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benefit advocate resume example with 12+ years of experience

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Jessica Claire
Montgomery Street, San Francisco, CA 94105 (555) 432-1000, resumesample@example.com
Work History
06/2016 to Current Benefit Advocate Alliant | Newtown, PA,
  • Verified and loaded all New patient insurance and submitted requests for referrals if required by ones insurance policy.
  • Verified and loads existing patient insurance changes by completing an insurance verification form for each patient and communicates changes to Drug Authorization Coordinator and Patient Assistance Specialist.
  • Worked with the patient to ensure any coordination of benefits issues are handled according to policy and procedure to ensure appropriate and timely processing of claims.
  • Monitored Pending Cobra accounts to ensure policy is active and the patients claims will be processed and paid appropriately.
  • Coordinated and communicates information required or requested by other teams within the mandated timeframe Followed policy and procedures outlined by management to ensure standardization of processes.
  • Notified Coverage and Benefits Manager of any issues that potential for a negative outcome for the organization.
  • Ensured up-to-date documentation on patient accounts on follow up or ongoing transactions.
05/2015 to 06/2016 Referral Coordinator Trinity Health Corporation | Star, ID,
  • Scheduled patient appointments with specific providers as requested from their primary care physician.
  • Carefully reviewed medical records for accuracy and completion as required by insurance companies.
  • Strictly followed all federal and state guidelines for release of information.
  • Acquired insurance authorizations for procedures and tests ordered by the attending physician.
  • Scheduled patient appointments.
  • Demonstrated knowledge of HIPAA Privacy and security regulations by appropriately handling patient information.
  • Efficiently performed insurance verification, pre-certification and pre-authorization functions.
03/2014 to 03/2015 Receptionist Rv Retailer | Montgomery, AL,
  • Completed registration quickly and cordially for all new patients.
  • Scheduled patient appointments for returning visits.
  • Provided administrative support for six physicians.
  • Demonstrated knowledge of HIPAA Privacy and Security Regulations by appropriately handling patient information.
09/2013 to 03/2014 Billing account specialist Unitypoint Health | Evansdale, IA,
  • Strictly followed all federal and state guidelines for release of information.
  • Examined diagnosis codes for accuracy, completeness, specificity and appropriateness according to services rendered.
  • Scheduled patient appointments.
  • Provided administrative support for ten physicians.
  • Accurately entered procedure codes, diagnosis codes and patient information into billing software.
  • Acted as a liaison between the business department, billers and third party payers in resolving billing and reimbursement accuracy.
  • Demonstrated knowledge of HIPAA Privacy and Security Regulations by appropriately handling patient information.
  • Appropriately and correctly identified errors and re-filed denied/rejected claims as they were received from the Patient Account Representative.
  • Added modifiers as appropriate, coded narrative diagnoses and verified diagnoses.
  • Thoroughly reviewed remittance codes from EOBS/AR's.
10/2012 to 05/2013 Pre-Service Assistant Blue Cross Blue Shield Of TN | City, STATE,
  • Loaded complete authorizations for services designated by internal policy.
  • Loaded demographic information for initial prior- authorization.
  • Answered difficult telephone inquiries from providers regarding the Utilization Management program.
  • Interacted daily with members, facilities and providers advising them of decisions to approve, extend, or deny services.
  • Helped maintain department goals and standards Utilized programs such as Outlook, Facets, Care Advance and Microsoft.
  • Provider Services.
05/2008 to 10/2012 Provider Services Blue Cross Blue Shield Of TN | City, STATE,
  • Provided claim status to all in-state providers.
  • Released benefits and eligibility details to requesting provider for Tennessee members.
  • Contacted out of state insurance carrier to inquire on claim status.
  • Demonstrated knowledge of HIPAA Privacy and Security Regulations by appropriately handling patient information.
  • Submitted refund requests for claims paid in error.
  • Experienced in FACETS, Mainframe, Outlook, and microsoft applications.
  • Involved in assisting supervisor on resolving difficult accounts for local hospitals.
  • Responsible for working an inquiry list to ensure timely and effective resolutions for providers and patient's claims.
Education
Expected in 2004 to to High School Diploma | Gordon Lee Memorial High school, Chickamauga, Ga GPA:
Expected in to to August 2004- December 2005 | Dalton State College, Dalton, Ga. GPA:

Skills
  • Medical terminology expert
  • Records management professional
  • Patient referrals expert
  • Familiar with commercial and private insurance carriers
  • Insurance and collections procedures
  • Understands insurance benefits
  • Understands Medicare, Medicaid and Medicare Advantage policies
  • Research and data analysis
  • Excellent problem solver
  • Resourceful and reliable worker
  • Close attention to detail
  • Adept multi-tasker
  • Office support (phones, faxing, filing)
  • Excellent verbal communication

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Resume Overview

School Attended

  • Gordon Lee Memorial High school
  • Dalton State College

Job Titles Held:

  • Benefit Advocate
  • Referral Coordinator
  • Receptionist
  • Billing account specialist
  • Pre-Service Assistant
  • Provider Services

Degrees

  • High School Diploma
  • August 2004- December 2005

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