Wilma Sutton
Roxboro,NC
Summary
To obtain a challenging position in healthcare utilizing my vast knowledge, skills, and interpersonal relations acquired through my working experience.
Overview
26
26
years of professional experience
Work History
Patient Account Representative
Henry County Health Center via Team Staffing Solutions
07.2018 - 11.2025
- Prepared claims for scrubber to bill out to insurance carriers.
- Worked aged claims for BCBS, Commercial plans and Medicaid.
- Corrected claims in clearinghouse to be billed out and resubmitted to insurance.
- Appealed and submitted registration claims.
- REMOTE
Patient Account Team Lead
Duke PRMO
07.2004 - 06.2010
- Worked High Dollar Physician claims.
- Filed appeals with Medicare and Medicaid and Managed Care Insurances.
- Attended Bi-weekly meetings with Director and Manager on the processing of High Dollar Claims.
- Worked on registration denial by calling insurance companies for updated patient insurance information, denied claims and to resolve the denial.
Patient Account Representative
Duke PRMO
07.2004 - 06.2010
- Worked Pediatric work file of 60-180 day claims.
- Called Insurance companies to check on denied claims, corrected claims for billing issues, transferred individual claims to proper area for additional issues to be resolved.
- Performed adjustments on claims needing write-offs.
- Appealed claims that were denied by insurance.
- Worked urgent and emergent inpatient cases, called Insurance to verify benefits and pre-cert IP stay.
- Applied diagnosis code and gave clinical information to insurance company to get authorization or pre-certification approved for their inpatient stay.
- Performed specialized clerical tasks in settling patient accounts receivable.
- Worked on unidentified payments.
- Worked on Medicare A technical credits.
- Opened a batch for payment corrections and transfers/adjustments.
- Corrected claims for Medicare recoupments.
Billing Specialist Customer Service Lead
Alegent Health
01.2002 - 06.2004
- Provide direction and supervision to the Physician Receivables Office Customer Service Telephone Call Center staff.
- Supervised 6 employees, established work schedules, assigned tasks, conducted employee evaluations, trained new employees.
- Handled patient calls where supervisor was requested.
- Researched billing question and responded back to patient.
- Monitored Symposium online telephone software throughout the day to determine workflow adjustments needed.
- Maintained staff productivity records and produced monthly reports.
- Worked overdue claims, appealed denials and did insurance follow-up for commercial payers.
- Filed secondary claims.
Financial Counselor/Commercial Biller
Sentara NDC Medical Center
08.1999 - 01.2002
- Coded physician dictation.
- Corrected physician dictation.
- Corrected claim rejection edits.
- Set up payment plans for patients.
- Handled patient and insurance inquiries.
- Did the billing for Occupational Health Services.
- Worked past due insurance claims.
- Evaluated individuals for indigent programs available.
- Assisted Medicare patients with billing questions.
Education
High School Diploma -
Bloomington High School
Bloomington, IL06-1974
Skills
- Leadership
- Epic
- Analytical
- Communication
- Problem-solving
- Trubridge RCM
Summary of Qualifications
25+ years’ experience in a medical billing setting: Multi-faceted billing experience - Radiology, Family Practice, Dermatology, Urgent Care, Orthopedic, inpatient, ER, Financial Counselor, Customer Service Telephone Center Lead. Detail oriented and accurate, Excellent follow-through
Timeline
Patient Account Representative
Henry County Health Center via Team Staffing Solutions
07.2018 - 11.2025
Patient Account Team Lead
Duke PRMO
07.2004 - 06.2010
Patient Account Representative
Duke PRMO
07.2004 - 06.2010
Billing Specialist Customer Service Lead
Alegent Health
01.2002 - 06.2004
Financial Counselor/Commercial Biller
Sentara NDC Medical Center
08.1999 - 01.2002
High School Diploma -
Bloomington High School