Tera Gabel
Bismarck,ND
Summary
Detail-oriented Quality Assurance Specialist with a proven track record at Great Plains Restorative Services. Expert in quality control and problem-solving, ensuring compliance with insurance standards. Recognized for enhancing customer satisfaction as a top performer at Blue Cross and Blue Shield of North Dakota, demonstrating strong decision-making and effective troubleshooting skills.
Overview
26
26
years of professional experience
Work History
Quality Assurance Specialist
Great Plains Restorative Services (formerly Great Plains Rehabilitation Services)
06.2015 - Current
- Conduct thorough review of medical documentation and insurance coverage criteria for claims submission.
- Reduced claim denials by meticulously reviewing and correcting billing data prior to submission.
- Review all medical documentation prior to the dispensing of high-end products to assure proper coverage criteria are met.
- Maintained up-to-date knowledge of regulatory changes, ensuring product compliance across multiple insurance markets.
- Provide education for support staff to ensure we are following insurance guidelines and documentation requirements to ensure payment for services provided.
Medicare Billing Specialist
Great Plains Rehabilitation Services
06.2010 - 06.2015
- Monitored claim denials and implemented corrective actions to reduce rejections significantly.
- Prepare insurance refunds for any overpayments.
- Research and resolve all unpaid claims.
- Reviewed patient accounts for accuracy and resolved discrepancies in billing records.
- Participated in networking events within the healthcare industry to stay informed about changes affecting the field of medical billing.
- Provided exceptional customer service by promptly addressing patient inquiries or concerns related to their Medicare bills.
Customer Service Representative
Blue Cross and Blue Shield of North Dakota
Bismarck, North Dakota
01.2000 - 02.2008
- Resolved customer inquiries efficiently, enhancing overall satisfaction and loyalty.
- Maintained detailed records of customer interactions, ensuring proper follow-up and resolution of issues.
- Processed medical claims appropriately according to their specific insurance policy
- Exceeded performance metrics consistently, earning recognition as a top performer within the team.
Education
Bachelor of Science - Human Development And Education
North Dakota State University
Fargo, ND12.1996
Skills
- Strong focus on accuracy
- Quality control expertise
- Problem-solving skills
- Resourceful and self-reliant
- Strategic decision-making
- Strategic team guidance
- Proficient in Epic and Brightree systems
Timeline
Quality Assurance Specialist
Great Plains Restorative Services (formerly Great Plains Rehabilitation Services)
06.2015 - Current
Medicare Billing Specialist
Great Plains Rehabilitation Services
06.2010 - 06.2015
Customer Service Representative
Blue Cross and Blue Shield of North Dakota
01.2000 - 02.2008
Bachelor of Science - Human Development And Education
North Dakota State University