Rita D. Givhens
Bolingbrook,IL
Summary
Versatile insurance professional with comprehensive experience in medical claims processing, examination, auditing and adjustment. Extensive knowledge of policies regarding PPO, HMO, Medicaid, Medicare plans and administration, as well as HIPAA laws. Highly skilled in uncovering discrepancies and opportunities to maximize reimbursement, as well as implementing process improvements. I am skilled in various areas of claim analysis, customer service (patients, hospitals, insurance providers), quality control and regulatory compliance. Strong track record of success in developing and implementing new strategies and workflow initiatives to increase efficiency, staff development and customer satisfaction. Extensive experience in appealing processes, auditing and monitoring documents for quality and compliance. Constant eye on performance and areas for enhancement to achieve results.
Overview
20
20
years of professional experience
Work History
Sr. Account Receivable Clerk
UnitedHealth Group-Optum
04.2022 - Current
- Handle all functions within the Revenue Cycle department to ensure accurate claim submission.
- Submit corrected claims to insurance payers for reconsideration for payment
- Resolve denial or partially paid claims interaction with insurance carriers.
- Submit appeals along with medical records if needed to insurance payers.
- Update patient demo so that claims can be appropriately processed.
- Work on correspondence to update information, such as updating patient insurance and correcting claims according to the EOB from the insurance payer.
- Responsible for following up on medical claims with all insurance carriers, including commercial, managed care, HMO, Medicare, and Medicaid.
Senior Patient Account Representative
Nephrology Associates of Northern IL And Indiana
Oak Brook, IL
06.2019 - 03.2020
- Handle all multiple functions within Revenue Cycle department to ensure accurate claim submission and reimbursement for insured members
- Analyze and resubmit over 120 medical claims such as (inpatient, outpatient, and physician) billing to insurance carriers for payment in a timely manner
- Responsible for follow up on medical claims with all insurance carriers, including commercial, managed care, HMO, Medicare and Medicaid
- Resolve denial or partially paid claims interaction with insurance carries, patients, hospitals, dialysis units or physicians
- Knowledge of underpaid or overpaid claims for patient accounts and issuing refunds to insurance carriers or patients when appropriate
- Submit corrected claims, medical records, or appeals if needed to insurance Payers for reconsideration for payment
- Knowledge of electronic health record software (Epic, application), NexGen
Document Retrieval Specialist
CLAIM SERVICES, INC
Aurora, Illinois
04.2005 - 03.2020
- Provide support to several hospital staff and patients in retrieving documentation necessary for processing inpatient/outpatient medical claims
- Answer high volume of incoming patient calls; place outbound calls to patients to obtain critical information needed to process medical claims
- Developed proficiency in use of ICD9/10CPT coding processes Interface frequently with health insurance providers that offer diverse types of health coverage including HMO, PPO, Medicaid, and Medicare
- Work extensively with specialized claims including pre-existing, accident details and subrogation, and Worker Compensation
- Trained new associates in company policies and procedures Interact with other departments to troubleshoot ongoing claims issues to ensure client satisfaction
Insurance Follow-Up Specialist
REVMD PARTNERS LLC
Westmont, IL
01.2018 - 02.2020
- Responsible for all secondary billing and collection for hospital and physical services
- Duties include reviewing accounts and billing secondary electronic or paper claims for all insurance payers
- Obtain critical information and submit any missing documentation that's needed to complete the file
- Such as appeals, denials, and collection regarding A/R
- Review healthcare contract and language to ensure appropriate contract workflow applies
- Analysis Explanation of Benefits for accurate payments or denials
- Analyze and document information derived from written and verbal communication and maintain detailed and accurate records
- Submit corrected claims, medical records, or appeals if needed to insurance Payers for reconsideration for payment
Audit and Recovery Analyst
EQUIAN
Warrenville, Illinois
03.2012 - 05.2017
- Handle all facets of auditing and recovery for the company’s largest client with particular attention paid to overpayment
- Reconcile accounts, utilizing proper coding processes
- Verify accuracy of insurance information and timely payments, process deductions and code transactions
- Support collections calling on insurance companies
- Identifying/analyzing/validating over 120 medical claims per day, utilize expertise in client concepts, contact and benefits reimbursements methodologies to identify discrepancies
- Review grievance/appeals in line with HIPAA guidelines; enter all applicable overpayment appeals data into tracking system
Education
Certificate of Completion - Cybersecurity
Coding Temple
Bachelor of Science - Management Information Systems
National Louis University
Chicago, ILAssociate of Applied Science - Computer Information Systems
City Colleges of Chicago - Wilbur Wright College
Chicago, ILSkills
- Microsoft Office Suite
- Access
- Excel
- PowerPoint
- Outlook
- MS Project
- SQL Servers
- Software Development Life Cycle (SDLC)
- HTML
- Proprietary Electronic Medical Records (EMR)
- Health Records
- Epic
- Soarian
- Cerner
- Citrix
- Electronic health record software
- Basic
- Operating System
- CPT coding
- Policies
- PathSystem-PathLink
- Atlas
- Citizen-VMware Horizon
- Citrix Workspace
- Perceptive Content–Image Now
- Availity
- TMHP-Texas Medicaid Portal
- MDIV
Timeline
Sr. Account Receivable Clerk
UnitedHealth Group-Optum
04.2022 - Current
Senior Patient Account Representative
Nephrology Associates of Northern IL And Indiana
06.2019 - 03.2020
Insurance Follow-Up Specialist
REVMD PARTNERS LLC
01.2018 - 02.2020
Audit and Recovery Analyst
EQUIAN
03.2012 - 05.2017
Document Retrieval Specialist
CLAIM SERVICES, INC
04.2005 - 03.2020
Certificate of Completion - Cybersecurity
Coding Temple
Bachelor of Science - Management Information Systems
National Louis University
Associate of Applied Science - Computer Information Systems
City Colleges of Chicago - Wilbur Wright College