benefits and eligibility representative resume example with 11+ years of experience

Jessica Claire
, , 100 Montgomery St. 10th Floor (555) 432-1000,
Professional Profile

Detail-oriented and dependable team player with strong organizational skills. With over 10 years experience, I am confident I have the ability to handle multiple projects simultaneously with a high degree of accuracy and positive attitude.

  • Bilingual in Spanish and English
  • Insurance eligibility/authorization verification
  • Schedule management
  • Administrative support
  • HIPAA compliance
  • Employee training and development
  • Microsoft Office, Excel, Type 50 wpm
  • First Aid/CPR
  • BLS certification
  • Appointment Setting
  • Patient Information Verification
  • Payment Collection
  • Spreadsheets
  • Office Supply Ordering
  • Medical Records Maintenance
  • Directing Callers
03/2023 to Current Benefits and Eligibility Representative State Of Massachusetts | Falmouth, MA,
  • Obtain and validate demographic and financial information that are listed and not listed on eligibility forms, contact collateral sources of information, and determine the immigrant status.
  • Ensure accuracy and completeness with eligibility forms submitted by the members requesting benefits.
  • Respond to member inquiries to provide information regarding the eligibility requirements.
  • Reconcile MHO case information with information from other agencies and sources to verify continued eligibility for benefits.
  • Review applications for different aid programs and determine which qualification criteria for individuals.
  • Process and certify documents for accuracy and compliance with government regulations.
  • Train staff on current eligibility requirements and policies.
  • Resolve discrepancies with client applications to verify eligibility.
  • Assist clients with completion of applications and paperwork.
08/2015 to 03/2023 Patient Service Representative II Altamed | Anaheim, CA,
  • Acquire insurance authorizations for services
  • Efficiently perform insurance verification and pre-certification/pre-authorization functions
  • Work with billing department to ensure patient claims and accounts are accurate
  • Manage over 100 incoming and outgoing calls per day
  • Maintain detailed administrative and procedural processes to improve accuracy and efficiency
  • Update patient accounts and information daily
  • Communicate with patients via phone, email and in person to ensure proper follow up with provider
  • Complete registration quickly and cordially for all new patients
  • Handle and process confidential patient information
  • Schedule patient appointments
  • Demonstrate knowledge of HIPAA Privacy and Security regulations by appropriately handling patient information
  • Took copayments and compiled daily financial records.
  • Reviewed and corrected claim errors to facilitate smooth processing.
  • Monitor shared portal in-boxes and ensure inquires are addressed
  • Assisted and conducted new hire interviews and training
  • Explained plans for treatment and payment options.
  • Helped address client complaints through timely corrective actions and appropriate referrals.
  • Facilitated communication between patients and various departments and staff.
  • Offered simple, clear explanations to help clients and families understand hospital policies and procedures.
  • Maintained energy and enthusiasm in fast-paced environment.
07/2012 to 07/2015 Appointment Scheduler Summit Orthopedic | Saint Paul, MN,
  • Managed incoming and outgoing calls for busy medical office.
  • Maintained detailed administrative and procedural processes to improve accuracy and efficiency.
  • Updated patient accounts and information on a daily basis.
  • Communicated with patients via phone, email and in person to ensure proper follow up with provider.
  • Completed registration quickly and cordially for all new patients.
  • Handled and processed confidential patient information.
  • Acquired insurance authorizations for procedures and tests order by the attending physician.
  • Scheduled surgeries and procedures in conjunction with Surgical Coordinator.
  • Scheduled patient appointments.
  • Provided Administrative support for three physicians.
  • Demonstrated knowledge of HIPAA Privacy and Security Regulations by appropriately handling patient information.
  • Confirmed patient information, collected copays and verified insurance.
  • Consistently informed patients of their financial responsibilities prior to services being rendered.
  • Efficiently performed insurance verification and pre-certification as well as pre-authorization functions.
  • Monitored shared portal in-boxes and ensured inquiries were addressed.
07/2011 to 07/2012 Administrative Assistant Myr Group | Portland, OR,
  • Treated all patients, their families, visitors, peers, staff and providers in a pleasant and courteous manner.
  • Recorded and filed patient data and medical records.
  • Precisely completed appropriate claims paperwork, documentation and system entry.
  • Carefully reviewed medical records for accuracy and completion as required by insurance companies.
  • Assisted in the maintenance of medical charts and/or electronic medical records (filing, Op Reports, test results, home care forms).
  • Prepared prescription refill requests on behalf of the physician.
  • Strictly followed all federal and state guidelines for release of information.
  • Scheduled patient appointments.
  • Completed registration quickly and cordially for all new patients.
  • Determined prior authorizations for medication and outpatient procedures.
  • monitored shared email in-boxes and ensured inquiries were addressed.
  • Provided administrative support for three physicians.
  • Scheduled radiology exams for patients.
  • Resolved and clarified issues with patients medications and collaborated with local pharmacies.
  • Performed qualitative analysis of records to ensure accuracy, internal consistency and correlation of recorded data.
  • Researched questions and concerns from providers and provided detailed responses.
Expected in 2004 to to High School Diploma | General Studies Newton South High School, Newton, MA GPA:
General Studies

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Resume Overview

School Attended

  • Newton South High School

Job Titles Held:

  • Benefits and Eligibility Representative
  • Patient Service Representative II
  • Appointment Scheduler
  • Administrative Assistant


  • High School Diploma

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