Driven and motivated with a desire to work closely with both customers and coworkers. Proficient at reviewing and making knowledgeable decisions.
Skills
over a year's hands-on experience handling claims.
ability to read and decipher claim denials.
strong knowledge of medical terminology, ICD and CPT code.
over a year's worth of customer service experience.
Excellent interpersonal skills
High-energy attitude
Experience
Financial Clearance Specialist, 12/2014 to 08/2021 Anmed Health – Anderson, SC,
Managed and obtained insurance authorizations for patients.
Worked closely with patients to fill out paperwork and obtain necessary information in form of referrals and authorization overrides.
Contacted insurance companies to obtain necessary preauthorizations needed for upcoming tests and procedures.
Contacted insurance carriers to obtain authorizations, notifications and pre-certifications for patients.
Provided accurate information to all parties, including patients, insurance providers, healthcare staff and office personnel by using effective written and verbal communication skills.
Notified ordering providers of denied authorizations.
Coordinated resolutions for issues and appealed denied authorizations.
Identified reasons behind denied claims and worked closely with insurance carriers to promote resolutions.
Performed detailed medical reviews of prior authorization request, following established criteria and protocols.
Scheduled peer to peer reviews for physicians to discuss medical necessity with insurance providers.
Updated reference materials with Medicare, Medicaid and third-party payer requirements, guidelines, policies and list of accepted insurance plans.
Clarified patient inquiries and questions to update patient account information in computer system.
Created master spreadsheet to record procedures, denials and approvals.
Transmitted claims to insurance companies for payment and reconciled EOBs.
Stayed current on HIPAA regulations, benefits claims processing, medical terminology, and other procedures.
Accurately processed large volume of medical claims every shift.
Patient Registration Representative, 07/2011 to 11/2014 Children's Of Alabama – Birmingham, AL,
Updated patient demographic information to prevent treatment and recordkeeping errors.
Registered patients using proper data entry procedures and fully compliant ICD-10 and CPT codes.
Answered phone calls to provide assistance, information and medical personnel access.
Scheduled and confirmed patient appointments for diagnostic, surgical and consultation services.
Conducted patient intake interviews to collect medical information and insurance details.
Compiled physical and digital documents, charts and reports.
Updated group medical records and technical library to promote smooth office operations.
Prepared and sent financial statements to support bookkeeping functions.
Maintained positive attitude and effectively de-escalated clients during crisis situations.
Answered and logged incoming inquiries via phone, fax and email.
Coordinated schedules and appointments, sending out reminders regarding appointment dates.
Issued, gathered and inspected intake forms to confirm correct signatures and information.
Investigated insurance policies to determine claim eligibility and processed files in accordance with instructions.
Managed average of 60 patients per day and processed new claims utilizing appropriate adjudication system.
Created and maintained accurate and confidential patient files according to regulatory mandates.
Completed claims forms for different types of appointments and worked on resolutions for denials or other insurance issues.
Communicated with patients to gather intake data and verify chart information.
Customer Service Representative Specialist, 07/2010 to 01/2011 Db Schenker – Dallas, TX,
Researched resolutions, contacted necessary departments and responded back to customer back phone, mail or fax as follow up.
Kept customer and system account information accurate and current to support timely resolutions for concerns.
Submitted claims to insurance companies and researched and resolved denials and explanations of benefit rejections.
Contacted insurance providers to verify insurance information and obtain billing authorization.
Assisted with updating patient profile information as needed.
Reviewed and submitted request for prescription refills.
Associate Customer Communication Specialist, 05/2006 to 06/2009 Coventry Health Care – City, STATE,
Managed multiple projects and tasks simultaneously while managing client expectations.
Supported customer service goals and enhanced relations through friendly, knowledgeable and positive communication.
Delivered fast, friendly and knowledgeable service for routine questions and service complaints.
Met and exceeded productivity targets by handling every interaction with top-notch customer service.
Addressed inquiries, resolved customer issues and managed customer relations.
Assisted customers with the filing of Workers compensation, Auto liability, General liabitlity, Property liability, and Homeowners claims.
Education and Training
High School Diploma: , Expected in 06/1998 Plant City High School - Plant , GPA:
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