Miriam Holdread
Goshen,IN
Summary
Meticulous Medicaid and Commercial Biller with expertise in patient billing, claims processing, and insurance verification. Known for strong attention to detail and effective communication, ensuring accurate billing and prompt resolution of discrepancies.
Overview
1
1
Language
14
14
years of professional experience
Work History
Medicaid and Commercial Biller
Goshen General Hospital
Goshen, IN
06.2022 - Current
- Performed daily follow-up on outstanding claims to ensure prompt payment from payers.
- Reviewed and verified insurance claims for compliance with regulations.
- Verified insurance eligibility for patients by calling appropriate parties.
- Prepared detailed claims for submission to insurance companies according to policy guidelines.
- Processed and monitored invoices, payments, and adjustments to ensure timely payment from insurance companies.
- Analyzed patient accounts for errors or discrepancies in order to resolve issues quickly.
- Maintained up-to-date records of all billing activities including charges, adjustments, denials, and collections.
- Documented all account activity into electronic medical record system ensuring accuracy of data entry.
- Collaborated with other departments such as the clinical staff to obtain necessary documentation for processing claims accurately.
- Checked claims coding for accuracy with ICD-10 standards.
- Coded invoices properly based upon patient services and medical records.
- Reviewed engine assigned codes and modifiers to update and verify accuracy.
- Reconciled codes against services rendered.
- Reviewed legal claims for accuracy and issues.
- Collaborated with the finance team to streamline billing processes effectively.
- Monitored accounts receivable to identify unpaid balances promptly.
- Communicated with patients regarding payment options and financial policies.
- Provided customer service support by responding promptly to inquiries from patients regarding their bills.
- Researched discrepancies in accounts receivable for accurate reconciliation of balances.
- Assisted in training new billing staff on procedures and software usage.
- Generated monthly reports to document financial status of accounts receivable.
- Conducted regular audits of delinquent accounts to identify any potential problems or areas needing improvement.
- Worked with team members to identify and develop process improvements.
- Submitted claims to insurance companies.
- Accurately input procedure codes, diagnosis codes and patient information into billing software to generate up-to-date invoices.
- Verified accuracy of information and resolved discrepancies with vendors before entering invoices for payment.
- Provided prompt and accurate services through knowledge of government regulations, health benefits and healthcare terminology.
Surgical Authorization Specialist
Gerig Surgical Associates
Goshen , IN
03.2017 - 05.2022
- Reviewed and processed authorization requests for various medical services.
- Verified patient eligibility for insurance coverage and benefits.
- Verified insurance authorizations with payers via telephone or web-based systems.
- Maintained accurate records of authorization approvals and denials.
- Reviewed authorization requests for accuracy and completeness.
- Monitored daily workflow queues within the department ensuring all tasks are completed accurately and timely.
- Processed prior authorization requests in accordance with departmental guidelines.
- Monitored changes in insurance regulations affecting authorizations.
- Educated staff on authorization policies and procedures.
- Communicated with healthcare providers to gather necessary documentation.
- Facilitated communication among providers, patients, payers, and other departments.
- Provided customer service to internal and external customers related to authorization requests.
- Ensured accurate tracking of authorization statuses for timely processing using electronic databases or manual filing systems.
- Created spreadsheets utilizing Microsoft Excel for tracking authorization status updates from payers.
- Generated monthly reports detailing productivity metrics such as number of authorizations processed per day, week, month.
- Resolved discrepancies in patient information and insurance details.
- Investigated discrepancies identified during audits of claims submitted for reimbursement by providers.
- Researched patient eligibility, coverage information, and benefit levels.
- Analyzed denials received from third party payers to identify trends in denials and develop proactive measures for resolution.
- Ensured timely submission of accurate documentation to support payment of services rendered by providers.
- Prepared appeal letters on behalf of clients when necessary to resolve disputes with insurers.
- Maintained current knowledge of applicable regulations, laws, and standards.
- Conducted training sessions for new employees regarding company policies related to the authorization process.
- Attended continuing education seminars on topics relevant to the role such as coding changes or insurance policy updates.
- Participated in meetings with staff members from other departments such as billing and coding teams to provide clarification on policies related to authorizations.
- Assisted in the development of new processes and protocols to improve operational efficiency.
- Performed careful reviews of applicant data to ascertain compliance with eligibility criteria for economic assistance.
- Explained eligibility details and affordability options to patients with kindness and respect.
- Responded to client inquiries and concerns and escalated complex problems to department supervisors.
- Interacted respectfully with individuals from various backgrounds from different cultures daily, providing a high level of respect and patience with each interaction.
- Conversed with people from different cultures daily, providing a high level of respect and patience with each interaction.
Referral and Authorizaion Specialist
Goshen Family Physicians
Goshen, IN
05.2016 - 05.2017
- Coordinated patient referrals to specialists and services efficiently.
- Managed appointment scheduling and follow-up communications with patients.
- Assisted patients in understanding insurance coverage and referral processes.
- Communicated regularly with healthcare providers to ensure referral accuracy.
- Maintained detailed records of patient referrals and outcomes in the system.
- Collaborated with clinical teams to streamline referral workflows and procedures.
- Resolved patient inquiries regarding referrals and appointment statuses promptly.
- Communicated regularly with referring physicians, nurses, case managers, social workers, and other healthcare professionals regarding referral processes and requirements.
- Participated in staff meetings and provided feedback on ways to improve procedures related to referral processing.
- Entered confidential patient information and updated electronic records in database.
- Tracked referral request progress and resolved issues to maintain smooth processing.
- Coordinated with provider offices to ensure timely completion of referrals prior to scheduled appointments.
- Tracked progress of each referral throughout its lifecycle from submission through authorization or denial notification.
- Assisted patients in understanding their insurance coverage and answered questions about referrals, authorizations, and other related issues.
- Gathered and verified insurance requirements to meet payer requirements.
- Collaborated with team members to ensure the accuracy of referral data entered into the system.
- Reviewed all documentation associated with each referral request to ensure compliance with relevant regulations.
- Resolved escalated patient complaints relating to denied or delayed referrals promptly.
- Maintained detailed records of all patient referrals, including dates of submission, status updates, and any additional information required by insurance providers.
- Developed strategies for improving efficiency within the department while maintaining high standards of customer service.
- Assisted patients by answering questions and providing information regarding referrals.
- Aided clinical team to support administrative needs for clinical referrals.
- Processed incoming referral requests for medical services and submitted them to the appropriate insurance companies for authorization.
- Provided support to referring physicians in obtaining pre-authorization for services as necessary.
- Monitored changes in payer policies related to referral processing and communicated those changes internally.
- Obtained PA for services such as diagnostic imaging.
- Researched and responded to inquiries from providers regarding pending or denied referrals in a timely manner.
- Maintained confidentiality of patient information in accordance with HIPAA regulations.
- Verified documents and associated records to catch and resolve discrepancies.
- Scheduled patients according to availability, urgency and insurance authorization guidelines.
- Reviewed referral details and expectations with providers and patients and requested new referrals when necessary.
- Managed daily patient referrals daily through multi-line telephone system.
- Developed productive working relationships with numerous insurance company representatives.
- Reviewed demographic, clinical and insurance information before sending to referred specialists.
- Facilitated communication between primary care physicians, specialists, and patients to ensure a smooth referral process.
- Conducted follow-up with patients and healthcare providers to ensure satisfaction and address any concerns post-referral.
- Participated in training and professional development opportunities to stay current with best practices in referral coordination.
- Worked closely with billing departments to ensure accurate coding and billing for referred services.
- Maintained accurate and up-to-date patient records, including referral status and follow-up information.
Surgical Pre Registration
Goshen General Hospital
Goshen, IN
04.2012 - 05.2016
- Completed day-to-day duties accurately and efficiently.
- Assisted with customer requests and answered questions to improve satisfaction.
- Processed patient registrations efficiently and accurately.
- Maintained organized records and updated information regularly.
- Coordinated with healthcare staff to verify patient data.
- Utilized electronic health record systems for data entry.
- Ensured compliance with privacy regulations during registrations.
- Trained new clerks on registration procedures and systems.
- Resolved patient issues promptly and professionally.
- Carefully checked insurance information for benefits coverage and input pre-authorization documents into system.
- Processed patient registration forms, collected fees, and issued receipts for services rendered.
- Provided assistance with completion of paperwork related to the registration process.
- Registered patients for outpatient procedures and emergency services.
- Answered incoming calls from patients seeking information about services offered by the facility.
- Assisted with scheduling appointments based on provider availability.
- Greeted patients upon arrival and directed them to appropriate areas.
- Scanned documents and insurance cards to include in patient charts.
- Worked with nurses and other clinic staff to process patients and direct to appropriate departments.
- Responded to incoming department phone calls and directed callers to appropriate team members based on need.
- Prepared documents for archiving in accordance with organization policies.
- Assisted with compiling documents required for insurance claims processing.
- Utilized computer systems to track all incoming applications for registration purposes.
- Reviewed patient medical records and verified accuracy of information in the system.
Education
GED -
Goshen High School
Goshen06-2002
Skills
- Patient billing management
- Claims processing procedures
- Insurance verification processes
- Billing and collections
- Authorization processing
- Prior authorization processing
- Claims denial resolution
- Insurance confirmation
- Billing procedures
- Account reconciliation
- Claims documentation
- Electronic medical records
- ICD-10 coding
- Data analysis
- Data input
- Medical terminology
- HIPAA compliance
- Eligibility procedures
- Workflow management
- Appointment scheduling
- Patient registration
- Problem solving
- Analytical thinking
- Judgment in healthcare
- Team collaboration
- Communication strategies
- Confidentiality
- Patient interactions
- Billing process optimization
- Billing process optimization
- Patient registration
Languages
Spanish
Full Professional
Timeline
Medicaid and Commercial Biller
Goshen General Hospital
06.2022 - Current
Surgical Authorization Specialist
Gerig Surgical Associates
03.2017 - 05.2022
Referral and Authorizaion Specialist
Goshen Family Physicians
05.2016 - 05.2017
Surgical Pre Registration
Goshen General Hospital
04.2012 - 05.2016
GED -
Goshen High School