Siani Mccauley

• Manage outstanding insurance claims and ensure accurate patient account resolution.
• Analyze aging reports and implement strategies to reduce AR days and bad debt.
• Submit and track Medicaid claims, maintaining compliance with NC regulations.
• Resolve claim denials, process adjustments, and post payments efficiently.
• Serve as liaison between patients, providers, and payers to resolve billing issues.

• Supported patients by clarifying insurance coverage and coordinating provider selection.
• Resolved escalated service concerns and provided financial counseling to patients.
• Communicated with internal teams to expedite issue resolution and documentation updates.

• Scheduled and promoted in-home and virtual healthcare assessments.
• Maintained HIPAA-compliant patient documentation and billing records.
• Collaborated with patients and providers to verify insurance and resolve payment issues.

• Streamlined credentialing processes to enhance efficiency and reduce turnaround times for provider applications .
• Obtained NPI numbers for providers and facilities and updated existing profiles.
• Tracked provider credentials to ensure compliance with regulatory standards through CAQH.
• Implemented tracking systems for credentialing workflows to improve communication across departments.
• Complete credentialing and re-credentialing applications for providers with insurance payers to maintain active participation and billing compliance.

Review and follow up on aging reports to resolve outstanding accounts and ensure timely reimbursement.
• Appealed claim denials and underpayments, identifying root causes, and working with payers to achieve resolution.
• Coordinate with clinical and administrative staff to ensure accurate coding, documentation, and authorization for services.
• Post insurance and patient payments, adjustments, and refunds in the billing system with accuracy and timeliness.
• Respond to patient inquiries regarding balances, insurance coverage, and payment options, maintaining a high level of customer service

• Delivered technical support and resolved account issues efficiently.
• Consistently met and exceeded sales targets through upselling strategies.
• Provided exceptional service, ensuring customer satisfaction and retention.