Revenue Cycle Specialist, Patient Financial Counselor Lead, Patient Access Specialist, Medicaid Enrollment Expertise

1. PAMELA J. SETTER
4261 GARDNER ST.
STERLING HEIGHTS, MI 48310
(248) 330-3523 – C
setterp@gmail.com
Revenue Cycle Specialist, Patient Financial Counselor, Patient Access Support Specialist
OBJECTIVE:
Seeking a professional position in healthcare management/revenue cycle to positively impact and contribute an extensive
variety of talents, skills and experiences attained over 23 years of quality work in the field.
SUMMARY:
 Proficient with all insurance payors to include Medicaid and Medicare traditional and managed care plans, HMO
plans; i.e. HAP, BCN, Tricare, Champ VA and all commercial payors.
 Hired to facilitate, and administer the commercial billing role to include new, corrected, and revised claim
processing, responsible for follow up of unpaid billed claims and related coordination of the billing process as
necessary for the commercial insurance department.
 Process original or corrected claims with 100% accuracy.
 Hired to pilot/implement a new Financial Counselor role within the HF Health System, Macomb Warren ED
setting, Main campus Detroit, MI, Cancer Care Associates, PC, and Crittenton Hospital Medical Center.
 Duties included research for applicable patient funding to include Medicaid enrollment, Cobra and specialty
pharmacy and disease specific assistance programs.
 Direct resource to commercial, Medicaid and Medicare billing specialists. Assist with claim rejections, solve
denials up to and including composing appeals
EXPERIENCE:
Aug 2016 – Present StoneCrest Center BCA/Acadia – Detroit, MI Patient Financial Counselor
Facilitate assistance for patients admitted to this inpatient Mental Health facility
Verify insurance eligibility and benefits.
Enroll patients in Medicaid when applicable.
Assess out of pocket obligations.
Collections of prior balances, or current amount of out of pocket obligations.
Collections of past due balances utilizing self-pay aging report.
Direct resource to commercial, Medicaid and Medicare billing specialists.
Assist with claim rejections, solve denials up to and including composing appeals.
04/2014-06/2016 Crittenton Hospital Medical Center, Rochester,MI Patient Financial Counselor
Recruited by referralof CHMC C.F.O. to implement, administer and facilitate the role of Patient Financial Counselor.
Facilitate the uncompensated care program; assist with all facets,research available programs to secure reimbursement for
the uninsured, to include but not limited to Medicaid enrollment. Assist patients with account balance inquiries. Direct
resource to assist Patient Registration/Access, Patient Accounting,Insurance Verification as needed.

2. 07/2013-04/2014 Advomas, Troy,MI Patient Representative
Facilitate reimbursement opportunities for patients who are un-insured/under-insured in the EC and inpatient setting on
behalf of William Beaumont Hospital Royal Oak, MI campus. Meet with patients/family, explain coverage options,
reimbursement resources including but not limited to Medicaid enrollment. Purpose,to secure optimal reimbursement.
04/2010-04/2013 Henry Ford Health System Troy,MI Billing Specialist I
Hired to facilitate, and administer the commercial billing role to include new, corrected, and revised claim processing,
responsible for follow up of unpaid billed claims and related coordination of the billing process as necessary for the
commercial insurance department. Process original or corrected claims with 100% accuracy.
Patient Financial Navigator
Hired to pilot/implement a new role within the HF Health System, Macomb Warren ED setting, Main campus Detroit, MI.
The purpose to provide customer awareness to facility balances and educate in the event that there is a viable opportunity
for an otherwise uninsured/underinsured patient to secure full coverage from varying resources such as Medicaid. Direct
resource to assist Customer Service Representatives,and Call Center Staff, as needed.
07/2007-04/2010 Cancer Care Associates PC RoyalOak,MI Oncology Patient Financial Counselor
Primary responsibility to implement the role of Financial Counseling, Outreach Coordinator role. Duties included
research for applicable patient funding to include Medicaid enrollment, Cobra and specialty pharmacy and disease
specific assistance programs. Liaison to the billing department. Collaborated with all physician providers/clinical staff.
Direct resource to assist Patient Service Representatives, Billing Staff, and all clinicians as needed.
04/1993-07/2007 St. Joseph Mercy Oakland Pontiac,MI Patient Financial Counselor
Determined liability on patient accounts and worked with patients/family to provide financial assistance to include the
facility uncompensated care program, Medicaid enrollment assistance or assess for patient liability payment arrangement
commitments. Coordinated processes to avoid or minimize reimbursement delays. Resource link to Patient
Registration/Access, Patient Accounting and Insurance Verification staffas needed.
Cash Poster
Responsible for posting payments to facility accounts for an assigned client base.
Patient Access Registrar
Responsible for accurately capturing data relative to medical services rendered to patients of the facility.
EDUCATION:
MAJOR Business, Health Sciences
Berkley High School, Berkley, MI Graduate, Cum Laude
MAJOR Human Services, Business
Baker College /Oakland Community College, Auburn Hills, Michigan 1.3 YEARS ATTENDED
AAPC Certified Coding Course Completion, Clawson, MI, 2012
SKILLS:
Word, Excel, Outlook, All insurance payer Web Sites, One Chart, Care Plus and IDOC EMR, Epic, Star, Cerner,
Medipac, Meditech, Healthquest, Allscripts, Nterprise, Medicaid program, Medicare and Medicare products, and CDM,
CPT and ICD 9/10 proficient. Knowledgeable about HIPAA and EMTALA.

3. PERSONAL ATTRIBUTES:
Approachable, Detail Oriented, Time Management and Prioritization proficient, Diligent, Tenacious, Articulate and a
Good Communicator.
Successfully piloted to successfulimplementation after proving ROI, the Patient Financial Navigator/Counselor role for
Henry Ford Hospital Systems, Cancer Care Associates,PC (large private Hem/Onc specialty practice),and Crittenton
Hospital.
Piloted on behalf of the vision of the Director of Patient Accounting to potentially increase the Patient Financial
Counselor role platform for Memorial Hospital Owosso, MI, to be based upon the ROI outcome by the increased staffing.
Sterling Heights, MI 24th Precinct Delegate, Elected Aug 2016.
ADDITIONAL SUPPLEMENTAL EMPLOYMENT EXPERIENCE:
Receptionist 01/2015-06/2015, Part-time weekend receptionist reporting to the Business Office Manager,
Heartland/Betty Danto Nursing Center, West Bloomfield, MI. Assisted with coordination of admissions, answered all
incoming phone calls, filed documents in patient charts as needed. Received and processed payments. Liaison to all unit
personnel.
Receptionist 01/2016-Present, Part-time 8-10 hours/week receptionist reporting to the Director, Oakmont Independent
Living facility, Sterling Heights, MI. Duties include maintaining a secure environment for the residents, answer all
resident calls for emergency situations. Serve the residents in varying capacities. Showing a movie in the theatre, serving
the Sunday afternoon tea, etc. Verify the building is secure at all times. Give facility tours for prospective residents.
REFERENCES:
Debbie Averill, Oncology Financial Navigator, St. Joseph Mercy Oakland, former associate.
248-860-9516, debbieaverill@comcast.net
Teri Lyn Fulton, Utilization Review Coordinator, Behavioral Center of MI, former supervisor.
586-491-9077, terifulton@yahoo.com
Annalynn Hall, Practice Manager, Cancer Care Associates, PC, former supervisor.
248-551-6352
Robin Beeman, Director Business Development, Cardon Outreach, business associate.
586-876-5013, rbeeman@cardonoutreach.com