Hillary Belshe

Detail-oriented Senior Revenue Cycle professional with direct experience identifying, analyzing, and resolving hospital and medical claim underpayments, denials, and revenue leakage. Proven track record researching patient accounts, validating expected reimbursement, documenting findings for appeals and recovery, and performing root-cause analysis to prevent recurring issues. Consistently maintains 100%+ quality assurance ratings while processing high-volume claims (500+ weekly), interpreting payer policies, and partnering cross-functionally to improve first-pass yield and revenue integrity.

Eager to leverage claims resolution, underpayment analysis, and process improvement expertise in a Senior Revenue Cycle Analyst Underpayments role focused on maximizing appropriate reimbursement and mentoring team members.

Provider Claims Processing Specialist - AmeriHealth Caritas Family of Companies, Inc. - Columbus, OH

(2023-10)

• Own end-to-end research, evaluation, and resolution of high-volume (500+ weekly) medical and hospital claims, prioritizing complex underpayment, eligibility, prior authorization, benefits verification, denial, and appeal inquiries to support accurate reimbursement and clean claim outcomes.
• Investigate and validate expected reimbursement amounts; identify billing discrepancies, underpayment opportunities, and denial-related root causes (eligibility, prior authorization, medical necessity, coordination of benefits); provide actionable guidance to reduce recurring revenue leakage and improve first-pass yield.
• Process, track, and document denials, appeals, and claim adjustments with thorough, audit-ready findings required for reimbursement recovery; escalate systemic patterns with recommendations for upstream process fixes that strengthen revenue integrity.
• Support claims-related recovery workflows by maintaining data integrity and ensuring complete documentation trails for complex cases involving potential underpayments, overpayments, or adjustments.
• Consistently achieve 100%+ quality assurance ratings while translating complex payer requirements into clear guidance; drive process improvements that reduce claim friction and enhance operational efficiency.
• Partner cross-functionally with providers and internal teams to resolve open items independently, close loops, and contribute to workflow enhancements aligned with revenue cycle performance goals.

Executive Administrator (C-Suite) Operations Support - Screenpointe Inc. - Worthington, OH

(2012 - 2023)

Progressed through roles of increasing responsibility (Drug Screener → BCI Fingerprint Technician → Verification Specialist → Criminal Investigator → Client Account Manager → Executive/C-Suite Operations Support) within an FCRA-regulated background screening firm.

• Managed high-volume, detail-intensive compliance and investigative workflows using federal, state, municipal, PACER, and BCI systems; maintained rigorous, audit-ready documentation and chain-of-custody records for every case.
• Conducted thorough multi-source research and data analysis to resolve complex cases, identify discrepancies, and support accurate, regulatory-compliant decision-making—skills directly transferable to underpayment investigation and reimbursement validation.
• Performed eligibility-style verifications, employment/education/reference checks, and policy interpretation while handling highly confidential information with exceptional discretion and HIPAA-adjacent compliance standards.
• Prepared executive-level reports, compliance documentation, and client-facing summaries with clear, actionable written communication under tight turnaround expectations—supporting the documentation rigor required for appeals and recovery.
• Drove process improvements and conducted internal QA audits; earned successive promotions through ownership, accuracy, and results in a regulated environment where errors carry significant compliance and financial risk.
• Collaborated daily with leadership and cross-functional teams; independently closed complex loops, improved workflow efficiency, and mentored junior team members on standards and procedures.

Coursework - Criminal Justice - Columbus State Community College (2012 - 2012)

Diploma - Olentangy High School (2010 - 2010)