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Eligibility Clerk Resume Example

Resume Score: 80%

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ELIGIBILITY CLERK
Professional Summary
Motivated, adaptable professional with exceptional organizational, communication, and problem-resolution skills in the healthcare and customer service industry.
Skills
  • Extensive customer-service experience combined with excellent project-coordination and general administrative skills. 
  • Computer proficiency including Microsoft Office Suite (Word, Excel, PowerPoint), Microsoft Outlook, Windows 2007), OAS GOLD, INVISION, ECW, Wellsoft,EZ-CAP.
  • Familiarity with Medi-cal, Medicare, FamPac and other government funded programs.
  • Knowledge of medical office and Emergency room procedures.
  • Bilingual in Spanish. 
  • ​
Work History
Eligibility Clerk , 06/2010 to Current
Alameda County Medical Center – Oakland, CA

  • Registered and interviewed patients to obtain accurate and complete demographic and financial information.
  • Managed various general office duties such as answering multiple telephone lines, completing insurance forms.
  • Researched and verified patient eligibility for insurance coverage. 
  • Prepared and processed consent, charge slips, patient packets, and medical record forms.
  • Informed patients of the availability of government funded and charity discount programs.
  • Trained new employees on multiple medical billing programs and data entry software.
  • Verified and created claim numbers by communicating with various insurance companies.
  • Scheduled surgeries for multiple surgeons and booked operating rooms.
  • Trained new employees on multiple medical billing programs and data entry software.
Eligibility Worker , 09/2012 to 07/2013
San Francisco Department of Public Health – San Francisco, CA
  • Registered and interviewed patients to obtain accurate and complete demographic and financial information.
  • Managed various general office duties such as answering multiple telephone lines, completing insurance forms.
  • Researched and verified patient eligibility for insurance coverage. 
  • Prepared and processed consent, charge slips, patient packets, and medical record forms.Informed patients of the availability of government funded and charity discount programs.
  • Located, checked in and pulled medical records for appointments and incomplete patient charts.
  • Contacted patients regarding unpaid and underpaid accounts to resolve any issues.
  • Trained new employees on multiple medical billing programs and data entry software.
Claims Examiner 1, 02/2009 to 09/2012
Community Health Center Network – San Leandro, CA
  • Responsible for processing/examining claims submitted by CHCN clinics based on comprehensive knowledge of benefits package based on utilization guidelines and appropriate division of financial responsibility.
  • Reviewed daily claims reports and adjust any errors. 
  • Assisted in preparing audit packages for annual HMO audits and for certified coder review/PDR process including retrieving claims and other necessary documentation.
  • Worked with Certified Coder and/or Medical Director on claims requiring further examination for coding or medical review
Assistant Office Manager , 01/2005 to 02/2009
Altamira Construction Company – Oakland, CA
  • Ordered and distributed office supplies while adhering to a fixed office budget.
  • Oversaw inventory and office supply purchases.
  • Composed and drafted all outgoing correspondence and reports for managers.
  • Prepared and distributed payroll for staff of 12 direct reports.
  • Oversaw daily office operations for staff of 12 employees.
  • Compiled financial reports pertaining to cash receipts, expenditures and profit and loss.
  • Posted receipts to appropriate general ledger accounts.
Education
Bachelor of Science: Health Care Administration , Current
University Of Phoenix - Oakland, CA
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Resumes, and other information uploaded or provided by the user, are considered User Content governed by our Terms & Conditions. As such, it is not owned by us, and it is the user who retains ownership over such content.

Resume Overview

Companies Worked For:

  • Alameda County Medical Center
  • San Francisco Department of Public Health
  • Community Health Center Network
  • Altamira Construction Company

School Attended

  • University Of Phoenix

Job Titles Held:

  • Eligibility Clerk
  • Eligibility Worker
  • Claims Examiner 1
  • Assistant Office Manager

Degrees

  • Bachelor of Science : Health Care Administration , Current

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