centralize scheduling coordinator pre authorization specialist resume example with 10+ years of experience
JessicaClaire
Montgomery Street, San Francisco, CA94105609 Johnson Ave., 49204, Tulsa, OK
Home: (555) 432-1000
Cell:
resumesample@example.com
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Professional Summary
10+ years of medical administration experience in various healthcare facilities Extensive experience in ICD-9 and CPT-4 coding Strong knowledge of medical terminology, Medicare and managed care guidelines Excellent communication skills both verbal and written Computer proficient Ability to multi-task and work in fast paced environment.Inpatient and outpatient records coding specialist with ICD-9, ICD-10 and ASC coding expertise. Familiar with commercial and private insurance carriers. Seeks a position of increased responsibility and authority.Customer service-oriented Administrative Assistant skilled in greeting patients, scheduling appointments and preparing patient charts.
Skill Highlights
Knowledge of HMOs, Medicare and Medi-Cal
Maintains strict confidentiality
Medical Manager Software
ICD-9 coding
CPT and HCPCS coding
Internal medicine billing
HHM and Medisoft billing systems
HIPAA compliance
Medical billing software
Patient-focused care
Strong work ethic
Team player with positive attitude
Deadline-driven
Exercises good judgment
Professional Experience
Centralize Scheduling Coordinator/Pre-Authorization Specialist, 01/XXX3 to 06/XXX4 Costar Group, Inc. – Us-Ny Field Based, DC,
Accurately schedule appointments and adjusted schedules as necessary for a variety of exams and procedures Entered complete and accurate data into computer system regarding information on the patient, exam, physician and the like Utilized the CPT-4 and ICD-9 coding manuals to administer proper codes Answered telephone calls, responded to routine inquiries, and served as a resource person to those seeking information on outpatient exams Actively participates in continuous quality improvement activities Maintains a working knowledge of applicable Federal, State, and local laws and regulations, the Integrity/Compliance Program, Code of Conduct, as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical, and professional behavior Compile weekly/monthly practice reports on projections, procedures, and referral authorizations.
Carefully reviewed medical records for accuracy and completion as required by insurance companies.Assigned additional diagnosis codes based on specific clinical findings (laboratory, radiology and, pathology reports as well as clinical studies) in support of existing diagnoses.Strictly followed all federal and state guidelines for release of information.Directed patient flow during practice hours, minimizing patient wait time.Arranged and assisted with hospital admissions.Maintained an organized logging system for tracking test results.Scheduled patient appointments.Scheduled radiology exams for patients.Acted as a liaison between the business department, billers and third party payers in resolving billing and reimbursement accuracy.
Pre-Authorization Specialist/Patient Access Rep, 01/2009 to 02/XXX3 Bayonne Medical Center – City, STATE,
Responsible to obtain pre-certification and/or managed care referrals for inpatient and outpatient encounters Other responsibilities include performing verification of benefits, and pre-certification for elective and emergency center admissions Additional duties may include assisting the Department of Patient Access Services in performing pre-registration requirements, order entry, etc.
Position requires self-motivated individual who can handle high patient volumes and fast pace OR Operations Administrative Asst Facilitated daily OR operations and intra departmental functions Assisted OR coordinator with the consistent flow of OR cases on daily basis Communicated specifically with the anesthesia department, surgeons, and all perioperative staff Worked independently at the OR desk and maintains a customer service focus atmosphere Performed departmental administrative functions as required Patient Access Representative (Per Diem) Responsible for performing all inpatient and outpatient including same day, diagnostic outpatient and emergency department All pre-registration and registration functions for all area of the hospital: obtaining accurate patient demographics, insurance benefits via telephone or online services, financial liability and pre-certification information from patients, physician's office and/or insurance carriers for services to be rendered and/or in the process of being rendered at the facility either via telephone and/or face to face Performed complete and accurate pre-registration functions to provide information which maximize reimbursement, achieve collection ratios, meet account receivable (A/R) goals and provide timely information for all area in the facility Effectively use Meditech, electronic mail & Internet sites pertaining to pre-registration.
Accounts Receivable Manager, 07/2007 to 10/2008 Manhattan Rehabilitation Services – City, STATE,
Maintained records inpatient accounting files regarding manual logs and on-line functions for submissions of third party payers and recording receivables Initiated transfers, cancellations, audit adjusts and verifications of charges to patient accounts Reviewed all accounts of self-pay billing and performed appropriate on-line function to release or hold patient statement Prepared, reviewed, and analyzed billing control lists, hard copy billing documents for hospital inpatient and outpatient charges as well as all professional fees for all procedures performed Composed appreciation of policies and procedures of submissions to third party payers Reviewed medical record documents and provided additional documentation for claim processing when authorized Posting of charges and adjustments as received by third party payers. Ensured timely and accurate charge submission through electronic charge capture, including the billing and account receivables (BAR) system and clearing house.Applied payments, adjustments and denials into medical manager system.Posted charges, payments and adjustments.Acted as a liaison between the business department, billers and third party payers in resolving billing and reimbursement accuracy.
P/T Pre-Authorizations Specialist, 10/2006 to 02/2007 Dr. Devarajan P. Iyengar, MD – City, STATE,
Delegated the individuals at the front desk department of their daily tasks Obtained pre-certification following Medicare and managed care guidelines for radiology testing, inpatient chemotherapy, and medications Developed and maintain all authorizations in a logbook Utilized the CPT-4 and ICD-9 coding manuals to administer proper codes Received a high volume of phone call on a multilink switchboard system Mailedproper explanation of benefits Prepared correspondences to outside providers and third party payers.
Medical Receptionist/Pre-Authorizations Rep, 06/2003 to 07/2006 South Hudson Medical Association – City, STATE,
Greeted patients and visitors, received co-pays for the scheduled visit Verified patient information as well as updating demographic information in current IDX system Organized new patients charts, assisting patient with registration forms Utilized the CPT-4 and ICD-9 coding manuals to administer proper codes Performed automated appointment scheduling and maintain patients' medical charts, printed schedules for daily activity for each provider Answered telephone, give information to callers routed to appropriate personnel Entered proper messages into in-house email system to a specific physician of a patient Obtained authorizations from all major medical insurance carriers for testing procedures order by doctors.
Education and Training
Diploma: Medical Billing and Coding, Expected in 7 2007 to Anthem Institute (formally The Chubb Institute) - Jersey City, NJ GPA: Award for Perfect Attendance, Awarded for Academic Excellence
Medical Billing and Coding Award for Perfect Attendance, Awarded for Academic Excellence, 4.0 GPA
Associate of Science Degree: Health Management, Expected in 5 2001 to Essex County College - Newark, NJ GPA: Health Management
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