Raven Spriggs
Bolingbrook
Summary
Detail-oriented Medical Billing and Accounts Receivable Specialist with experience in hospital and insurance follow-up, denial resolution, payment posting, specialty pharmacy, provider relations, and customer service. Skilled in working high-volume accounts, ensuring timely reimbursement, and maintaining compliance with HIPAA and payer guidelines. Proven ability to work remotely, meet productivity standards, and resolve complex billing issues efficiently.
Overview
11
11
years of professional experience
2012
2012
years of post-secondary education
1
1
Certification
Work History
Accounts Receivable Specialist
Ensemble Health Partners
Bolingbrook
06.2025 - Current
- Review and work hospital insurance accounts with outstanding balances
- Follow up with insurance companies (Medicare, Medicaid, Commercial plans) on unpaid or underpaid claims
- Investigate and resolve claim denials, rejections, and payment discrepancies
- Correct billing or coding errors and resubmit claims when needed
- Ensure payments are applied correctly and balances are updated
- Meet productivity and quality standards set by Ensemble
- Maintain detailed account notes and documentation
- Comply with HIPAA and hospital billing regulations
- Work accounts based on aging and priority guidelines
Specialty Pharmacy Representative I
CVS Health
11.2024 - 06.2025
- Handle inbound refill requests, ensuring timely renewals and precise documentation.
- Quickly resolve customer issues, fostering strong member connections.
- Track interactions meticulously, enhancing process efficiency.
- Customize service based on individual needs, boosting satisfaction.
- Utilize electronic platforms for accurate data management.
AR Billing Specialist
Change Healthcare
05.2022 - 05.2023
- Managed revenue cycle for accurate claims and reimbursements
- Enhanced payment timeliness by refining resubmission processes
- Resolved claims issues with multiple insurers, boosting cash flow
- Corrected payment errors, ensuring accurate refund processing
- Utilized Epic, NexGen, Waystar for effective health record management
- Maintained accurate records of underpaid claims and processed timely refunds, ensuring compliance and fostering trust with insurance carriers and patients.
Provider Relations Representative
PCG Consultants
03.2022 - 05.2022
- Handled calls, resolving inquiries and verifying Medicaid efficiently.
- Processed claims accurately, improving patient documentation and HIPAA compliance.
- Collaborated to enhance denied claim coding, achieving measurable improvements.
- Adhered to policies, contributing to streamlined operations.
Customer Service Advocate
OptumRx
10.2018 - 11.2020
- Managed high-volume calls, boosting member satisfaction and service efficiency.
- Supported Medicare and Medicaid benefits, ensuring accurate, timely member assistance.
- Conducted pharmacy calls, confirming prescriptions, enhancing delivery precision.
- Coordinated orders, optimizing home delivery services for members.
- Resolved provider disputes, strengthening relationships, streamlining processes.
Loan Specialist
LSI
02.2017 - 07.2018
- Requested credit reports, enhancing underwriting accuracy and loan approval efficiency.
- Supported underwriters with data, boosting decision-making speed and effectiveness.
- Conducted interviews to align loan offers with applicant needs, ensuring satisfaction.
- Verified and updated loan applications, maintaining data integrity and completeness.
Patient Care Secretary
Vitas Hospice
03.2015 - 02.2017
- Handled admin tasks and calls, boosting office efficiency and patient satisfaction.
- Supported patients and families, enhancing care quality and satisfaction.
- Coordinated family-staff communication, ensuring prompt medical assistance.
- Addressed patient emergencies, resolving issues swiftly and effectively
Education
Associate of Science - Medical Billing And Coding
Ultimate Medical Academy
Clearwater, FL 02.2022 - 04.2024
Bolingbrook High School
Bolingbrook, IllinoisSkills
- Microsoft Office Healthcare Billing
- Medical Insurance
- EMR
- CPT Coding
- Call Center
- Customer Service
- Epic
- NexGen
- ICD-10
- Claims management
- Insurance follow-up
- Revenue cycle
Certification
- Certified Revenue Cycle Representative (CRCR)
Timeline
Accounts Receivable Specialist
Ensemble Health Partners
06.2025 - Current
Specialty Pharmacy Representative I
CVS Health
11.2024 - 06.2025
AR Billing Specialist
Change Healthcare
05.2022 - 05.2023
Provider Relations Representative
PCG Consultants
03.2022 - 05.2022
Associate of Science - Medical Billing And Coding
Ultimate Medical Academy
02.2022 - 04.2024
Customer Service Advocate
OptumRx
10.2018 - 11.2020
Loan Specialist
LSI
02.2017 - 07.2018
Patient Care Secretary
Vitas Hospice
03.2015 - 02.2017
Bolingbrook High School