Lora Roach

Managed daily insurance operations using Centricity ETM, including claim appeals, reprocessing, and corrected claim submission. Updated and verified insurance coverage, processed authorizations for radiation therapy, and handled adjustments and month-end reporting. Performed clerical duties and processed incoming faxes.

Managed fitting room organization and cashier operations, including closing procedures and fund deposits. Assisted customers in locating items and navigating the store layout. Delivered excellent customer service to enhance the shopping experience.

Managed financial counseling duties including insurance verification and authorization for surgeries and diagnostic testing. Processed daily A/R, refunds, adjustments, and collections reports. Utilized knowledge of HCFA, CPT, ICD10, Medicare/Medicaid, and handled referrals and clerical tasks.

Processed insurance claims for the appeals process and managed daily Epic A/R workqueues. Handled patient and insurance refunds, working daily refund reports. Obtained authorizations for appointments, verified insurance coverage using real-time systems, and processed claim edits and reports.

Verified and obtained authorizations for upcoming appointments, faxing approvals to insurance carriers. Confirmed patient insurance coverage, co-pays, and deductibles prior to appointments. Assisted with special projects and performed daily clerical duties.

Researched and processed unpaid insurance and medical claims, updating patient and insurance information. Managed daily refunds, A/R collections, and task management queues, resolving remittance errors. Processed commercial insurance, posted payments, updated CPT/ICD codes, and maintained documentation and archives.

Followed up on unpaid and problem claims, processing claims and collection reports. Researched EOBs and medical records, handling Medicare and Missouri Medicaid claims. Managed delinquent accounts, answered inquiries from patients and insurers, and assisted with clerical duties and special projects.

Handled patient and insurance company calls, posting payments and refunds to accounts. Updated patient information, processed claims to carriers, and researched EOBs and medical records. Updated CPT codes in the system to facilitate claim reprocessing.

Responsible for updating CPT/HCFA codes and patient address changes. Processed and filed clean claims efficiently. Performed various clerical duties to support claims operations.

Graduated with a Certificate in Data Processing.