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Rebecca Woogen
Philomath,OR
Work Preference
Summary
Experienced Template Developer with a strong background in medical billing and coding. Translates complex business requirements into functional templates, enhancing operational efficiency through quality assurance and effective communication. Skilled in ICD-10, delivering accurate and timely solutions while fostering collaboration.
Overview
20
20
years of professional experience
Work History
Template Developer
Evicore Healthcare
Philomath, OR
07.2024 - Current
- Develop, modify, and maintain clinical templates and inners within the development (DEV) environment to support utilization management and prior authorization workflows.
- Interpret business requirements and translate them into functional template configurations that align with client specifications and organizational standards.
- Perform unit testing and quality assurance to validate template functionality, accuracy, and expected outcomes before submission for review.
- Collaborated with Client Manager to submit completed enhancements for review and approval, integrating feedback to improve template quality.
- Promote approved changes through the Integration environment for additional end to end testing and validation prior to production deployment.
- Verified successful implementation throughout development lifecycle, ensuring templates functioned correctly before production release.
- Review and prioritize work items assigned through Azure DevOps(ADO), analyzing business and client requirements for template enhancements, updates, and new template development.
Communications Coordinator
Evicore Healthcare
Philomath, Oregon
10.2022 - 07.2024
- Generate Doc Gen emails and coordinate communication efforts across different departments.
- Utilized Doc Gen Smartsheet to release letters and clarify delays, ensuring timely communication.
- Prepared and coordinated manual letters for mailing, faxing, and case attachment in Image One to streamline communication processes.
- Covered Doc Gen Error Daily Reports and communicated errors through Daily Error Report emails to maintain operational efficiency.
Claims Associate Rpresentative
Evicore HealthCare
Philomath, Oregon
06.2019 - 10.2022
- Processed and investigated claims, ensuring timely authorizations to support efficient claims management.
- Compiled reports on 175+ claims, consistently meeting daily processing goals to maintain workflow efficiency.
- Verifying member eligibility, checking contracting pricing and pricing claims.
- Managed billing inquiries and tracked payments to support accounts receivable processes and ensure accurate financial reporting.
- Resolved Cherwell tickets by addressing IT support requests and troubleshooting issues.
Telecomute Claims Adjuster
United HealthCare Group
03.2017 - 06.2019
- Delivered expertise on claims by researching, investigating, negotiating, processing, and adjusting claims to ensure accurate resolutions.
- Authorized payments or referred claims to investigators for further review, ensuring thorough evaluation of complex cases.
- Generated reports and analysis, identified trends, and conducted data entry and re-work to support data integrity and informed decision-making.
Claims Coding Specialist-Authorization Denials
University of North Carolina Physician and Associates
Raleigh, North Carolina
08.2012 - 07.2013
- Managed authorization denials across departments, clinics, and insurance companies to ensure compliance and timely resolutions.
- Resolved coding errors, submitted appeals, and followed up with insurance companies on authorization denials and appeal statuses to streamline processes.
- Rectified authorization request discrepancies to enhance accuracy and minimize denials.
Medicaid In-Patient Follow Up Rep
University of North Carolina
Raleigh, North Carolina
07.2011 - 08.2012
- Addressed escalated Medicaid provider issues and delivered Medical Assistance Counseling on retro eligibility questions.
- Review medical records and contact provider representatives for claim determination.
- Resolved high dollar and residual balance accounts to ensure timely payment and reduce outstanding debts.
- Coordinated daily requests from managers and coworkers to streamline workflow and enhance operational efficiency.
Medical Biller
Monterey Bay GI Consultants
Monterey Bay, California
07.2008 - 02.2011
- Processed medical claims ensuring compliance with insurance policies.
- Reviewed patient accounts for accuracy and completeness before submission.
- Posted payments and charges, sorted daily work, obtained billing information from patients, submitted claims to insurance companies promptly, and performed routine calls to insurance companies to verify claim status and eligibility.
- Followed up on outstanding claims to secure timely processing and resolution.
- Communicated with insurance companies to resolve claim discrepancies.
Patient Account Representative
Patient Financial Services
Raleigh, North Carolina
07.2008 - 02.2011
- Managed claims status follow-ups, appealed denied claims, processed billing, and enrolled providers in state Medicaid programs to facilitate timely reimbursements.
- Coordinated payment plans and resolved patient account discrepancies promptly.
- Managed patient inquiries regarding account balances and billing procedures.
- Processed insurance claims and verified patient eligibility for services.
- Verified patient eligibility for out of state Medicaid hospital claims, ensuring compliance and accurate processing.
Patient Account Representative
ORSA
02.2008 - 06.2008
- Processed hospital payments, initiated collections for outstanding accounts, managed patient inquiries via phone, organized paperwork, and verified patient information related to claims.
- Assisted patients with billing inquiries and account management processes.
- Guided patients through billing inquiries and account management processes. with billing inquiries and account management processes.
- Processed insurance claims using electronic health record systems efficiently.
- Resolved discrepancies in patient accounts through detailed investigations.
Medical Receptionist
Carolina Psychological
Willimington, North Carolina
12.2007 - 01.2008
- Electronically managed appointment scheduling and cancellations; ensured efficient patient check-in and check-out processes.
- Electronically managed appointment scheduling and cancellations, ensured efficient patient check-in and check-out processes.
- Processed patient intake forms and verified insurance information accurately.
- Responded to phone inquiries from patients and healthcare providers., organized patient files, created new patient charts, and verified insurance information.
- Coordinated communication between patients and healthcare providers promptly.
Office Manager
Dr. Nunziata Raschella
Poughkeepsie, NY
12.2006 - 12.2007
- Managed receptionist duties, arranged appointments, handled new patients, collected medical information, processed payments.
- Contacted insurance companies, verified patients' insurance information, updated patient demographics, scheduled referrals, organized paperwork.
- Executed manual coding of medical records with precision.
- Processed prescription orders in accordance with pharmacy regulations.
- Collaborated with medical representatives on medications and supplies, processed Medicaid/Medicare forms and claims.
Education
Medical Billing And Coding Specialist - Medical Billing And Coding
Ridley-Lowell Businss And Technical Institue
Poughkeepsie, NY 09-2006
Skills
- Specialized in Medical Terminology, Human Body, ICD-10, CPT-4, HCPCS, CMS 1500, Template Validation, Digital Template Design, Practice Management Systems, Medical Manager, Health Insurance, Medicaid, Medicare, 3rd Party Payers, Workflow Optimization, Electronic Submissions, Medical Billing and Coding, proficient in Unet, CDB, creating ORS, P-Care, Meditech, Tiny Term, Prime Clinical Management, A2K, Soverna, CT Vision, SSI, Template Configuration, Data Analysis, Integration, DEV
- Experienced in Microsoft Suite, Documentation Efficiency, Medisoft
- Template creation
- Unit testing
- Azure DevOps
- Template design
- Clinical Terminology
- Effective communication
Timeline
Template Developer
Evicore Healthcare
07.2024 - Current
Communications Coordinator
Evicore Healthcare
10.2022 - 07.2024
Claims Associate Rpresentative
Evicore HealthCare
06.2019 - 10.2022
Telecomute Claims Adjuster
United HealthCare Group
03.2017 - 06.2019
Claims Coding Specialist-Authorization Denials
University of North Carolina Physician and Associates
08.2012 - 07.2013
Medicaid In-Patient Follow Up Rep
University of North Carolina
07.2011 - 08.2012
Medical Biller
Monterey Bay GI Consultants
07.2008 - 02.2011
Patient Account Representative
Patient Financial Services
07.2008 - 02.2011
Patient Account Representative
ORSA
02.2008 - 06.2008
Medical Receptionist
Carolina Psychological
12.2007 - 01.2008
Office Manager
Dr. Nunziata Raschella
12.2006 - 12.2007
Medical Billing And Coding Specialist - Medical Billing And Coding
Ridley-Lowell Businss And Technical Institue