US Credits Rep I - R1RCM - Remote (Montana)
(2025-09 - 2026-05)
- Execute meticulous account audits and deep-dive research to identify, validate, and resolve complex credit balances in a high-volume environment.
- Navigate diverse insurance web portals to extract critical payer information, ensuring flawless interpretation of coordination of benefits (COB) and contract terms.
- Apply expert-level knowledge of state-specific laws and Standard Operating Procedures (SOPs) to issue compliant patient and payer refunds, mitigating legal and financial risk.
- Adapt dynamically to evolving virtual workflows and digital job aids, consistently maintaining a [95%+] accuracy and efficiency rating.
Credit Balance Specialist - R1RCM - Remote (Montana)
(2024-03 - 2025-09)
- Managed an extensive credit balance workload of [X] accounts monthly, consistently meeting or exceeding key performance indicators (KPIs) for volume and accuracy by [X]%.
- Investigated and resolved critical internal and external inquiries from payers, providers, and patients in a highly professional, timely manner.
- Thrived in a fast-paced, rapidly shifting environment, demonstrating superior resilience and maintaining high daily productivity metrics.
Insurance Reimbursement Specialist II - Kootenai Health - Coeur d'Alene, ID
(2015-08 - 2024-03)
- Directed the end-to-end follow-up process for professional accounts receivable across diverse commercial insurance and government payers.
- Tracked, appealed, and resolved claims inquiries, rejections, and denials proactively, capturing maximum net revenue for the organization.
- Reduced overall A/R days by [X]% and prevented bad debt by systematically identifying and correcting root causes of recurring denials.
- Maintained sharp alignment with third-party payer billing rules (Medicare, Medicaid, Commercial) to guarantee clean claim submissions and accelerate cash flow.
Medicare Buy-In Specialist - Oregon Department of Human Services - Salem, OR
(2014-08 - 2015-04)
- Audited and reconciled complex discrepancies between the State's Buy-in master records and the Social Security Administration/CMS master health insurance databases.
- Collaborated within a specialized team to ensure eligible recipients were accurately accreted for Medicare Part A and B, effectively mitigating the State of Oregon's financial liabilities.
Medicare Medicaid Advocate - Oregon Department of Human Services - Salem, OR
(2008-09 - 2014-08)
- Advocated for dual-eligible clients as a subject matter expert navigating the complex Medicare Prescription Drug Benefit.
- Researched, analyzed, and negotiated non-routine enrollment and billing discrepancies directly with pharmacies, prescription drug plans, and CMS.
- Utilized advanced problem-solving skills to ensure vulnerable clients received critical medications at federally required copayment levels.
