Rachel Hadfield
Washington,IL
Summary
Dynamic Revenue Cycle Specialist with extensive experience across diverse projects, demonstrating excellence in claims processing and denial management. Adept at analyzing data to drive process improvements and enhance billing accuracy. Strong communicator and team leader, committed to achieving optimal outcomes in fast-paced environments. Proficient in electronic health record systems and compliance regulations.
Overview
23
23
years of professional experience
Work History
Revenue Cycle Specialist
Firstsource Solutions
Louisville, Kentucky
08.2024 - Current
- Managed patient accounts to ensure timely billing and collections processes.
- Reviewed claims for accuracy and compliance with insurance guidelines.
- Collaborated with healthcare providers to resolve billing discrepancies efficiently.
- Analyzed revenue cycle data to identify trends and improve processes.
- Utilized electronic health record systems for data entry and retrieval tasks.
- Processed appeals related to denied or rejected claims in a timely manner.
- Contacted insurance providers to check patient coverage.
- Audited payments from third-party payers to ensure accuracy of reimbursement amounts.
- Ensured all regulatory requirements were met when submitting claims for payment.
- Researched discrepancies on unpaid invoices and reconciled them.
- Maintained current knowledge of insurance policies, procedures, regulations, and guidelines.
- Identified areas where process improvements can be made within the revenue cycle.
- Specialize in professional billing for government payers, with an emphasis on Medicaid claims, denials, eligibility, and authorizations.
- Served as Government Denials Specialist for Mayo Clinic Health Systems.
- Out-of-State Medicaid project for Prisma Health Systems, ensuring compliance and efficient processing.
Systems Operations & Insurance Follow Up
MedData, Inc.
Brecksville, USA
01.2006 - 01.2020
- Streamlined claims generation, reporting, and distribution for hundreds of provider groups nationwide.
- Developed and maintained accurate databases for efficient data management.
- Led audits across all departments to reinforce policy adherence.
- Facilitated improved payment outcomes through strategic collaboration with key stakeholders.
- Organized training sessions to implement innovative processes internationally.
- Produced concise documentation for instructional purposes.
- Ensured flexibility and compliance in a changing regulatory landscape, responding to SOX and OIG audits.
- Conducted thorough research on billing practices and insurance regulations.
- Analyzed operational workflows to identify areas for efficiency improvements.
- Developed and maintained documentation for system procedures and best practices.
- Facilitated training sessions for new team members on operational processes.
- Collaborated with cross-functional teams to align system operations with organizational goals.
- Generated reports from different sources such as application logs or database tables.
Assistant Cage & Credit Manager
Par-A-Dice Hotel & Casino
East Peoria, USA
01.2003 - 01.2006
- Oversaw 90 employees, ensuring efficiency and productivity across operations.
- Monitored outstanding accounts and initiated collection activities as needed.
- Reviewed and approved credit limits for high-value customers in hospitality sector.
- Conducted interviews and trained new hires on company policies and procedures.
- Delivered one-on-one and classroom training sessions to enhance employee performance.
- Prepared and presented monthly financial reports to management for review.
- Audited cash handling procedures, including cage and vault operations, ensuring compliance.
- Scheduled payroll for three shifts, reconciling discrepancies promptly.
- Ensured adherence to corporate, state, and federal regulations during all processes.
- Reported operational findings to State Gaming Board, IRS, and FBI as required.
Education
ICD9 Coding Course & Medical Terminology Course -
Illinois Central College
East Peoria, ILBachelor of Arts - Psychology
Luther College
Decorah, IAGeneral Degree -
Chenoa High School
Chenoa, ILSkills
- Analytical skills
- Budget planning
- Creative problem solving
- Conflict resolution
- Detailed research
- Inventory management
- Active listening
- Project management
- Team leadership
- Effective time management
- Written and verbal communication
- Claim processing
- Revenue cycle management
- Insurance verification
- Data analysis
- Medical billing practices
- Process improvement
- Attention to detail
- Denial management
- Claims review
- HIPAA compliance
Hobbies and Interests
- Baking
- Beading
- Crochet & Knitting
- Counted Cross Stitch
- Girl Mom
- Herbal & Natural Remedies
- Home Improvement
- Music
- Rescue Dog Advocate
- Sewing
- Yoga
References
Available upon request.
Tech Expertise
- 10-key
- Apple Products
- CMS
- CUBS
- ECommerce
- Edits +
- Epic
- FACS
- Finthrive
- GE Healthcare Centricity
- GPMS
- Jira
- Microsoft Office
- Management Systems
- Quadax
- Quatrix
- Ring Central
- SharePoint
- Skype for Business
- VPN
- Windows
- Zoom
Timeline
Revenue Cycle Specialist
Firstsource Solutions
08.2024 - Current
Systems Operations & Insurance Follow Up
MedData, Inc.
01.2006 - 01.2020
Assistant Cage & Credit Manager
Par-A-Dice Hotel & Casino
01.2003 - 01.2006
ICD9 Coding Course & Medical Terminology Course -
Illinois Central College
Bachelor of Arts - Psychology
Luther College
General Degree -
Chenoa High School
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