Raquel Bailey
St. Louis
Summary
Member/Customer Representative with 7 years of experience in medical billing and claims processing, proficient in utilizing Epic systems and ensuring accurate prior authorizations. Demonstrates a strong ability to streamline processes, evident in reducing claim processing time by over 12%, and excels in enhancing communication efficiency with clients and providers. Committed to leveraging analytical skills and industry knowledge to drive optimal patient outcomes and support team initiatives.
Overview
8
8
years of professional experience
Work History
Medicaid Specialists
Elevate Patient Financial Solutions
06.2024 - Current
- Manage Medicaid claims, ensuring compliance and timely resolutions for patient accounts
- Assist pregnant women with applying for Medicaid
- Collaborate with healthcare providers to resolve complex billing issues
- Document and notate each account worked
Pharmacy Claims Coordinator
Elevance Health
12.2023 - 06.2024
- Coordinate authorizations, ensuring prompt claim resolutions and reducing errors.
- Verify prescriptions, enhancing treatment accuracy and minimizing mistakes.
- Streamline client-provider communication, improving response efficiency.
- Reach out to insurance companies to verify coverage for patients
Engagement Center Specialist
Syneos Health
09.2023 - 11.2023
- Answering inbound calls
- Assisting patients, doctors and sales reps
- Trouble shooting callers with diabetes meds
Insurance Follow-up Representative
R1 RCM Revenue Cycle
03.2023 - 07.2023
- Following up on insurance claims, doing research to find out why a claim has not been paid
- Updating insurance information when necessary
- Reaching out to insurance companies to check the status of claims
- Entering right offs into Epic
- Working off a spreadsheet daily
Patient Services Representative
Washington University
11.2022 - 03.2023
- Working face to face with patients
- Checking patients in and out of Chemotherapy
- Scheduling appointments
- Calling the insurance companies to verify coverage
- Processing information in Epic
Member Services
Home State Health
08.2020 - 08.2022
- Assist with inbound calls from members of MO Medicaid
- Update demographics for members, any personal information members need
- Discuss benefits and other helpful resources for members through the state
- File grievances
- Coordinate authorizations, ensuring prompt claim resolutions and reducing errors
- Verify prescriptions, enhancing treatment accuracy and minimizing mistakes
- Streamline client-provider communication, improving response efficiency
Patient Service Representative
SSMHEALTH
02.2017 - 08.2020
- Perform the day-to-day processes of documenting and resolving patient concerns and inquiries
- Making adjustments to patient's accounts
- Update information in the patient business services system based on content provided by the patient
- Processing payments
Education
High school diploma -
University City High School
University City05.2008
Skills
- Customer service
- Experienced
- Medical billing
- CPT coding
- Data entry
- Insurance claims
- Patient services
- Appointment scheduling
- Epic system
- Medicaid
- Grievance filing
- Claims processing
- Prior authorization
Personal Information
Title: Member/Customer Representative
Timeline
Medicaid Specialists
Elevate Patient Financial Solutions
06.2024 - Current
Pharmacy Claims Coordinator
Elevance Health
12.2023 - 06.2024
Engagement Center Specialist
Syneos Health
09.2023 - 11.2023
Insurance Follow-up Representative
R1 RCM Revenue Cycle
03.2023 - 07.2023
Patient Services Representative
Washington University
11.2022 - 03.2023
Member Services
Home State Health
08.2020 - 08.2022
Patient Service Representative
SSMHEALTH
02.2017 - 08.2020
High school diploma -
University City High School
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