HOLLY LEIFHEIT
Charlotte
Summary
Dynamic Senior Claims Representative at UnitedHealth Group with expertise in claims processing and regulatory compliance. Proven track record in conflict resolution and effective communication, successfully managing complex medical claims to ensure timely payments. Committed to exceeding performance standards while maintaining patient confidentiality and enhancing customer service experiences.
Overview
13
13
years of professional experience
Work History
Senior Claims Representative
UnitedHealth Group
05.2023 - Current
- Manage and evaluate a high volume of complex medical claims to ensure accurate and timely payment
- Maintain a thorough knowledge of insurance policies and regulations to interpret and apply claims processing accurately
- Ensure compliance with HIPAA regulations and patient confidentiality
- Utilize appropriate SOPs and necessary documents for adjusting claims
- Close claims by issuing checks, sending correspondence due to over-payment charges or denial of claims, and pend to other departments for further review
- Analyze information to evaluate assigned claims to process correctly and efficiently
- Meet company and state requirements, regulations, contractual agreements, and group performance standards deadlines
- Attend group training and participate in individual coaching as requested by management
- Coordinate and communicate with multiple departments (URN, Repricing, Workforce)
Administrative Assistant
Wells Fargo
Charlotte
10.2022 - 05.2023
- Lead and participate in assigned projects and provide resourceful information as required
- Participate in meetings to share, discuss, and resolve questions or errors
- Maintain confidentiality of sensitive information and documents to ensure data security
- Interact and act as a liaison with business clients, business partners, outside counsel, internal and external office staff, expert witnesses, and vendors
- Process expense reports according to Wells Fargo policy, route/process invoices, and process check requests
- Maintain accurate and organized physical and electronic files in accordance with the Records and Information Management Policy and Legal Department Records Management Procedure
- Open, sort, and distribute incoming messages and correspondence throughout the department
- Analyze and review internal and external documents before presenting them to a team of attorneys
- Make travel arrangements, adjustments as needed, create itineraries, and coordinate ground transportation
Insurance Coordinator
Pettinato's Children Dentistry
Wesley Chapel
01.2018 - 10.2022
- Verify dental benefits for a schedule of 60+ patients a day involving a treatment plan estimate
- Educate patients on their benefits and explain how they are applied to their treatment plan
- Investigate coverage of claims through telephone, mail correspondence, and/or contact with representatives within insurance carriers
- Perform monthly audits to ensure payments are in line with patients benefits verified
- Generate, validate and process internal invoices
- Follow-up on prior authorizations submitted for treatment within insurance guidelines
- Perform end-of-day tasks by confirming cash and electronic payments received for the day match daily report generated
- Negotiate and create payment options available for patient receiving treatment
- Manage relationships and contracts with insurance company representatives and negotiate contracts and fee schedules to maximize reimbursement rates for the practice
- Help process provider applications and re-applications for credentialing
- Perform test claims to confirm contract rates in internal system match contract agreed upon between office and insurance carrier
Office Coordinator
Great Expressions Dental Centers
Wesley Chapel
11.2016 - 01.2018
- Validate dental benefits and input correctly into internal system
- Perform bi-weekly reports to review failure of claims and benefits being applied to patients treatment
- Appropriately escalate issues to management for support and/or guidance
- Evaluate, negotiate, and resolve payment discrepancies in patient accounts
- Accurately apply payments and refunds to patients account
- Develop and implement marketing strategies to attract new patients and increase patient retention rates
- Support the hiring manager with recruiting, interviewing, and on-boarding activities
- Review weekly, bi-weekly, and monthly reports to facilitate revenue cycle management
- Maintain and organize incoming e-mails, sending communication responses back within a timely manner
- Generate and distribute invoices created for treatment performed within office
- Communicate with external offices in regards to outside referrals created for necessary treatment
- Assist with yearly review of contract rates between office and insurance carriers
- Initiate and submit prior authorization on behalf of patient
Customer Service Representative
Express Scripts
08.2012 - 06.2016
- Communicate with patients via phone inquiring about their prescription benefits
- Educate patients on benefits and pharmacies in/out of the network
- Provide upcoming plan changes and provide other plan options within the company
- Provide cost savings by switching from a local pharmacy to a mail-order pharmacy
- Accurately apply payments to patients account provided verbally over the phone
- Identify cause and effect trends to provide reports as necessary
- Review patient inquiries pertaining to account balances, charges, and claim denials
- Provide customer service with great quality within a set time frame and provide accurate information
- Review plan guidelines involving prior authorization and tier exceptions for patients medication
- Actively attend meetings to provide feedback and trends arising within department
- Update patient information in our database via verbal communication, fax, or email
- Assist with open enrollment for Medicare patients and educate them on benefits with plan options
- Exceed company metrics and demonstrate goal-driven competencies
Education
High School Diploma -
Camden County High School
Kingsland, GA05.2009
Nursing -
College of Coastal Georgia
Kingsland, GASkills
- Claims processing
- Medical coding
- Regulatory compliance
- Attention to detail
- Customer service
- Coverage verification
- Effective communication
- Conflict resolution
Timeline
Senior Claims Representative
UnitedHealth Group
05.2023 - Current
Administrative Assistant
Wells Fargo
10.2022 - 05.2023
Insurance Coordinator
Pettinato's Children Dentistry
01.2018 - 10.2022
Office Coordinator
Great Expressions Dental Centers
11.2016 - 01.2018
Customer Service Representative
Express Scripts
08.2012 - 06.2016
High School Diploma -
Camden County High School
Nursing -
College of Coastal Georgia
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