Myriam Clement

• Submit high-volume insurance claims with a focus on first-pass accuracy, helping minimize rejections and accelerate reimbursement turnaround times.
• Review and correct denied or rejected claims and prepare appeals that support recovery of delayed and underpaid reimbursements.
• Manage follow-up for government and commercial payer accounts, driving timely resolution of outstanding claims and improving cash collections.
• Process patient statements, copayments, deductibles, and coinsurance balances to support consistent revenue recovery.
• Establish payment arrangements and coordinate collection activities for delinquent accounts, contributing to reductions in aged receivables.
• Obtain and submit medical records and supporting documentation requested by payers to facilitate claim approvals and appeal success.
• Ensure compliance with HIPAA and company policies while maintaining accurate billing and account documentation.

• Posted payments, denials, and contractual adjustments for high-volume specialty pharmacy accounts.
• Managed collections and reimbursement follow-up for commercial and government payers, supporting timely recovery of outstanding balances.
• Worked denials, appeals, and claim resubmissions to maximize reimbursement and reduce unresolved accounts receivable.
• Reconciled accounts and resolved payer discrepancies and short payments, improving payment accuracy and cash flow.
• Utilized Excel and Pivot Tables to analyze and track accounts receivable performance, identifying collection and reimbursement opportunities.
• Assisted patients with copay assistance programs and payment arrangements, helping improve patient collections and account resolution rates.

• Processed medical claims for Medicare, Medicaid, HMO, and PPO plans while maintaining timely submission standards.
• Obtained authorizations and retro-authorizations for services rendered, reducing claim delays and reimbursement risk.
• Verified patient eligibility and managed claim submissions through Availity to improve clean claim rates.
• Analyzed denial trends and identified opportunities for process improvement, supporting reductions in recurring claim denials.
• Maintained accurate billing records and ensured timely claim follow-up to accelerate payment resolution.

• Reconciled accounts and resolved outstanding balances, contributing to improved account accuracy and collections performance.
• Processed refunds, adjustments, and payment corrections while ensuring compliance with payer and company guidelines.
• Reduced delinquency through proactive collections and account follow-up, helping decrease aging receivables.
• Maintained detailed account documentation and reporting to support reconciliation and reimbursement tracking.

Work Government and Commerical accounts

• Managed insurance follow-up and appeals for unpaid and denied claims, increasing reimbursement recovery opportunities.
• Verified insurance coverage and maintained denial reports to support denial prevention and resolution efforts.
• Reviewed claims for coding, pricing, authorization, and billing accuracy to reduce payment delays and rework.

• Prepared and submitted electronic and paper insurance claims for multiple payer types, supporting timely reimbursement.
• Followed up on unpaid accounts and appealed denied claims, improving recovery of outstanding balances.
• Posted payments and reviewed EOBs for accuracy to ensure proper reimbursement and account reconciliation.
• Established patient payment plans and managed collection accounts, contributing to increased patient collections.
• Worked with primary, secondary, and tertiary insurance carriers to resolve complex billing and reimbursement issues.