insurance authorization representative resume example with 12+ years of experience
JessicaClaire
Montgomery Street, San Francisco, CA94105(555) 432-1000, resumesample@example.com
Professional Summary
Medical Biller and Insurance Follow-Up Representative with 17 years experience supporting numerous physician and
hospital claims in a busy medical atmosphere. Highly experienced with commercial and private insurance carriers.
Desire a position in Medical Billing and Insurance Follow-up with challenging billing systems. Strong ability to
communicate clearly and effectively to patients and insurance carriers. Excellent multi-tasker and demonstrates team
player with a positive attitude. Enthusiastic employee with excellent people skills, self-motivation and dedicated work
ethic. Strong attention to detail and extensive knowledge of medical terminology. Expertise includes verifying insurance
coverage, record and contract reviews.
Licenses
Medical Office Admin Certificate
Skill Highlights
Deadline-driven
 Team player with positive attitude
Strong work ethic
Hospital and physician billing knowledge
Patient-focused care
Skilled at diverse billing systems
Able to comprehend facility Terms & Contracts
HIPAA compliance
Bilingual
Medical Manager Software
Managed care contract knowledge
ICD-10 coding
Knowledge of HMOs, Medicare and Medi-Cal
Maintains strict confidentiality
Managed care contract knowledge
Extensive medical terminology knowledge
Professional Experience
07/2016 to CurrentInsurance/Authorization RepresentativeCognizant Technology Solutions | Brookfield, WI, Recorded and filed patient data and medical records. Wrote clear and detailed clinical phone messages for physicians and nurses. Acquired insurance authorizations for procedures and tests ordered by the attending physician. Prepared prescription refill requests on behalf of the physician. Scheduled patient appointments. Completed registration quickly and cordially for all new patients. Consistently ensured proper coding, sequencing of diagnoses and procedures for unpaid follow up claims for reimbursement. Added modifiers as appropriate, coded narrative diagnoses and verified diagnoses for reimbursement of corrected claims. Completed appeals and filed and submitted claims. Posted daily super bill charges, payments and adjustments. Thoroughly investigated past due invoices and minimized number of unpaid accounts. Applied payments, adjustments and denials into medical manager system. Carefully prepared, reviewed and submitted patient statements.
10/2013 to 04/2015Claims RepresentativeCentral Maine Medical Center | Topsham, ME,
Thoroughly investigate past due medical claims and minimize number of unpaid accounts.
Strictly follow all federal and state guidelines for release of information.
Examine diagnosis codes for accuracy, completeness, specificity and appropriateness according to services rendered.
Acquire insurance authorizations for procedures and tests ordered by the attending physician.
Consistently review proper coding, sequencing of diagnoses and procedures.
Demonstrate knowledge of
HIPAA Privacy and Security Regulations by delicately handling patient information.
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Appropriately and correctly
identify errors and re-file denied/rejected claims upon receipt from the Patient Account Representative.
Thoroughly
review remittance codes from EOB'S.
Confirm patient information, and verify insurance.
Evaluate the
accuracy of provider charges, including dates of service, procedures, level of care, locations, diagnoses, patient
identification and provider signature.
Complete appeals, file and submit claims to insurance carriers.
Carefully prepare,
review and submit patient statements.
Remain up-to-date with all insurance requirements, including the details of patient financial responsibilities, fee-for-service and managed care plans.
Perform quality control of the data entry system to verify that claims and payments are posted correctly.
Prepare and attach all required claims documentation including referrals, treatment plans or other required
correspondence to reduce incidence of denials.
Efficiently perform insurance verification and pre-certification and
pre-authorization functions.
Perform full-cycle medical billing in a fast-paced medical billing company.
12/2007 to 10/2013Insurance Follow-Up RepresentativeCHOC CHILDREN'S | City, STATE,
Patient billing and insurance carrier follow-up.
Thoroughly investigated past due invoices
and minimized number of unpaid accounts.
Strictly followed all federal and state guidelines for release of information.
Demonstrated knowledge of HIPAA Privacy and Security Regulations by appropriately handling patient information.
Confirmed patient information, collected copays and verified insurance.
Posted charges, payments and adjustments.
Carefully prepared, reviewed and submitted appeals when necessary.
Use adequate customer service skills on incoming patient calls regarding their account balances.
Assisted in appointment scheduling when needed.
Checked patients in and out in a fast paced hospital setting.
Education and Training
Expected in to to ROP, Anaheim, CA 06 /1990
Certified Administrative Medical Assistant | , , GPA:
Skills
Administrative, billing, billing systems, CA, Contracts, CPT, customer service skills, data entry, diagnosis, documentation, fast, financial, insurance, medical billing, coding, quality control, scheduling, Team player, treatment plans
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Resume Overview
School Attended
Job Titles Held:
Insurance/Authorization Representative
Claims Representative
Insurance Follow-Up Representative
Degrees
ROP, Anaheim, CA 06 /1990
Certified Administrative Medical Assistant