Rebecca Maxfield
Layton,UT
Summary
Medical Claims Investigator and Appeals Writer with over 25+ years of successful experience in accurately processing claims and executing appeal protocols accordingly.
Overview
20
20
years of professional experience
Work History
Senior Verification Specialist
Byram Healthcare
12.2018 - Current
- Served as resource expert regarding order issues that may impact patient satisfaction.
- Investigated and resolved queries and complaints pertaining to urgent orders.
- Resolved disputes in collaboration with contract administrators.
- Prevented financial delinquencies by working closely with managers to resolve billing issues before becoming unmanageable.
- Reviewed outstanding requests and redirected workloads for completeness.
Senior Appeals Writer
Lineagen, Inc
09.2016 - 10.2018
- Utilized exceptional writing, editing, and proofreading skills to produce engaging and error-free-content.
- Developed and conducted training sessions for new team members.
- Implemented complex appeal writing guidelines that increased revenue by 20%.
- Provided support to all staff with aspects of the appeals process.
Appeals Coordinator
Denials Management Inc.
06.2015 - 09.2016
- Assisted clients through the appeals process by gathering the necessary documentation to support the appeal argument(s).
- Kept abreast of regulatory and procedural factors including ERISA and the Affordable Care Act.
- Performed initial/client assessment and analysis to begin research process.
- Worked directly with facilities, clients, and management to overturn denied claim(s).
Senior Appeals Analyst
Intermountain Healthcare
05.2005 - 11.2014
- Utilized guidelines and review tools to conduct extensive research and analyze grievance and appeal issues.
- Navigated regulatory requirements proficiently, adhering to state and federal guidelines throughout the appeals process.
- Developed strong relationships with providers, insurance companies, patients, and their families fostering open communication channels for more efficient resolution of claim disputes.
- Coordinated with third party payers to resolve unpaid and denied claims.
Education
Associate of Arts - Psychology
Argosy University
Orange, CA06.2017
Certificate - Paralegal Studies
Weber State University
Ogden, UT04.2015
Skills
- HIPAA Compliance
- Medical Terminology
- Analytical writing skills
- Project management
- Critical thinking skills
- Patient confidentiality
- Policy Interpretation
- Attention to Detail
- Communication and Interpersonal Skills
- Claims Processing
- Detail Oriented
Timeline
Senior Verification Specialist
Byram Healthcare
12.2018 - Current
Senior Appeals Writer
Lineagen, Inc
09.2016 - 10.2018
Appeals Coordinator
Denials Management Inc.
06.2015 - 09.2016
Senior Appeals Analyst
Intermountain Healthcare
05.2005 - 11.2014
Associate of Arts - Psychology
Argosy University
Certificate - Paralegal Studies
Weber State University
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