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
Salt Lake City, Utah
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
Salt Lake City, Utah
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.
Salt Lake City, Utah
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
Salt Lake City, Utah
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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