CANDACE SCHRADER
Litchfield Park
Summary
Skilled A/R Manager with background in managing large receivable accounts, improving collection processes, and reducing outstanding balances. Proven ability to streamline billing systems for efficiency while maintaining high degree of accuracy. Strengths include team leadership, problem-solving abilities, and strong financial acumen backed by experience in contributing significantly to revenue growth due to effective collections management.
Overview
13
13
years of professional experience
Work History
AR Manager
Previa Health
05.2023 - Current
- Management of the accounts receivable (AR) including analysis of the aged AR, looking for root cause issues; writing rules where appropriate to stop errors from occurring.
- Denial management - investigating denial sources, resolving and appealing denials which may include contacting payer representatives Makes independent decisions regarding claim adjustments, resubmission, appeals, and other claim resolution techniques.
- Makes policy updates as needed, to all RCM policies.
- Responsible for training internal teams (Operations, Sales) as well as care center staff when appropriate.
- Works closely with our Revenue Integrity team, to support efforts to ensure reimbursement is in line with payer contract agreements. Performs Denial analysis utilizing the Trizetto platform.
- Work directly with practice consultants or physicians to ensure optimal revenue cycle functionality.
- Laser focused drive toward achievement of department's daily and monthly Key Performance Indicators (KPIs), requiring a team focused approach to attainment of these goals.
- Manage a team of 5.
Appeals Specialist
Irhythm Technologies
07.2021 - 12.2023
- Create Medical based appeal letters and obtain medical records from physician's offices to generate letters based on diagnosis code and patient history.
- Review reports for higher level of diagnosis code changes to submit to insurance company for maximum reimbursement.
- Review policy changes and adapt appeal packets and billing policies to reflect any necessary changes needed.
- Assist with various departments such as patient collections, benefit management/eligibility and prior authorizations.
- Located denial trends and communicated with management.
Medical Claims Specialist
Caduceus Health
09.2020 - 12.2022
- Demonstrate competency as a claims resolution specialist for a large-scale multi-specialty/multi-site healthcare organization in the U.S.
- Conduct AR Follow-up both on front end scrubs and back-end denials through best practices.
- Scrub charges for submission and launch appeals via the Athena billing platform.
- Review and clear claim edits in the system.
- Types of edits to be worked include registration, insurance, charge, and related issues for high volume practices.
- Demonstrate a detailed understanding of how to read and interpret EOB's and denials from all insurance carriers (including the financial components such as co-pays, deductibles, and co-insurance).
- Possess a thorough knowledge of appeals processing from end to end across all payer categories based on insurance denials.
- Differentiate between best practices of appeal, coding review, credentialing review and/or adjustment.
- Contact insurance companies and utilize web portal and websites for appeal, eligibility, remittance, and payment information.
Operations Manager
Professional Medical Billing
Litchfield Park
05.2017 - 09.2020
- Company Overview: Litchfield Park, AZ
- Oversee full medical billing cycle for multiple practices including Neurology, Neuropsychology, Primary Care, Behavioral Health, Family Practice and an Independent Diagnostic Testing Facility.
- Work an average of 25 to 30 appeals and denial of claims daily.
- Make sure that appeals are being worked and sent in a timely manner.
- Train account specialists to work appeals to payer specificity.
- Review of accounts to make sure all accounts are being worked to compliance.
- Complete full credentialing of providers for all insurance carriers.
- Run reports, overseeing team's KPIs.
- Managed a team of 10.
- Litchfield Park, AZ
Account Analyst
ANMM
Phoenix
05.2015 - 05.2016
- Responsible for accepting files, billing, follow-up for multi-specialty groups for out-of-net network providers.
- Focus on billing out and follow up for pain and anesthesia providers in ASC's.
Provider Claims Analyst
MMRG
Phoenix
12.2014 - 01.2015
- Review vision claims daily for processing.
- Work pended claims report for processing errors.
- Upload Electronic claims for processing.
- Answer calls from providers regarding payment of claims.
- Assisted calls from patients regarding unpaid claims.
- Processed claims for two capitated plans and one fee for service plan.
- Work month end reports for claim processing.
- Followed up on claims for fee for service plan to ensure payment.
- Received all prior authorization requests and processed the approval.
- Very high level of multi-tasking to ensure proper and prompt payment of claims.
Claims Analyst
Block Vision
Phoenix
10.2012 - 12.2014
- Resolve claim issues for providers.
- Educating providers on correct billing procedures in order to ensure proper payment of claims.
- Specialized in major claims issues.
- Responsible for identifying claims issues and trends.
- Work with providers educating on electronic claim issues and how to navigate online through website.
- Reviewed claims to track issues for use in provider education.
- Claim entry.
- Provide benefit information to providers and members.
Education
High School Diploma -
Maryvale High School
Phoenix, ArizonaSkills
- Inventory
- MS Office
- Management
- Microsoft Word
- Operations
- Training
- Medical Billing
- Medical Collections
- CMS 1500
- UB04
- Insurance Payors
- Team Building
- Management Reporting
- KPIs
- Workload Distribution
- Daily Operations
- Revenue cycle management
- Denial management
- Accounts receivable management
- Data analysis
- Team leadership
- KPI tracking
- Medical billing
- Claims resolution
- Training development
- Problem solving
- Effective communication
- Attention to detail
- Customer relationship management
- Dispute resolution
- Performance metrics tracking
- Staff training and development
- Time management abilities
- Quality assurance
Skill Summary
- Seasoned professional with strong ability to resolve claim issues for multiple providers in a wide range of medical specialties.
- Proven ability in major claim issues, collections, and billing.
- Proven ability in billing accounts receivable and accounts payable meeting and exceeding individual and team requirements.
- Proven ability in medical terminology, insurance codes, third party payers and collections techniques, including preparing weekly and monthly reports with 100% accuracy.
- Proficient in Microsoft Office Programs, customized software, and claims software.
- Excellent Organizational skills and Public Etiquette with the ability to communicate with internal and external customers, sales reps and other staff.
Timeline
AR Manager
Previa Health
05.2023 - Current
Appeals Specialist
Irhythm Technologies
07.2021 - 12.2023
Medical Claims Specialist
Caduceus Health
09.2020 - 12.2022
Operations Manager
Professional Medical Billing
05.2017 - 09.2020
Account Analyst
ANMM
05.2015 - 05.2016
Provider Claims Analyst
MMRG
12.2014 - 01.2015
Claims Analyst
Block Vision
10.2012 - 12.2014
High School Diploma -
Maryvale High School