James Strube

Managed healthcare revenue cycle activities across multiple hospital client accounts, including hospital claims billing, specialized Workers' Compensation and No-Fault accounts, payer follow-up, and complex account recovery. Consistently exceeded productivity and quality standards, completing approximately 45–46 claims per day against a 42-claim goal while maintaining 97–98% quality.

Audited paid claims against insurance contract guidelines, hospital policies, and patient/client responsibilities to validate reimbursement accuracy. Audited Medicare and Medicaid bills, verified contract compliance, researched payment status, and prepared appeals for claim reconsideration.

Researched past-due balances, open invoices, and received payments; processed cash applications and posted payments while supporting cash and collections teams. Maintained financial contract information for hotel properties and communicated with sites to resolve outstanding balances.

Investigated provider claim-status inquiries, payment delays, and incorrect payments and coordinated with internal teams to obtain information required for resolution. Served as liaison among providers/customers, insurance companies, and patients while maintaining essential account and statistical data.

Investigated medical claims, gathered supporting documentation, interpreted policy provisions, and determined appropriate payment or denial recommendations. Calculated payable benefits using the PruTrac2 claims system and handled approximately 100 daily calls from claimants, agents, hospitals, physicians, and attorneys.

Completed a Diploma in Medical Information Management with training in medical billing, insurance documentation, Medicare electronic claims, account auditing, collections, pre-determination, and pre-authorization.