Veronica L. Autman
Joliet,IL
Summary
Reimbursement Specialist that is detailed oriented. Excels in proven experience concerning analyzing and resolving underpayments, appeals, and contracts. Expertise in disputing underpayments and effective communication with payers has consistently resulted in achieving a high productivity standard of 120 accounts per day. Proficient in utilizing EPIC and Meditech technologies to manage claims, documentation, and financial reconciliations with exceptional efficiency and accuracy. A strong commitment to compliance and continuous improvement drives success in optimizing reimbursement processes.
Overview
28
28
years of professional experience
Work History
Reimbursement Specialist
R1 RCM
01.2019 - 01.2026
- Reviewed underpayments for Blue Cross and Medicaid replacement plans.
- Prepared and submitted appeals to Blue Cross and Medicaid replacement plans through online inquiries and faxes.
- Maintain thorough documentation, including root cause of underpayment issues, trends, outcomes, and lessons learned to support ongoing improvements.
- Worked all assigned accounts a least once every 30 days depending on balance.
- Downloaded the Blue Cross experience report from OneSource and uploaded into the host system.
- Reviewed and corrected errors on the Blue Cross experience report to prevent upload discrepancies.
- Followed up with Blue Cross and Medicaid replacement to resolve underpayments and denied claims via phone or online inquires.
- Reviewed, analyzed and identified Blue Cross underpayments using UB-04, EOBs, remittance, payer contracts, and hospital billing systems.
- Followed up on outstanding underpayments and denied claims in a timely manner.
- Collaborated with HIM/Coding and billing teams to resolve denied claims.
- Followed up with Blue Cross and Medicaid replacement on contracts, fee schedules and payer policies discrepancies.
- Utilized EHR/billing software (EPIC, Meditech, ECARE) to document, update, and manage patient accounts.
- Verified patient insurance coverage and benefits to ensure accurate billing and reimbursement.
- Ensured all work complied with HIPAA and internal compliance standards.
Reimbursement Specialist
AMITA HEALTH
03.2018 - 01.2019
- Reviewed underpayments for Blue Cross and Medicaid replacement plans.
- Prepared and submitted appeals to Blue Cross and Medicaid replacement plans through online inquiries and faxes.
- Maintain thorough documentation, including root cause of underpayment issues, trends, outcomes, and lessons learned to support ongoing improvements.
- Worked all assigned underpaid accounts a least once every 30 days depending on balance.
- Downloaded the Blue Cross experience report from OneSource and uploaded into the host system.
- Created a Blue Cross findings report (underpayments, appeals, denials and payments) and submitted to finance team.
- Reviewed and corrected errors on the Blue Cross experience report to prevent upload discrepancies.
- Followed up with Blue Cross and Medicaid replacement to resolve underpayments and denied claims via phone or online inquires.
- Reviewed, analyzed and identified Blue Cross underpayments using UB-04, EOBs, remittance, payer contracts, and hospital billing systems.
- Followed up on outstanding underpayments and denied claims in a timely manner.
- Collaborated with HIM/Coding and billing teams to resolve denied claims.
- Followed up with Blue Cross and Medicaid replacement on contracts, fee schedules and payer policies discrepancies.
- Utilized EHR/billing software (EPIC, Meditech, ECARE) to document, update, and manage patient accounts.
- Ensured all work complied with HIPAA and internal compliance standards.
Reimbursement Specialist
PRESENCE HEALTH
06.2012 - 03.2018
- Reviewed underpayments for Blue Cross and Medicaid replacement plans.
- Prepared and submitted appeals to Blue Cross and Medicaid replacement plans through online inquiries and faxes.
- Maintain thorough documentation, including root cause of underpayment issues, trends, outcomes, and lessons learned to support ongoing improvements.
- Worked all assigned underpaid accounts a least once every 30 days depending on balance.
- Downloaded the Blue Cross experience report from OneSource and uploaded into the host system.
- Created a Blue Cross findings report (underpayments, appeals, denials and payments) and submitted to finance team.
- Reviewed and corrected errors on the Blue Cross experience report to prevent upload discrepancies.
- Followed up with Blue Cross and Medicaid replacement to resolve underpayments and denied claims via phone or online inquires.
- Reviewed, analyzed and identified Blue Cross underpayments using UB-04, EOBs, remittance, payer contracts, and hospital billing systems.
- Followed up on outstanding underpayments and denied claims in a timely manner.
- Collaborated with HIM/Coding and billing teams to resolve denied claims.
- Followed up with Blue Cross and Medicaid replacement on contracts, fee schedules and payer policies discrepancies.
- Utilized EHR/billing software (EPIC, Meditech, ECARE) to document, update, and manage patient accounts.
- Ensured all work complied with HIPAA and internal compliance standards.
Billing and Follow up Specialist
PROVENA HEALTH
09.1997 - 06.2012
- Submitted electronic and paper claims to Blue Cross for timely reimbursement.
- Collaborated with coding and billing team to correct errors and prevent future claim denials.
- Utilized EHR/billing software (Meditech, ECARE) to document, update, and manage patient accounts.
- Analyzed, corrected, and resubmitted denied or rejected claims by reviewing UB-04, EOB, remittance, Blue Cross UPP statement and medical records.
- Verified patient insurance coverage and benefits to ensure accurate billing and reimbursement.
- Communicated with insurance carrier and patient to resolve billing issues and discrepancies.
- Analyzed billing data to identify trends and areas for improvement in the reimbursement process.
- Prepared and submitted claim disputes to Blue Cross through online inquiries, faxes and emails.
- Followed up with Blue Cross on outstanding and denied claims via phone or online inquiries to secure reimbursement.
- Ensured all work complied with HIPAA and internal compliance standards.
Education
Diploma - Computer Programming
INTERNATIONAL CORRESPONDENCE SCHOOL
Scranton, PA06.1990
Skills
- Medical Billing Software
- Coding systems
- Information Management
- Insurance Software
- General Technical
- Administrative
Timeline
Reimbursement Specialist
R1 RCM
01.2019 - 01.2026
Reimbursement Specialist
AMITA HEALTH
03.2018 - 01.2019
Reimbursement Specialist
PRESENCE HEALTH
06.2012 - 03.2018
Billing and Follow up Specialist
PROVENA HEALTH
09.1997 - 06.2012
Diploma - Computer Programming
INTERNATIONAL CORRESPONDENCE SCHOOL