Meghan Ladner
Kiln,MS
Summary
Highly-motivated Dental Provider Services Representative, with desire to take on new challenges. Adept at working effectively unsupervised and quickly mastering new skills. Looking to bring my 15+ years of dental related experience in insurance accounts receivable, patient account management, provider services and billing issue resolutions, to a challenging, growth-oriented position. With my strong work ethic, adaptability, and exceptional interpersonal skills, I know I will be a great asset to your company.
Overview
13
13
years of professional experience
Work History
Provider Services Representative
Avesis
Phoenix, Arizona
10.2022 - Current
- Investigated concerns such as billing and claims questions on behalf of providers.
- Kept records of provider interactions by thoroughly recording details of inquiries.
- Eliminated contractual risks by instructing providers and coordinating educational material distribution.
- Reviewed complex and unusual claims to determine coverage restrictions.
- Handled numerous calls each day with consistent high satisfaction ratings from callers.
- Promoted high provider satisfaction by resolving problems with knowledgeable and friendly service.
- Engaged in conversation with providers to understand needs, resolve issues and answer policy questions.
- Responded quickly and effectively to complaints from contracted providers regarding payment issues or other matters.
- Provided guidance on contract language, policy interpretation and reimbursement procedures to providers.
- Collaborated with other departments within the organization to resolve complex issues related to provider relations activities.
- Assisted providers in understanding their contractual obligations and ensured timely resolution of any discrepancies or disputes.
- Developed and maintained strong relationships with providers by responding promptly to inquiries, resolving issues and providing ongoing support.
- Identified opportunities for process improvements related to provider relations activities.
- Limited project downtime and generated client retention by adhering to practitioner contracts and resolving provider grievances.
Dental Office Manager
Waveland Dental Center
Waveland, Mississippi
05.2011 - 10.2022
- Responded to patient queries and concerns to resolve issues in accordance with company policies and procedures, healthcare regulations and dental board standards.
- Managed operations for multi person dental practice, facilitating excellent patient support services, direction and guidance.
- Prepared timely office reports covering metrics such as expenses, patient loads and billing.
- Remained calm and professional in stressful circumstances and effectively diffused tense situations.
- Recruited and trained new employees to meet job requirements.
- Reviewed completed work to verify consistency, quality and conformance.
- Assessed billing statements for correct diagnostic codes and identified problems with coding.
- Checked claims coding for accuracy with ICD-10 standards.
- Accurately input procedure codes, diagnosis codes and patient information into billing software.
- Performed accurate and fully compliant monthly closing processes, accruals and journal entries.
- Performed insurance verification, pre-certification and pre-authorization.
- Evaluated pending claims to identify and resolve problems blocking auto-adjudication.
- Adhered to HIPAA requirements to safeguard patient confidentiality.
- Filed insurance claims by obtaining and entering data related to patient, insurance provider and medical code for procedures and services provided.
- Complied with insurance regulations dictated by local, state and federal agencies.
- Called insurance companies to ascertain pertinent information regarding policies and payment benefits for patients.
- Precisely calculated refunds, premiums and adjustments.
- Retained strong medical terminology understanding in effort to better comprehend procedures.
Education
High School Diploma -
Harrison Central High School
Gulfport, MSSkills
- Strong interpersonal skills
- Insurance Verification
- HIPAA Compliance
- Policy Interpretation
- Provider Relations
- Goal-oriented mindset
- Call Documentation
- De-Escalation Techniques
- Account Management
- Regulatory Compliance
- Customer Service
- Adaptability and Flexibility
- Quality Control
- Administrative and Office Support
- Time management abilities
- Issue and Complaint Resolution
- Professionalism
- Report creation
- Medical terminology knowledge
- Continuous Improvement
- Analytical Skills
- Product and service knowledge
- Microsoft Office expertise
- Customer Data Confidentiality
- Excellent Communication
- Project management abilities
- Multitasking
- Work Prioritization
- Decision-Making
- Team Collaboration
- Computer Skills
- Calm Under Pressure
- Inbound and Outbound Calling
- Complaint Investigation
Timeline
Provider Services Representative
Avesis
10.2022 - Current
Dental Office Manager
Waveland Dental Center
05.2011 - 10.2022
High School Diploma -
Harrison Central High School