Financial Clearance Team Member II Resume Example Company Name

FINANCIAL CLEARANCE TEAM MEMBER II

Summary

Results-focused healthcare professional with strength in Financial Clearance and Medical Ancillary authorizations. Proactive leader with strengths in communication and collaboration. Proficient in leveraging prior authorizations and knowledge to promote secured and approved authorizations. Adept at managing concurrent objectives to promote efficiency and influence positive outcomes.

Skills

Strong communication skills, both written and verbal.
Quality analytical skills and extensive reviewing skills.
Resourceful team player who excels at building trusting professional relationships with patients/ members and colleagues.
Proficient in medical software's such as; EPIC, EMR, CENTRIC,ECARE NEXT, and Microsoft Office applications.
Adaptable to change and ability to manage high priority projects within deadlines.
Ability to analyze reports, trouble shooting, conflict resolution, critical thinking, team building.

Program evaluation
Content management expertise
Thorough knowledge of insurance plan types
Medical recordkeeping, documentation skills, medical terminology
Insurance Verification

Experience

Company NameCity, StateFinancial Clearance Team Member II02/2016 to Current

Initiate pre-service prior authorization for ancillary Radiology and surgical services. While attaching all necessary supporting clinical documentation for approvals such as; supporting clinical notes, labs, prior imaging and other testing listed in patients chart pertaining to current condition.
Exceed quality scores on consistent basis by diligently following production orders and maintaining company standards.
Uphold high standards of productivity and quality in all areas of operations.
Train new employees on Radiology guidelines and requirements to support team efficiency. As well as audit newly trained employee processed accounts.
Cultivate partnerships with managed care organizations, hospitals and insurance carriers to promote swift payment and issue resolution.
Maintain consistent patient confidentiality in alignment with HIPAA protocols by using encryption software.
Prepare and attached all required supporting documentation including referrals, treatment plans or other required correspondence to reduce incidence of denials.
Conduct insurance eligibility/benefit verification, referral/authorization, and financial education on designated accounts.
Enhance the patient experience throughout all patient interactions by serving as the customer service point of contact by demonstrating knowledge of Sutter's Health system and service offerings.
Obtain and verify demographic, clinical, financial, and insurance information in the process of pre-registering and financially clearing patients for service delivery, Including the entry of patient/guarantor information in the patient registration/accounting systems.
S.M.E for ancillary Radiology authorizations team and regional departments within Sutter.
Authorizations region department liaison for processing high priority accounts/ URGENT accounts, and add on procedures for next day.
Assist clinical liaisons in account escalations for non- secured patient liability/ or unsecured insurance authorizations.

Company NameCity, StateMedical Office Service Coordinator08/2014 to 01/2015

Performed patient registration, discharge,appointment scheduling, referral coordination and medical insurance verification.
Maintained accurate patient records for billing purposes and physicians references.
Proficient experience using health care computer health systems and applications such as; EPIC,EMR,Centric, Right-Fax, ECare Next, and Microsoft Office applications.
Greeted patients in an orthopedics clinic, while providing a high level of customer service in a busy office setting.
Bookkeeping experience, including cash handling, balancing financial records and preparing deposits.
Coordinated incoming patient referrals to proper departments for further authorization and notified referring physician of denials.

Company NameCity, StateCertified Nursing Assistant01/2009 to 10/2012

Documented activities and recorded information in EMR system.
Documented patient intake and dietary requirements, also assisting with feeding and monitoring.
Responded to patient alarms and needs-assessment requests to identify course of treatment.
Assisted patients with shaving, bathing and oral hygiene to promote healthy habits and overall wellness.
Conducted routine checks on standard patient vitals, including blood pressure, blood sugar and heart rate.
Facilitated activities of daily living, including personal hygiene management, feeding and ambulation.
Rendered hands-on nursing care under direct RN supervision, adhering to medical center policies and procedures.
Collaborated with interdisciplinary healthcare teams to provide high-quality patient care.

Education and Training

Certifcation:Healthcare04/2018NAHAM, City

(NAHAM) The National Association Of Healthcare Access Management.

* Certified Healthcare Access Associate

National Certification:Phlebotomy06/2010National Career Education, City

Home Health Aide Certification:Home Health/ End of Life And Hospice03/2010Twin Rivers Adult Education, City

CNA:Nursing Assistant10/2009Prime Career College Of Sacramento, City

Resume Overview

School Attended

NAHAM
National Career Education
Twin Rivers Adult Education
Prime Career College Of Sacramento

Job Titles Held:

Financial Clearance Team Member II
Medical Office Service Coordinator
Certified Nursing Assistant

Degrees

Certifcation : Healthcare 04/2018
National Certification : Phlebotomy 06/2010
Home Health Aide Certification : Home Health/ End of Life And Hospice 03/2010
CNA : Nursing Assistant 10/2009

Financial Clearance Team Member II Resume Example

Resume Score: 80%

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