Marianne Schifano
Killeen,TX
Summary
As a previous A/R Specialist III/Team Lead I am ready to share my knowledge, experience, professionalism and motivation with others. Seasoned Revenue Cycle Management Billing Specialist with excellent planning and problem solving abilities. Offering 17 years of experience and a willingness to take on any challenge. Organized, driven and adaptable professional with successful history managing high caseloads in fast-paced environments.
Overview
17
17
years of professional experience
Work History
DENIAL SPECIALIST
Conifer Health Solutions LLC
01.2022 - Current
- Developed strategies to resolve complex issues related to denials.
- Reviewed and evaluated claims to determine if they meet the insurance criteria for reimbursement.
- Identified any discrepancies in patient information, provider information, or coding accuracy as part of the denial process.
- Reconciled accounts receivable balances with payers when necessary.
- Assisted in developing new protocols for improving claim processing accuracy rates.
- Investigated and documented payment errors resulting from incorrect processing of claims.
- Resolved billing disputes between providers and third party payers in a timely manner.
- Analyzed and interpreted policy language, medical records, and other relevant data to identify coverage issues.
- Monitored assigned accounts for payment resolution or appeal opportunities.
- Maintained communication with providers regarding denied claims and appeals processes.
- Collaborated with fellow team members to manage large volume of claims.
- Precisely calculated refunds, premiums, and adjustments.
- Retained strong medical terminology understanding in effort to better comprehend procedures.
- Organized information by using spreadsheets, databases or word processing applications.
- Collaborated with team members to improve overall efficiency of processing tasks.
- Managed claim disputes, negotiated settlements, and documented outcomes.
- Coordinated with adjusters for claim investigation and resolution.
- Coordinated and planned investigations of claims to confirm compensability and coverage.
- Provided exceptional customer service by addressing inquiries promptly and accurately.
A/R Specialist/ Team Lead
McKesson Corporation/ Change Healthcare
12.2008 - 09.2021
- Twelve years experience in analyzing accounts receivable reports to identify problems
- I work with insurance companies through correspondence, appeals and inquiries to resolve claim issues
- I track daily, weekly and monthly reports to identify and resolve potential problems
- I perform mid month and month-end reports to ensure balancing and accurately post payments and/or adjustments where needed
- I verify insurance addresses and requirements for proper filing efficiency
- I verify doctor credentialing
- I understand CPT codes and modifiers as it relates to correct coding and proper billing
- I train new hires for job functions as well as how it relates to others in a team.
Business Office Manager
Community Care Center
01.2007 - 01.2008
- In this position I performed the duties of assistant to the Nursing Center Administrator
- This position included the following tasks
- Payroll for 80+ employees on biweekly schedule using ADP Payroll System
- Being part of a chain of command for employee complaints and grievances
- This required tact and the ability to diffuse events before they became situations
- Everyday business concerns of 65-76 residents of the Nursing Facility
- This included monthly billing, collections and record keeping of room & board, physical therapy, resident physician charges, trust funds and individual expenses.
Skills
- Building Resilience as a Leader
- Innovation Framework
- Diversity, Inclusion & Belonging
- Team Advocate Agent Training
- Leadership DNA
- Leadership - Practical Skills
- Effective Listening
- Building Trust
- Leadership Foundations
- Eligibility Determination
- Payment posting
- Commercial insurance
- Teamwork and Collaboration
- Claim Amount Calculations
- Insurance Claim Forms Review
- Written Communication
- Reliability
- Interpersonal Skills
- Financial Transactions
- Relationship Building
- Skilled in Microsoft Products
- Medicaid knowledge
- Adaptability
- Large-Sum Computations
- Attention to Detail
- Effective Communication
- Payment and Investigation Escalations
- Continuous Improvement
- Problem-Solving
- Critical Thinking
- Business Correspondence
- Adaptability and Flexibility
- Regulatory Compliance Adherence
- Information Verification
- Professionalism
- Analytical Skills
- Medical Terminology
- Outstanding clerical abilities
- Account Management Software
- Active Listening
- Self Motivation
- Goal Setting
- Data Integrity
- Number-savvy
- Professional Demeanor
- Task Prioritization
- Multitasking
- Insurance terminology
- Account Management
- Team Collaboration
- Organizational Skills
- Time management abilities
Skills Training
- Building Resilience as a Leader
- Innovation Framework
- Diversity, Inclusion & Belonging
- Team Advocate Agent Training
- Leadership DNA
- Leadership - Practical Skills
- Complacency
- Effective Listening
- Communication Foundations
- Building Trust
- Leadership Foundations
References
References available upon request.
Timeline
DENIAL SPECIALIST
Conifer Health Solutions LLC
01.2022 - Current
A/R Specialist/ Team Lead
McKesson Corporation/ Change Healthcare
12.2008 - 09.2021
Business Office Manager
Community Care Center
01.2007 - 01.2008