Financial Clearance Specialist Resume Example
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FINANCIAL CLEARANCE SPECIALIST
Professional Summary
Financial Clearance Specialist with 17 years experience in a fast-paced, innovative healthcare organization. Also
earned the Certified Healthcare Access Associate (CHAA) credentials through NAHAM.
Skills
Pre-encounter administration Registration Quality Data Integrity Proficient in medical policies for major healthcare payers Star, Cerner, EcW Medical Terminology HIPAA Compliance | Maintained Patient Financial Confidentiality Customer Service Exceptional Workflow Management Data Entry Project Management Microsoft Office 2013 |
Work History
Financial Clearance Specialist, 04/2014
to Current
Northwestern Medicine – Buffalo Grove , IL
Dedicated to completing patient access workflows related to improve financial outcomes to decrease first pass denials and increase point of service collections. Cleared over 600 Radiology and Surgery accounts each month with an average of $900,000 in saved revenue for the facility. Use quality auditing and reporting tools to identify denial issues and trends by staff members, clinical area, payer, and provider. Work directly with Business Operations, Managed Care and other departments on identified process improvements. Provide training and education to managers and staff to obtain sustainable improvements in areas of opportunity.
Northwestern Medicine – Buffalo Grove , IL
Dedicated to completing patient access workflows related to improve financial outcomes to decrease first pass denials and increase point of service collections. Cleared over 600 Radiology and Surgery accounts each month with an average of $900,000 in saved revenue for the facility. Use quality auditing and reporting tools to identify denial issues and trends by staff members, clinical area, payer, and provider. Work directly with Business Operations, Managed Care and other departments on identified process improvements. Provide training and education to managers and staff to obtain sustainable improvements in areas of opportunity.
Ambulatory Services Scheduling Liaison, 04/2013
to 04/2014
Danbury Health Systems – Danbury , CT
Register and schedule patients' appointments by telephone utilizing the physician scheduler and individual departmental guidelines. Provide patient services and administrative support in clinic operations. Interact with parents, patients, physicians and other staff under moderate supervision in a courteous manner. Provide assistance to other employees within their department as well as other departments. Collect accurate demographic and insurance information. Update systems as needed in accordance with department standards for registration accuracy.
Danbury Health Systems – Danbury , CT
Register and schedule patients' appointments by telephone utilizing the physician scheduler and individual departmental guidelines. Provide patient services and administrative support in clinic operations. Interact with parents, patients, physicians and other staff under moderate supervision in a courteous manner. Provide assistance to other employees within their department as well as other departments. Collect accurate demographic and insurance information. Update systems as needed in accordance with department standards for registration accuracy.
Reimbursement Associate/ Clinical Operations Representative, 11/2010
to 04/2013
Mercy Healthcare – Ada , OK
Provide patient services and administrative support in clinic operations. Interacts with parents, patients, physicians and other staff under moderate supervision in a courteous manner. Provide assistance to other employees within their department as well as other departments. Collect and verify all demographic information to ensure accuracy. Ensure registration data integrity.
Mercy Healthcare – Ada , OK
Provide patient services and administrative support in clinic operations. Interacts with parents, patients, physicians and other staff under moderate supervision in a courteous manner. Provide assistance to other employees within their department as well as other departments. Collect and verify all demographic information to ensure accuracy. Ensure registration data integrity.
Financial Counselor, 03/2008
to 02/2010
Suburban Hospital – City , STATE
Communicated with insurance companies to determine appropriate benefits, required co-pay, and pre-authorization requirements for services being rendered to accurately secure proper reimbursement from insurance companies and patients. Obtained approval for surgical, radiology, and physical therapy procedures using the appropriate ICD-9 and CPT codes . Entered all necessary pre-authorization requirements into the computer management system to ensure correct transfer of information for billing purposes. Acted as a liaison between the patient/guarantor, insurance company, and physician office to ensure all necessary approvals for services rendered and received are obtained and documented appropriately. Resolved financial issues of patient accounts by reviewing a daily report of services rendered to verify benefit and pre-authorization details and update information as needed.
Suburban Hospital – City , STATE
Communicated with insurance companies to determine appropriate benefits, required co-pay, and pre-authorization requirements for services being rendered to accurately secure proper reimbursement from insurance companies and patients. Obtained approval for surgical, radiology, and physical therapy procedures using the appropriate ICD-9 and CPT codes . Entered all necessary pre-authorization requirements into the computer management system to ensure correct transfer of information for billing purposes. Acted as a liaison between the patient/guarantor, insurance company, and physician office to ensure all necessary approvals for services rendered and received are obtained and documented appropriately. Resolved financial issues of patient accounts by reviewing a daily report of services rendered to verify benefit and pre-authorization details and update information as needed.
Patient Access Representative II, 10/2000
to 02/2008
Children's National – City , STATE
Completed emergency room and inpatient computer aided online registrations using Star Navigator. Admitted and discharged patients by updating Star Navigator upon arrival to or departure from assigned unit. Obtained approval for inpatient admissions in a timely manner, Resolved financial issues of patient accounts by verifying demographic and insurance information to ensure appropriate reimbursement. Cooperated with other departments to meet the institutional objectives in terms of patient and account flow. Interacted regularly with parents, physicians, and patients. Entered data, filed records, and answered a multi-line phone for the Admissions Department.
Children's National – City , STATE
Completed emergency room and inpatient computer aided online registrations using Star Navigator. Admitted and discharged patients by updating Star Navigator upon arrival to or departure from assigned unit. Obtained approval for inpatient admissions in a timely manner, Resolved financial issues of patient accounts by verifying demographic and insurance information to ensure appropriate reimbursement. Cooperated with other departments to meet the institutional objectives in terms of patient and account flow. Interacted regularly with parents, physicians, and patients. Entered data, filed records, and answered a multi-line phone for the Admissions Department.
Education
Associate of Arts: 2007
Axia College of University of Phoenix -
Axia College of University of Phoenix -
High School Diploma: 2000
Caroline Senior High School - City, State
Caroline Senior High School - City, State
Certifications
Certified Healthcare Access Associate (CHAA) through NAHAM - 2016
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Resume Overview
School Attended
- Axia College of University of Phoenix
- Caroline Senior High School
Job Titles Held:
- Financial Clearance Specialist
- Ambulatory Services Scheduling Liaison
- Reimbursement Associate/ Clinical Operations Representative
- Financial Counselor
- Patient Access Representative II
Degrees
- Associate of Arts : 2007
High School Diploma : 2000
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