12.2021
- Investigated denial trends and payment issues, proposing solutions while collaborating cross-functionally with market access and management teams
- Responding to patients' inquiries regarding billing, processed payments, and updated accounts accordingly.
- Followed up on a high value account and utilized insurance portals for medical records submission as required.
- Reviewed Explanation of benefits (EOBs) for denied claims and prepared appeal submissions accordingly.
- Regularly reverified benefits to rectify denials, secured authorizations, and processed retroactive authorizations as needed.
- Managed members grievances and appeals, ensuring compliance with regulatory documentation, investigation, and timely resolution.
- Oversaw third-party insurance billing and collections for CPAP, BPAP and ventilator equipment ensuring patient compliance with usage guidelines.
- Processed strong knowledge of Durable Medical Equipment (DME) regulations and compliance standards.
- Proficient in utilizing Brightree, Emdeon, Excel, Adobe, Word, Outlook and Microsoft Teams for remote collaboration.
Sr. Reimbursement and Appeals Specialist
Dexcom Inc
07.2009 - 07.2019
- Possessed in-depth knowledge of Continuous Glucose Monitors (CGM), understanding their essential role for Type 1 diabetics and their for functionality for glucose monitoring.
- Conducted regular correction and rebilling on rejected claims, ensuring proper documentation, including a valid Letter of Medical Necessity.
- Followed up on EOBs and denials, requesting medical records, reviewing clinical criteria, and submitting appeals or retro authorizations as required.
- Delivered customer service to patients and liaised with insurance provide to. Secure CGM approvals, including conducting peer to peer discussions as Well as supporting patient grievances and appeals when prior authorization was not viable.
- Collaborated with team members by sharing expertise, assisting with quality. control prior to billing, and verifying insurance benefits and CGM overage.
- Established payment plans for patients opting for out-of-pocket expenses.
- Crafted a customized appeal letter articulating CGM unit calculations, leading to approvals for several thousands dollars in previously denied claims.
- Contributed to the development of the Mission Statement for Dexcom.
Education
Regional Occupational Program - Medical billing Certificate and Medi-cal Certificate
08.1999
High School Graduate - undefined
06.1981
Skills
Claims submission
Payer regulations
Clinical Research/review
HMO,EPO, PPO and POS
Follow up small balances/denials
Appeals process
DME, durable medical equipment
Insurance guidelines
Medical terminology
Case Management
CPT/ICD-10 codes
Insurance verification
Medical criteria
Benefit verification
Utilization
Preauthorization
Third party plans
WFH Remote
Meticulous
Problem-solving abilities
Provider Relations
Knowledge of insurance contracts
HIPAA understanding
Homecare billing
Peer to peer experience
Brightree
Oracle
Virtual Health
Unity
Citrix remote
CPR
Emdeon & EDI clearing houses
Adobe
Excel
Windows
Microsoft word
Outlook
Microsoft Teams
Zoom
AWS Connect phone support
ERM
Customer services
People skills
Excellent communication
Support and Multitask
Analytical abilities
Proper handling of protective health information (PHI)
Hospital billing
Experience overturn Auth
Accomplishments
Creating appeals letter , which generated thousands of dollars in revenue.
Interests
Timeline
Program Coordinator - Centene Corporation
07.2023 - 07.2025
Medical Biller - Sierra Winds Retirement
03.2022 - 05.2022
Intake Coordinator - Soleo Health-Pharmaceutical Strategies
01.2022 - 03.2022
Denial and Appeal Specialist - Great Elm Healthcare
06.2020 - 12.2021
Sr. Reimbursement and Appeals Specialist - Dexcom Inc
07.2009 - 07.2019
- Regional Occupational Program, Medical billing Certificate and Medi-cal Certificate
San Gorgonio High School - High School Graduate,