Complaint Specialist Appeals Specialist Credentialing Specialist Claims, Processor Insurance Specialist resume example with 9+ years of experience
Jessica Claire
, , 609 Johnson Ave., 49204, Tulsa, OK 100 Montgomery St. 10th Floor
(555) 432-1000 - - resumesample@example.com - -
(555) 432-1000 - - resumesample@example.com - -
Summary
Hands-on individual boasting a career spent managing administrative tasks in fast-paced offices with relative ease. A well-trained Insurance Verification Specialist offering a background in contacting insurance companies for critical information and crafting patient documents for billing purposes. Proven expertise in insurance products, service and customer needs. Familiar with analyzing documentation, liaising between parties and handling both routine and complex issues each day. Identifies and resolves concerns while promoting new products and meeting sales objectives.
Skills
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Experience
05/2018 to 12/2019
Complaint Specialist/ Appeals Specialist/ Credentialing Specialist/ Claims, Processor/ Insurance Specialist ILove Dental – City, STATE,
- Collaborated with carriers to resolve discrepancies in insurance payments.
- Closed sales on new policies by presenting insurance options to customers accurately and efficiently.
- Managed denials, late payments, extensions and other special circumstances by following up with relevant parties.
- Resolved routine and complex issues by performing detailed research.
- Fostered relationships with customers to expand customer base and retain business.
- Called insurance companies to ascertain pertinent information regarding policies and payment benefits for patients.
- Monitored reports to identify claims issues and worked with adjusters to resolve problems.
- Identified reasons behind denied claims and worked closely with insurance carriers to promote resolutions.
- Checked documentation for appropriate coding, catching errors and making revisions.
- Complied with confidentiality regulations in handling customer information.
- Assisted new policyholders with processing claims.
- Examined claims, records and procedures to grant approval of coverage.
- Analyzed insurance organizational structures, business and intermediaries, studying common clauses, policies and insurance contracts.
- Acted as intermediary between insurance companies and customers by researching and assessing information to determine claim validity.
- Trained employees on best practices and protocols while managing teams to maintain optimal productivity.
- Automated office operations for managing client correspondence, payment scheduling, record tracking and data communications.
- Confirmed facility and user credentials to initiate and maintain registration and enrollment processes.
- Completed enrollments into Medicaid, Medicare and private insurance plans.
- Processed documents and status-change requests, conducting followup assessment regarding enrollment inquiries.
- Set up NPI numbers for providers and facilities and updated current profile information.
- Performed database queries, compiling information according to requests and logging logistics changes.
- Tagged documents according to tiered access thresholds, updating packets, reviewing reports and forwarding items requiring approval or verification.
- Sourced, qualified and conducted screening interviews with job candidates.
- Prepared employees for assignments by establishing and conducting orientation and training programs.
- Proactively identified and solved complex recruitment problems impacting employer short- and long-term success.
- Provided insight regarding job duties to optimize productivity.
- Provided recruiting activity reports to management utilizing industry-specific software and guidelines.
- Implemented employee engagement and development activities, presentations and training to maximize productivity and unite workforce.
- Supported human resources, controlling resume flow within applicant tracking system.
- Troubleshot identified HR problems and implemented corrective actions to prevent recurrence.
- Strengthened traceability by developing organization systems for records, reports and agendas.
- Maintained informational resources, tracking and documenting requests for updates, certification and credentialing.
- Performed primary source verifications such as criminal histories, licenses and board certifications.
- Checked applications for missing information and organized all paperwork.
- Addressed credentialing requests, overseeing compliance with governmental and organizational guidelines regarding tiered data access.
- Utilization reports, aging reports, encounter forms
- Presented treatment plans,
- Coordinate and verify dental benefits
- Opened and closed the office, prepared bank deposits
- Maintain up-to-date billing system
- Maintained and accounted for all Patient A/R and Insurance A/R
- Reconciliation of accounts, carry out billing, collection and reporting activities according to specific deadlines
- Investigate and resolve customer queries
- Process adjustments, insurance audits, grievance sent by insurance on behalf of patient, credentialing doctors, negotiating new fees w/ insurances
- Prepare claims for insurance
- Maintain bookkeeping system through monthly financial reports
- Process accounts receivable and accounts payable
07/2011 to 05/2019
Benefits Coordinator/ Credentialing Specialist/ Insurances Specialist/ Comfort Dental Thousand Oaks – City, STATE,
- Confirmed facility and user credentials to initiate and maintain registration and enrollment processes.
- Completed enrollments into Medicaid, Medicare and private insurance plans.
- Processed documents and status-change requests, conducting followup assessment regarding enrollment inquiries.
- Set up NPI numbers for providers and facilities and updated current profile information.
- Performed database queries, compiling information according to requests and logging logistics changes.
- Tagged documents according to tiered access thresholds, updating packets, reviewing reports and forwarding items requiring approval or verification.
- Sourced, qualified and conducted screening interviews with job candidates.
- Prepared employees for assignments by establishing and conducting orientation and training programs.
- Proactively identified and solved complex recruitment problems impacting employer short- and long-term success.
- Provided insight regarding job duties to optimize productivity.
- Provided recruiting activity reports to management utilizing industry-specific software and guidelines.
- Implemented employee engagement and development activities, presentations and training to maximize productivity and unite workforce.
- Supported human resources, controlling resume flow within applicant tracking system.
- Troubleshot identified HR problems and implemented corrective actions to prevent recurrence.
- Strengthened traceability by developing organization systems for records, reports and agendas.
- Maintained informational resources, tracking and documenting requests for updates, certification and credentialing.
- Performed primary source verifications such as criminal histories, licenses and board certifications.
- Checked applications for missing information and organized all paperwork.
- Addressed credentialing requests, overseeing compliance with governmental and organizational guidelines regarding tiered data access.
- Utilization reports, aging reports, encounter forms
- Presented treatment plans,
- Coordinate and verify dental benefits
- Opened and closed the office, prepared bank deposits
- Maintain up-to-date billing system
- Maintained and accounted for all Patient A/R and Insurance A/R
- Reconciliation of accounts, carry out billing, collection and reporting activities according to specific deadlines
- Investigate and resolve customer queries
- Process adjustments, insurance audits, grievance sent by insurance on behalf of patient, credentialing doctors, negotiating new fees w/ insurances
- Prepare claims for insurance
- Maintain bookkeeping system through monthly financial reports
- Process accounts receivable and accounts payable
10/2013 to 09/2014
Treatment Coordinator/Office Manager Pacific Dental Services – City, STATE,
- Respond efficiently to patient and doctor needs and inquiries
- Resolve patient issues in accordance with company policies and procedures, healthcare regulations and dental board standards
- Write business correspondence and reports to Texas State Board of Dental Examiners
- Write business correspondence and reports to Texas Work Force Commission
- Present treatment plans, organize and present financial arrangements to patients
- Making sure staff has up-to-date training, certifications, and licenses
- Manage the processing of dental claims
- Maintained insurance A/R, patient A/R
- Manage specialist referral process
- Recruit and select office staff to meet operational requirements
- Making sure staff is up to date on credentials,
- Determine staff schedule, train front office employees
- Monitor and maintain the office budget
- Organize and oversee supply purchases, equipment upgrades and operations expenses
- Complete administrative functions including bank deposits, revenue posting, staff payroll and invoice processing
- Run and analyze management reports
- Support marketing and promotion initiatives
- Troubleshoot computer and systems problems, liaise with IT specialists to resolve problems
- Recruit and select new candidates, prepare paperwork for hires and terminations
- Conduct orientation of new staff members
- Identify and organize training programs for staff
- Motivate, mentor and coach staff, delegate and coordinate work tasks
- Manage performance including evaluations and feedback
- Resolve disputes and grievances
- Create and maintain databases
- Organize retention, protection, retrieval, transfer and removal of records
- Ensure security of data
- Evaluate existing procedures
- Design and implement procedural improvements
- Prepare materials describing procedures and standards
- Communicate changes in policies and procedures
12/2009 to 12/2010
Front Office Staff/ Dental Assistant La Jolla Cosmetic And Family Dentistry – City, STATE,
- Chair side assistance to the Dentist
- Prep the patients , set up the station with all needed instruments/materials
- Pour up models, bleach trays, night guards
- Extensive knowledge in taking digital X-rays
- Full mouth X-Rays and other needed X-Rays
- Clean and sterilize all instruments and station used
- Write up reports and refusals from patients
- Did Utilization reports, aging reports, encounter forms
- Presented and sold treatment plans
- Appointment scheduling, answered phones
- Coordinate and verify dental benefits
- Maintain Recalls, and unscheduled treatment
- Maintain inventory and supplies
- Trained and assisted new employees
- Opened and closed the office
- Maintain up-to-date billing system
- Follow up, collection and allocation of payments
- Carry out billing, collection and reporting activities according to specific deadlines
- Reconciliation of accounts
- Monitoring customer account details for non-payments, delayed payments and other irregularities
- Maintain accounts receivable customer files
- Prepare bank deposits
- Investigate and resolve customer queries
- Process adjustments, insurance audits, grievance sent by insurance on behalf of patient, credentialing doctors, negotiating new fees w/ insurances
- Organizing a recovery system and initiate collection efforts
- Communicating with customers via phone, email, mail
Education and Training
Expected in 11/2021
MBA: Health Administration
American InterContinental University - Schaumburg, IL
American InterContinental University - Schaumburg, IL
Expected in 06/2008
BBA: Health Administration
American InterContinental University - Hoffman Estates, IL
American InterContinental University - Hoffman Estates, IL
Expected in 06/2002
Certification in Dental Assisting:
Concorde Career College, Antonio Campus - San, San Antonio, TX
Concorde Career College, Antonio Campus - San, San Antonio, TX
Certifications
Management (9 years)
Insurance Verification (10+ years)
Auditing (10+ years)
Account Management (10+ years)
Accounts Payable (10+ years)
Accounts Receivable (10+ years)
Patient Education (10+ years)
Patient Scheduling (10+ years)
EDI (10+ years)
Community Outreach (10+ years)
Billing (10+ years)
Training (10+ years)
Medical Terminology (10+ years)
Customer Service (10+ years)
Documentation (10+ years)
Data Entry (10+ years)
Excel (10+ years)
Hiring (7 years)
Teaching (10+ years)
Word (10+ years)
Human Resource
Financial Analysis
Leadership Experience
Management Experience
Word Processing
Microsoft Office
Typing
Data Collection
Health Insurance
Front Desk
Dental Office Experience
Conflict Management
Infection Control Training
Office Manager Experience
Eaglesoft
Dentrix
Sales Experience
Time Management
Microsoft Excel
Computer Literacy
Dental Receptionist
Financial Report Writing
Operations Management (9 years)
Claims Processing (10+ years)
Account Reconciliation (10+ years)
Project Management (10+ years)
Telecommunication (10+ years)
Chairside Assisting
Dental Assisting
Willing to relocate: Anywhere
Additional Information
- Willing to relocate: Anywhere, Authorized to work in the US for any employer
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Resume Overview
School Attended
- American InterContinental University
- American InterContinental University
- Concorde Career College, Antonio Campus
Job Titles Held:
- Complaint Specialist/ Appeals Specialist/ Credentialing Specialist/ Claims, Processor/ Insurance Specialist
- Benefits Coordinator/ Credentialing Specialist/ Insurances Specialist/
- Treatment Coordinator/Office Manager
- Front Office Staff/ Dental Assistant
Degrees
- MBA
- BBA
- Certification in Dental Assisting
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