Deloris Boelter

Commercial Insurance work in all facets of the revenue cycle department. This role is focused on claims processing, managing accounts receivable, and ensuring proper collection is made on account within best practice timeframes. Problem solving skills are used analyze the situation, research data, and resolve and/or formulate a decision.

Responsible for insurance and Medicare. Also responsible for submitting electronic and paper claims. Follows up with clearing house vendors on accepted and working rejections.

Billing Specialist at Magnolia Manor (2021-03 – Present)

Commercial Insurance work in all facets of the revenue cycle department. This role is focused on claims processing, managing accounts receivable, and ensuring proper collection is made on account within best practice timeframes. Problem solving skills are used analyze the situation, research data, and resolve and/or formulate a decision.

Responsible for insurance and Medicare. Also responsible for submitting electronic and paper claims. Follows up with clearing house vendors on accepted and working rejections.

• Preparation of accurate medical claims based on contracted agreements for services to various payers (e.g. Commercial Payers, Government Payers, Employer/ Institutional Payers)
• Creates and submits secondary electronic medical claims in a timely manner
• Monitors billing requirements pursuant to contracts with third party payers or government programs
• Answer insurance/billing questions from branch staff and help educate (IE: auth, benefit verification, accounts receivable, etc.) to ensure preparation and submission of clean claims
• Perform routine revenue review of claims billed within the current month
• Create claim batches and process them via electronic submission
• Manually process any claims that are not eligible for electronic billing. Identify any claims that need attention, make corrections, and resubmit
• Reviewing and identifying claims pricing discrepancies based on updates/changes to fee schedules
• Review information from electronic medical records in patient account (IE: auth, benefit verification, orders, accounts receivable, etc.) to ensure preparation and submission of clean claims
• Accurately notate patient accounts to reflect all actions made including marginal, split claim notes, missing COGS, etc.
• Effectively utilize time and resources to meet performance goals
• Provides exceptional Customer service to internal and external customers
• Ensures compliance with federal, state, and local governments, third party contracts, and company policies
• Clearly communicate any billing related issues to all appropriate parties
• Monitoring the unbilled-pending invoices queues and communicate to the branch on missing or needed documents or information