Tracy Sims
Channahon,IL
Summary
Dynamic Claim Specialist with extensive experience at R1 RCM, proficient in processing insurance claims and resolving intricate payment issues.
Overview
34
34
years of professional experience
Work History
Claim Specialist
R1 RCM
Lisle, IL
05.2000 - Current
- Orchestrated day-to-day operations of billing department, including medical coding, payment posting, accounts receivables and collections for multiple cardiology groups
- Set up and maintained new electronic billing system
- Processed insurance company denials by auditing patient files, researching procedures and diagnostic codes to determine proper reimbursement
- Daily submitted large volume of electronic and paper claims to insurance companies including Medicare and Medicaid to collect medical payments
- Researched and followed up on denied insurance claims
- Participated in workshops and other training opportunities to remain current on billing procedures, regulations and industry updates
- Prepared billing statements for patients and ensured correct diagnostic coding
Patient Service Representative
Health Service Systems, Inc.
New Lenox, IL
08.1991 - 02.2001
- Determined proper course of action for claims processing
- Worked with management team to implement proper division of responsibilities
- Handled large volume of claims consistent with client and corporate policies, procedures, best practices and regulations
- Documented and communicated timely claims information while supporting accurate outcomes
- Balanced deposits and credit card payments each day
- Posted miscellaneous payments to general ledger accounts
- Efficiently posted payments and adjustments in accounting system
- Resolved complex insurance and customer payment issues by providing options or escalating problems to supervisors
Skills
- Team leadership
- Knowledge of Provider Credentialing and Contracts
- Extensive knowledge of NextGen Practice Management System
- Maintained PM system and files
- Trained front office staff
- Proficient in reviewing and processing insurance claims
- Set up and maintains all EFT/ERA payers
- Extensive experience in transmitting claims and patient statements electronically
Timeline
Claim Specialist
R1 RCM
05.2000 - Current
Patient Service Representative
Health Service Systems, Inc.
08.1991 - 02.2001