Caeli Hermsen
Lincoln
Summary
Motivated, detailed-oriented, and responsible professional with experience and a proven knowledge of customer service, billing management and workflow prioritization. A versatile team player with a passion for learning and growing within an organization.
Overview
4
4
years of professional experience
Work History
Claims Resolution Specialist
TELCOR
06.2022 - Current
- Work payer denials and appeals by performing analysis and investigation of individual scenarios while identifying commonalities or trends within current worklists or across future/past worklists in order to continuously improve quality and efficiency for customer outcomes, as well as TRCS Success
- Follow up and taking action by interpreting information, making determinations, applying knowledge and executing appropriate next steps on payer denials and appeals in order to facilitate payment, balance transfers, or adjustments based on customer-specific and/or payer-specific requirements
- Function in accordance to Standard Operating Procedures or Best Practices as documented or as verbalized from supervisors, other leadership, trainers, or other experienced team members
- Demonstrate knowledge of CPT, HCPCs modifiers, ICD-10 codes and EOB interpretation
- Demonstrate knowledge of payer requirements, clearinghouse portal navigation and appropriate interpretation of information
Billing and Insurance Manager
SJL Wellness
03.2022 - 06.2022
- Provide customer service while interacting with patients and team members
- Schedule patient appointments
- Prepare daily schedule for provider
- Prepare patient charts
- Verify patient insurance eligibility and benefits
- Enter and review charge information into EMR
- Prepare and submit claims to insurance companies
- Manage patient flow to reduce patient wait time
- Answer questions from patients, clinical and insurance companies
- Maintain patient confidentiality and follow HIPAA guidelines
- Perform other related duties as assigned.
Billing Specialist
Nebraska Orthopaedic and Sports Medicine, PC
03.2021 - 03.2022
- Assign and sequence ICD-10, CPT, and modifier codes to surgical procedures and fracture care
- Review reports and turn text into coding or transfer codes directly from op reports
- Enter and review for accuracy charge information into EMR
- Prepare and submit clean claims to various insurance companies either electronically or by paper
- Identify and resolve errors with coding
- Obtain prior authorization for services from insurance companies
- Maintain current knowledge of relevant coding/billing changes, research all information needed, and assist in implementing them
- Answer questions from patients, clinical, billing staff, and insurance companies
- Maintain patient confidentiality and follow HIPAA guidelines
- Perform other duties as assigned.
Office Manager/Chiropractic Assistant
Tarnick Chiropractic and Acupuncture
02.2020 - 03.2021
- Schedule patient appointments
- Establish and update patients accounts in EHR
- Verify patient insurance eligibility and benefits
- Code and assign billing charges to patient accounts using ICD-10 codes
- Review and post payments from insurance companies
- Prepare and resubmit claims to insurance companies
- Collect and process payments from patients
Foster Care Specialist
Better Living Counseling Services
05.2019 - 01.2020
- Provide support to foster homes
- Provide resources to foster parents
- Provide on-call support to foster homes
- Engage in face-to-face contact with foster parents and foster youth
- Assist with transportation needs of foster youth
- Assist to develop goals for foster youth
- Assist foster parents in navigating through crisis
Education
Bachelor of Science - Education & Human Services, Child, Youth & Family Studies, Education
University of Nebraska
Lincoln, NE05.2019
Skills
- Medical Billing and Coding
- Billing Management
- Liability Determinations
- Clerical Support
- Policy Coverage Determinations
- Problem Resolution
Timeline
Claims Resolution Specialist
TELCOR
06.2022 - Current
Billing and Insurance Manager
SJL Wellness
03.2022 - 06.2022
Billing Specialist
Nebraska Orthopaedic and Sports Medicine, PC
03.2021 - 03.2022
Office Manager/Chiropractic Assistant
Tarnick Chiropractic and Acupuncture
02.2020 - 03.2021
Foster Care Specialist
Better Living Counseling Services
05.2019 - 01.2020
Bachelor of Science - Education & Human Services, Child, Youth & Family Studies, Education
University of Nebraska
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