Over ten years experience of commended performance in key patient accounts and support roles. Excellent in customer care/communications, problem solving, relationship building and user training and support. Extended Knowledge in Medicare/Medicare and Commercial insurance verification, HMO billing, Knowledge of MS Office with additional proficiencies in assorted databases. HIPPA Compliant, Call Center Operations, Safe guarding of patient information, Complaint Handling Reports & Documentation, Workers Compensation
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Service Excellence Award, 2007,2008, 2009,2010,2011,2012
17 C.A.R.E. Awards, 2006-2012
Obtained Certified Pharmacy Technician license - 2015
Investigate patients insurance benefits and financial assistance opportunities.
Act as a liaison between department personnel, insurance companies and providers to determine the patients overall prescription benefit package.
Provide subject matter expertise on claim billing, insurance verification, prior authorization and appeal filing, along with financial assistance opportunities.
Communicate with insurance payors and providers to investigate pharmacy and medical benefits and determine patients financial responsibilities.
Perform Quality Assurance on benefit verifications and escalate issues and concerns to management.
Assist offices through the entire document process for prior authorizations and or appeals.
Build and maintain positive relationships with insurance companies and key referral sources.
Meet all performance metrics.
Ensure compliance with federal regulations, HIPPA and insurance requirements
Maintain patient records and confidentiality
Ensures compliance with federal regulations, HIPPA and insurance requirements.
Maintain patient records and confidentiality
Ensures claims are coded correctly and billed within a timely fashion
Effectively train all new staff, as well as over-seas (India Based) staff on Revenue Cycle software, Billing, insurance- verification, follow-up.
Identify development needs through employee evaluation and upper management consultation.
Helping department managers identify and correct training issues through individual or group training.
Act as liaison between upper management and hourly employees
Run reports for late charges and DRG changes.
Knowledge of insurance guidelines, with an emphasis in Medicare/Medicare HMO
Ensured compliance with federal regulations, HIPPA and insurance requirements
Identified opportunities to increase patient satisfaction through the use of excellent communication skills
Effectively trained new staff on Revenue Cycle software, payment posting, insurance verification and follow-up protocol and practices
Acted as liaison between patient and insurance companies as well as between staff and management
Obtained Medicare/Medicaid Authorizations for Outpatient Procedures
Answered inbound calls
Scheduled and Registered patients for outpatient/inpatient procedures
Certified Pharmacy Technician- 2015
AS400, EPIC, Medical billing, Excellent communication, Consultation, Customer Service, Medical and Pharmacy Insurance, Microsoft Access, Excel, Outlook, PowerPoint, Word, Patient liaison, Problem Solving, Troubleshooting.
Abbvie Black Business Network
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