Randi Michelle Bowman
WellSky
Potterville,MI
1
Certification
7
years of professional experience
Experienced with handling medical billing processes in a Home Infusion Therapy setting. Utilizes strong organizational skills to manage billing operations and ensure timely payments. Knowledge of medical coding and compliance standards, contributing to streamlined operations and accurate claims processing.
Work History
Sr. Reimbursement Coordinator
3 Years 9 Months- Home Infusion Therapy Billing
- Senior responsibilities include:
- Compiled comprehensive month-end reports for leadership review.
- Provided guidance to team staff on reimbursement protocols and system navigation to enhance operational efficiency.
- Conducted routine client meetings to gather feedback and address concerns, enhancing overall client satisfaction.
- Facilitated effective communication on billing and reimbursement issues between employer and clients to ensure clarity and resolution.
- Reimbursement Coordinator (2022-Current) responsibilities:
- Executed billing processes for multiple commercial, Medicare and Medicaid insurance companies, ensuring accurate procedure code application for each payer.
- Managed interactions with insurers to ensure timely resolution of claims and payment issues.
- Executed prompt resubmission of claims to maintain operational efficiency and minimize delays.
- Managed documentation process for appeals and reconsiderations, ensuring accuracy and adherence to deadlines.
- Coordinated retrieval and submission of medical records in response to payor inquiries.
- Executed billing procedures for secondary and tertiary insurances, facilitating efficient claims resolution.
- Facilitated client and patient interactions to effectively resolve issues.
- Experienced in CPR+, CareTend, Waystar and BI Reports.
- Leveraged advanced skills in Microsoft applications to facilitate data analysis and reporting tasks.
Medical Biller
2 Years- Assessed and confirmed insurance eligibility and benefits for patients.
- Evaluated treatment plans to ascertain necessity for prior authorization and secured approvals as required.
- Processed Medicare, Medicaid, and Tricare claims to support patient access to healthcare services. Assisted with commercial insurance plans and Medicare Part D inquiries to facilitate timely resolutions. Managed auto claims and workers' compensation cases to ensure efficient processing and client satisfaction.
- Executed verification of insurance payments to ensure accuracy and compliance.
- Executed claims resubmission process to facilitate timely resolution of discrepancies.
- Addressed payment discrepancies and filed necessary reconsiderations or appeals. Assisted in resolving payment discrepancies by submitting relevant appeals.
- Processed payments to patient accounts promptly. Generated billing for patients when required.
- Processed billing for secondary and tertiary insurance claims to ensure timely reimbursements.
- Managed incoming phone calls and addressed patient inquiries regarding billing concerns. Assisted patients by providing clear answers to questions related to their bills.
- Conducted comprehensive code diagnosis utilizing patient clinical data.
- Reviewed and submitted CMS 1500 forms to appropriate payers for timely reimbursement.
- Processed electronic claims and submitted paper claims as necessary.
- Compiled and analyzed aging reports to support effective decision-making.
- Managed follow-up communications with outstanding accounts to ensure timely resolution.
- Leveraged expertise in Cortex and Waystar EDI systems to enhance operational efficiency.
Education
CBCS - Medical Billing and Coding
Skills
Claims management
Prior Authorization
Insurance verification
Medical coding
Appeals handling
Denial management
Payment reconciliation
Claim corrections
HIPAA compliance
Time management
Organizational skills
Teamwork and collaboration
Certification
CBCS April 2020
Timeline
Sr. Reimbursement Coordinator
WellSky
11.2022 - CurrentRead More
Medical Biller
JP Medical Billing
01.2020 - 01.2022Read More
Career Quest Learning Center
CBCS from Medical Billing and Coding
Read More