Quote
Overview
Skills
Work History
Education
Summary
References
Generic

Susan Pavelka

Tucson,Arizona

Quote

Far and away the best prize that life offers is the chance to work hard at work worth doing.
Theodore Roosevelt

Overview

11
11
years of professional experience

Skills

  • Policy Enforcement
  • Escalation management
  • Training Management
  • Coaching and Mentoring
  • Data Analytics
  • Claims Processing
  • Medical Billing
  • Administrative Support
  • Insurance Verification
  • Performance Management
  • Team Leadership
  • Employee Performance Evaluations
  • Employee Scheduling
  • Athena
  • Epic

Work History

Call Center Supervisor

Tenet HealthCare
08.2021 - Current
  • Supervised 27 Call center Representatives in providing excellent customer service to callers requiring assistance for Billing and Scheduling issues.
  • Achieved high-quality service levels by continuously monitoring calls and providing constructive feedback to agents to enhance performance and address areas in need of improvement.
  • Maintained open lines of communication between management and staff, fostering transparent workplace culture that encouraged collaboration and innovation.
  • Achieved employee retention by designing engaging onboarding program focused on support and mentorship for new hires.
  • Developed training programs to enhance agent skill sets, leading to improved performance metrics.
  • Increased first-call resolution rates by equipping agents with comprehensive knowledge.
  • Recruited, trained and onboarded new agents, maintaining exceptional service standards.
  • Prepare weekly and annual performance reports.
  • Collaborated with other departments for seamless coordination in addressing customer concerns, resulting in faster issue resolution.
  • Developed and implemented training for Partner company.
  • Including, Daily, in-depth, training of billing process, cases, insurances, portal, and other functions in Athena
  • This included daily Q&A meetings after live call training.
  • Staying in constant communication with Partner management during entire training process and weekly meetings beyond training.

Billing Specialist

Tenet HealthCare
11.2012 - 08.2021
  • Strengthened Patient relationships through effective communication regarding billing issues and concerns
  • Assisted colleagues in resolving complex billing issues, promoting teamwork and knowledge sharing within department
  • Act as resource and intermediary between patient and insurance companies/third party payers and provider of service
  • Researched and resolved billing discrepancies to enable accurate billing
  • Collecting payment from patients, applying payments to patient accounts via phone
  • Provided excellent customer service, developing and maintaining client relationships
  • Special projects: Covid19 self-pay project
  • Run report and vet all patients to verify Insurance or self-pay, patient ID SS# or driver's license via Cerner or Athena patient records notating accounts as needed
  • Once all accounts are vetted, submitted to COVID19 HRSA UNINSURED TESTING AND TREATMENT FUND for approval and payment.

Patient Account Specialist

Tenet Health
11.2012 - 08.2021
  • Special projects: work nationwide accounts receivable as assigned, proactively identifying and resolving issues
  • Utilize Hospital face sheet and encounter notes to review, update and correct claims to be dropped to insurance/self-pay
  • Call Center: assisted in new hire training of patient account representative
  • Provided guidance to Call Center representatives to update insurance, transfer balances, update primary and secondary insurance to reprocess claims.

Patient Financial Counselor/ Patient Account Specialist

Tenet Health
11.2012 - 08.2021
  • Act as liaison between patients and their insurance companies; often coordinating payments and answering questions from both parties
  • Supported positive patient experience with empathetic communication during financial discussions, addressing concerns with professionalism and understanding
  • Review daily/weekly imaging schedule and prepare estimate based on insurance or self-pay to be presented to patient at check-in
  • Conduct interview with patients and/or family members to determine eligibility for Hardship program/Payment plan
  • Calculate and collect cash payments appropriately for overdue or large balance accounts
  • Negotiated payment plans with patients, maintaining high rate of successful payments
  • Follow up on any payments that were missed within set timeframe
  • Maintain complete records of all patients applying for financial assistance to include application, proof of income, acceptance/denial letter, and any other applicable documentation
  • Create and maintain document both in Excel and Word as well as reports within PWPM & Athena
  • Work missing slip list to ensure that claims were created and dropped in timely manner
  • Work Account open claims list as needed.

Patient Account Specialist

Tenet Health
11.2012 - 08.2021
  • Maintained high levels of data accuracy with meticulous attention to detail in processing insurance claims and updating patient records
  • Expedited claim resolutions by skillfully navigating complex insurance policies, regulations, and guidelines
  • Work rejection report: resolving rejection issues to ensure that claims go out in timely manner
  • Primarily working with Medicare, Medicaid, HMO's, PPOs, and commercial insurance
  • Applied payments (both patient and insurance) to account and balance batch at EOD
  • Acted as resource and intermediary between patient, insurance companies/third party payers and provider of service or departmental staff via email and phone calls
  • Worked special project completing Medicaid Meaningful Use Attestation for physicians
  • Confirming that all Medicaid EHR Incentive Program requirements have been met to qualify for over million in incentive payments
  • Worked cleanup/final collection of open accounts for Intergy and PWPM, when implementing new MR software.

Education

Associate of Applied Science -

Pima Community College
Tucson, AZ
01.2009

Summary

Proactive Call Center professional bringing excellent leadership skills and capability to help staff meet and exceed customer expectations. Accomplished in improving customer satisfaction, increasing quality and reducing call times with hands-on leadership of call center employees. Evaluates staff performance against forecasted trends and makes proactive adjustments to policies and procedures. Equipped to train, monitor and manage high-performance teams in fast-paced environments. Personable and decisive with expertise in diplomatic conflict resolution and consumer behavior.

References

References available upon request

Similar Profiles

  • Ashaunta Dias

    Ashaunta DiasAshaunta Dias

    Constant Observer/Behavior Technician at Tenet HealthcareConstant Observer/Behavior Technician at Tenet Healthcare

  • Ryan Myhre

    Ryan MyhreRyan Myhre

    Certified Clinical Hemodialysis Technician at Tenet HealthcareCertified Clinical Hemodialysis Technician at Tenet Healthcare

  • Rafael Uzcategui

    Rafael UzcateguiRafael Uzcategui

    Clinical Documentation Specialist II at Tenet HealthcareClinical Documentation Specialist II at Tenet Healthcare

  • ANNETTE HICKS

    ANNETTE HICKSANNETTE HICKS

    Regional Corporate Inpatient Coding Manager at Tenet HealthcareRegional Corporate Inpatient Coding Manager at Tenet Healthcare

  • Jaxon Woodworth

    Jaxon WoodworthJaxon Woodworth

    Supervisor at Surf Thru Express Car WashSupervisor at Surf Thru Express Car Wash

CREATE PROFILE
Susan Pavelka