benefits authorization resume example with 8+ years of experience
Jessica
Claire
resumesample@example.com
(555) 432-1000,
Montgomery Street, San Francisco, CA94105
:
Professional Summary
Healthcare Client Services Manager with experience in new-hire, continuation training, representative development, and patient services operations. Dynamic leader with a commitment to excellence. Accomplished in customer service management and operational streamlining with a strong focus on quality of service and patient care. Easily approachable with strong communication skills. Expert multi-tasker and a quick study with an infectious passion for providing an excellent customer care experience.
Skills
Customer Service Management
Handles confidential work with tact, integrity, and discretion
Excellent written and verbal communication
Detail oriented
Health Insurance Claims Management
Microsoft Office Suite
Knowledgeable in regulatory agency compliance guidelines
Education
Guthrie High SchoolGuthrie, OKExpected in 1996High School Diploma:GPA:Status
Work History
ViantBenefits Authorization
Chicago, IL, 07/2018Current
Communicate with clinical departments or Scheduling Representative to obtain scheduled appointments and/or orders prior to the service date.
Pre-register 98% of all scheduled patients a minimum of three (3) business days in advance of their arrival.
Obtain, validate and accurately enter in the computer system, the patient’s demographic and insurance information while maintaining an acceptable accuracy rate (95% plus) as evidenced by routine quality review. Information may be obtained from the physician’s office or the patient via direct contact, telephone or fax.
Thoroughly review the MPI so that duplicate medical records numbers are avoided.
Obtain signatures on all necessary forms and documents required by hospital and by law.
Ensure MSP Questionnaire is completed for every Medicare registration.
Work closely and cooperatively with the physician office staff, schedulers and other hospital departments to schedule and prepare required information before the patient’s arrival.
Utilize online programs to verify insurance eligibility and benefits, documenting findings on the patient account. Assist by contacting to the insurance company for pre-authorizations and pre-certifications as required prior to patient receiving service when asked by Director.
Effectively communicate with physician office staff to resolve authorization issues and coordinate registrations as required.
Collect co-payment, deductible or co-insurance previously identified by the Insurance Verification Specialist or as indicated on the insurance card or online eligibility system, when the patient arrives for service.
If working in Emergency registration, ensures compliance with the EMTALA regulation for all patients.
Log cash collected, generate receipts, and maintain balanced cash at all times.
Meet monthly cash collection goals as determined collaboratively by Department Director/Manager and CBO.
Consistently obtain and copy/scan insurance cards and driver licenses.
Responsible for knowing the functions of the phone system in order to professionally handle incoming calls, appropriately transfer calls, and assist with any internal calls when asked to do so by Department Director or Team Lead.
Perform the reception/greeter function at the front desk entrance as needed.
Verify medical licensure and check Medicare Sanctions websites for non-credentialed physicians ordering outpatient diagnostic tests (Community Hospital Only).
Consistently demonstrate premier customer service and communication skills with all internal and external customers/contacts and ensure the patient and their family members have the best hospital encounter possible.
Meet established quality and productivity standards for self and for the team.
Anticipate and adapt to change (e.g., hospital policy changes, operational/procedures, insurance changes) in a positive manner.
Foster and reinforce team-based results.
Adhere to time and attendance standards as outlined in the Human Resource Policy manual. Provide proper notification of absence or tardiness within established departmental time frames.
Ensure patient confidentiality adhering to HIPAA guidelines.
Demonstrate the knowledge, skills and abilities (competencies) to perform the duties outlined above annually in the form of a test or as evidenced by daily quality review and direct observation of the Team Lead and the Department Director/Manager.
Track and monitor productivity as requested.
Keep Department Director or Team Lead apprised of any delays in the registration process.
Remain current on scheduling, registration, insurance verification, and other patient registration processes in order to cover in the absence of other team members.
Provides counsel to Treatment Operations Director regarding needs of the community, personnel needs, financial needs, professional practices, and health planning.
Assures documentation of services provided is accurate and timely.
Maintains the administrative policies and management activities including budget control, cost determination and reports to the Treatment Operations Director.
Employs and contracts, recruits, manages, and directs qualified personnel to carry out policies and procedures of the clinic.
Ensures adequate staff education and evaluation.
Demonstrates an in-depth knowledge of, and ensures compliance with, all local, state and federal laws relating to all of the operations.
Responsible for supervision and evaluation of satisfaction survey of all clients served.
Organizes and directs clinic’s ongoing functions.
Provides clerical support which may include preparation of admission, orientation and new hire packets, monitoring and ordering office supplies, typing, special projects, filing and copying.
Assists with maintenance of personnel files.
Promotes the company’s philosophy and mission by presenting a positive image to patients/families, physicians and community.
Provides effective communication to patient/family, team members, and other health care professionals and maintains confidentiality.
Excellent interpersonal and organization skills
Provide opening and closing duties.
United HealthcareSenior Pharmacy Helpdesk Tech/Trainer
City, STATE, 10/201212/2013
Providing ongoing processing in incidents, problems and service requests generated by users
Meet and maintain SLAs
Ensure quality assurance and continual improvements
Responding to and diagnosing problems through discussion with users
Ensuring a timely process through which problems are resolved, including problem recognition, research, isolation, resolution, and follow-up steps
Providing support to end users on a variety of issues
Responding to telephone calls, email and personnel requests for technical support
Documenting, tracking, and monitoring problems to ensure a timely resolution
Interacting with network services, software systems engineering, and/or applications development to restore service and/or identify and correct core problem
Simulating or recreating user problems to resolve operating difficulties
Recommending systems modifications to reduce user problems
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