Susie A. Procter
Summary
Experienced denial management and insurance specialist with strong track record in healthcare claims processing and resolution. Skilled in analyzing and addressing claim denials, ensuring compliance with industry regulations, and optimizing reimbursement processes. Known for effective team collaboration, adaptability to changing needs, and results-driven approach. Proficient in EPIC EMR system as well as various insurance payer portals. Proficient in utilizing medical coding systems, insurance protocols, and data analysis tools.
Overview
15
15
years of professional experience
Work History
Follow-Up/Denial Specialist
Ochsner Medical Center
08.2022 - Current
- Maintained knowledge of insurance coverage benefit levels, eligibility systems and verification processes.
- Improved claim denial resolution by thoroughly researching and identifying root causes of denials.
- Optimized workflows within the team by assigning tasks based on individual strengths and expertise in particular payers or denial reasons.
- Streamlined communication between departments, facilitating faster resolution of denied claims.
- Identified root cause of denials to provide plans for denial resolution.
- Reduced aging accounts receivable balance with timely appeal submissions for denied claims.
- Ensured compliance with industry regulations and guidelines during denial management activities, avoiding potential legal issues or penalties.
Insurance Coordinator
Forrest General Hospital
01.2015 - 01.2022
- Developed comprehensive training materials for new staff, leading to quicker onboarding and higher initial productivity levels.
- Improved claim resolution times by consistently following up on outstanding insurance claims and diligently addressing any discrepancies.
- Reduced errors in claim submissions by conducting thorough audits of patient accounts prior to submission, ensuring accuracy and completeness of information.
- Achieved timely resolution of denied or underpaid claims through thorough research and concise appeals submissions.
- Expedited reimbursements with effective communication between providers, payers, and patients regarding claim status.
- Collaborated with healthcare professionals to obtain necessary documentation for claim submission and payment.
Assistant Manager
Cookies & Creme Kids Spa
01.2017 - 01.2020
- Supervised day-to-day operations to meet performance, quality and service expectations.
- Maintained a clean, safe, and organized store environment to enhance the customer experience.
- Developed strong working relationships with staff, fostering a positive work environment.
- Monitored cash intake and deposit records, increasing accuracy, and reducing discrepancies.
- Completed regular inventory counts to verify stock levels, address discrepancies, and forecast future needs.
Accounts Payable/Receivable & Payroll Manager
Prime Care Nursing, Inc.
01.2012 - 01.2015
- Assisted employees with inquiries regarding their paychecks, deductions, and other related issues, providing clear and concise communication.
- Performed calculations in overtime, vacation, and sick hours to provide accurate data to payroll processing database.
- Provided customer service to employees regarding payroll inquiries and issues.
- Uploaded time records into computer system and made adjustments to create accurate database for payroll processing functions.
- Prepared year-end reports for W-2s and 1099s, ensuring accuracy and timeliness in tax filing.
- Facilitated smooth month-end closing procedures through timely preparation of account reconciliations and adjustments.
- Improved cash flow management with timely invoicing, accurate expense reporting, and diligent follow-up on outstanding balances.
- Reduced errors in accounts receivable by consistently reconciling customer accounts and promptly addressing discrepancies.
Insurance Brokerage Office Manager
USIB LLC, Insurance Brokerage & Risk Management
01.2011 - 01.2012
- Educated clients on various insurance products, enabling informed decisions regarding their coverage options.
- Generated referral business from satisfied customers who shared positive experiences with friends and colleagues.
- Provided exceptional customer service by responding quickly to inquiries, resolving issues, and anticipating client needs.
- Assisted clients with claims processing, ensuring a smooth experience during difficult times.
- Collaborated with underwriters to negotiate favorable terms for clients, ensuring competitive pricing and comprehensive coverage.
- Streamlined the insurance application process, resulting in faster approvals and increased efficiency.
Lead Surveillance Agent
Harlow’s Casino Resorts
01.2010 - 01.2011
- Monitored security cameras for improper actions by patrons and dealers.
- Displayed adaptability by seamlessly transitioning between different roles within the department as required.
- Supervised and trained surveillance agents.
- Increased operational efficiency with the proficient use of surveillance equipment, logging incidents for further investigation.
- Ensured compliance with gaming regulations, promptly reporting any violations or discrepancies observed.
- Effectively prioritized tasks during high-pressure situations, ensuring timely responses to potential threats without compromising overall security coverage.
Education
Bachelor of Science - Speech Communications
The University of Southern Mississippi
Hattiesburg, MS01.2007
Skills
- Computer/Technical Literacy Skills
- Maintains all clerical duties including data entry, documentation, reporting, and updating clients’ medical and financial files using Microsoft Word, Microsoft Excel, Microsoft Power Point & various other software
- Telecommute with various insurance carriers and patients, while effective and efficiently documenting all calls
- Performs manual intervention of claims such as correcting system insurance buckets, changing claim bill types, and/or adding any required function to complete a hospital account
- Analytical/Research Skills
- Thoroughly research & investigate manually and electronically claims, processed EOBs/RAs, and collaborate with various business partners to ensure prompt and accurate claim adjudication
- Examines patient’s claims and accounts to determine the appropriate collection logic while gathering supporting data for appeal submissions in an effort to obtain proper claim processing from insurance payers
- Examines contracts between provider & insurances to ensure claims correct processing
- Interpersonal & Teamwork
- Assists customers, process payments, and provide a productive means of communications between the Underwriters, Agents, & customers
- Works as a team player to enhance and expedite the process of potential payment of insurance claims to increase the hospital’s cash flow
- Engages & communicate with a diverse population of patients, providers, and the surrounding community
- Quantitative Skills
- Ability to process payroll, along with accounts payable and accounts receivables, for multiple companies under one umbrella while insuring that all activities are listed under the correct GL codes and payment/refunds are posted correctly
- Ability to post and balance accounts
- Maintain a detail record of all activities related to billing and follow up of claims including applying all necessary adjustment/deductions and payments/refund
- Appeals processing
- Eligibility determination
- HIPAA compliance
- Claims analysis
References
References are available on request
Qualifications
- Skilled liaison for insurance, provider, and patient
- Proficient in the usage of computers given my years of experience with various computer systems including EPIC & Microsoft
- In-depth knowledge of billing, processing, & denial management of claims as well as prioritizing, managing, and meeting deadlines
Timeline
Follow-Up/Denial Specialist
Ochsner Medical Center
08.2022 - Current
Assistant Manager
Cookies & Creme Kids Spa
01.2017 - 01.2020
Insurance Coordinator
Forrest General Hospital
01.2015 - 01.2022
Accounts Payable/Receivable & Payroll Manager
Prime Care Nursing, Inc.
01.2012 - 01.2015
Insurance Brokerage Office Manager
USIB LLC, Insurance Brokerage & Risk Management
01.2011 - 01.2012
Lead Surveillance Agent
Harlow’s Casino Resorts
01.2010 - 01.2011
Bachelor of Science - Speech Communications
The University of Southern Mississippi
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