Vanessa Mcdougler
Parma Heights,OH
Summary
Methodical Revenue Cycle Specialist with strong attention to detail and in-depth understanding of billing procedures. Excellent planning and problem-solving abilities. Prepared to bring 17 plus years of related experience to a dynamic position with room for career growth.
Overview
19
19
years of professional experience
Work History
Revenue Cycle Specialist II
University Hospital Case Medical Center
09.2018 - Current
- Reached out to insurance companies to verify coverage.
- Identified and resolved payment issues between patients and providers.
- Balanced and reconciled accounts.
- Contacted responsible parties for past due debts.
- Verified patient insurance eligibility and entered patient information into system.
- Processed payments using cash and credit cards, maintaining accurate records of transactions.
- Filed and maintained patient records in accordance with HIPAA regulations.
- Responded to inquiries by directing calls to appropriate personnel.
- Trained new staff on filing, phone etiquette and other office duties.
- Greeted and assisted patients with check-in procedures.
- Answered incoming calls, scheduled appointments and filed medical records.
- Entered patient demographic and insurance data into electronic medical record system.
- Handled customer service inquiries in person, via telephone and through email.
- Investigated insurance claims denials and appeals.
- Resolved billing inquiries and disputes in timely fashion.
- Managed patient registration process, confirming data accuracy and completeness.
- Followed document protocols to safeguard confidentiality of patient records.
- Helped address client complaints through timely corrective actions and appropriate referrals.
- Built and maintained positive working relationships with patients and staff.
- Applied administrative knowledge and courtesy to explain procedures and services to patients.
- Reviewed patient records, identified medical codes, and created invoices for billing purposes.
- Audited and corrected billing and posting documents for accuracy.
- Handled account payments and provided information regarding outstanding balances.
- Delivered timely and accurate charge submissions.
- Kept vendor files accurate and up-to-date to expedite payment processing.
- Prevented financial delinquencies by working closely with managers to resolve billing issues before becoming unmanageable.
Financial Clearance Specialist III
Moffitt Cancer And Research Institute
04.2016 - 08.2018
- Researched denied claims and contacted insurance companies to resolve these issues.
- Reached out to insurance carriers to obtain prior authorization for testing and procedures.
- Verified eligibility and compliance with authorization requirements for service providers.
- Fielded telephone inquiries on authorization details from plan members and medical staff.
- Developed and maintained productive working relationships with healthcare providers.
- Processed patients lacking coverage for planned procedures.
- Evaluated clinical criteria for approval or denial of services requiring pre-authorization.
- Reviewed appeals for prior authorization requests and communicated with payers to resolve issues.
- Input all patient data regarding claims and prior authorizations into system accurately.
- Analyzed medical records and other documents to determine approval of requests for authorization.
- Tracked referral submission during facilitation of prior authorization issuance.
Financial Counselor
MetroHealth Medical Center
07.2004 - 07.2014
- Conducted interviews with patients and family members and answered questions regarding insurance benefits.
- Worked directly with clients to provide financial counseling and education using individualized counseling model and personal finance course.
- Liaised between patient, doctor and insurance provider to smooth claims processes.
- Documented details regarding contact with patients, providers and other individuals in system.
- Imaged and scanned patient and registration documentation into electronic patient records.
- Provided counseling to help patients navigate financial assistance programs for uncovered bills.
- Gathered demographic and insurance information to register patients for medical appointments.
- Greeted visitors and initiated triage processes for clients to streamline patient flow.
- Maintained clean and organized workspaces to promote smooth operation and easy access to patient information.
- Verified insurance coverage to confirm patient coverage for necessary medical services.
- Answered telephone calls to offer office information, answer questions, and direct calls to staff.
- Performed various administrative tasks by filing, copying and faxing documents.
- Secured patient privacy by learning and following HIPAA regulations to keep organization compliant with relevant laws.
- Assisted with medical coding and billing tasks.
- Resolved scheduling conflicts to avoid double-booked appointments and provider availability issues.
- Collected payments and co-pays from customers using large variety of insurance programs, adjusting amounts based on specific plan directives.
Education
Associate of Arts - Health Administration
University of Phoenix
Tempe, AZ03.2008
Medical Assistant Diploma - Medical Assisting
Remington College
Cleveland, OH04.1999
Skills
- Accounts Payable and Accounts Receivable
- Medical Billing
- Insurance Verification/authorizations
- Medical Terminology Knowledge
- Collecting Payments
- Productivity Standards
- Electronic Health Records Systems
- CMS-1500 Billing Forms
- Medical Claims Submission
- Microsoft Office
- 10-Key Data Entry
Languages
Spanish
Native or Bilingual
Software
Soarian
Epic
Quadax
Microsoft Word/Excel
Onbase
Aemr
Athena
Timeline
Revenue Cycle Specialist II
University Hospital Case Medical Center
09.2018 - Current
Financial Clearance Specialist III
Moffitt Cancer And Research Institute
04.2016 - 08.2018
Financial Counselor
MetroHealth Medical Center
07.2004 - 07.2014
Associate of Arts - Health Administration
University of Phoenix
Medical Assistant Diploma - Medical Assisting
Remington College
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