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insurance validation resume example with 20+ years of experience

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Jessica Claire
, , 100 Montgomery St. 10th Floor (555) 432-1000, resumesample@example.com
Professional Summary

Responsible Cashier proficient in handling money, restocking merchandise and helping customers locate products. History of keeping work areas clean, neat and professionally arranged. Good listening skills combined with attentive and detail-oriented nature.

Skills
  • Professional Customer Service
  • Organization
  • Communication Skills
  • Time-Management
  • Decision Making
  • Conflict resolution
  • Point of Sale Knowledge
  • Accuracy handling cash register operations and cash transactions
  • Scanning merchandise
  • High Attention to details while multi-tasking
Work History
09/2020 to Current Insurance Validation Value City Furniture | Amherst, NY,
  • COB and Insurance Eligibility, which includes: primacy rules for priority payment, integration of benefits, Medicare training, secondary insurance, end stage renal disease.
  • Established & understanding of reason codes: dependent not covered, payment prior to coverage, terminated coverage, lapse of coverage.
  • Established & understanding of Medical terminology: Medical Terminology Certification.
  • Established understanding of terms, example: advanced beneficiary notice, prior authorization, timely filing, non participation provider, participating provider, remittance advice.
  • Documentation of each account for accuracy in reference to details of eligibility.
  • Being in compliance with HIPAA on all accounts.
  • Documented entire validation process, noting changes or alterations completed.
  • Working from home since July, 2020.
03/2020 to 09/2020 Third Party Liability Claims Researcher City Of Norfolk, Va | Norfolk, VA,

CURRENTLY WORK AT THIS EMPLOYER: FIRST JOB BEFORE MOVING TO INSURANCE VALIDATION POSITION

  • Contacting attorney's offices, representatives of insurance carriers, insurance carrier adjusters, and workmen's compensation carriers for medical claims to determine if there is potential case for third party liability.
  • Established and updating all account information to ensure that all information is accurate for future referencing.
  • Performance compliance with HIPAA on all accounts.
  • Performing coordination of benefits with auto and third party auto carriers.
  • Performing documentation of each account for accuracy in reference to details for managing account and medical expenses.
  • Establishing and obtaining information from attorney's offices, insurance adjusters, and workmen's compensation by letters for determination of interests on when necessary.
  • Managing over 35 calls per day.
  • Worked closely with team members to deliver project requirements, develop solutions and meet deadlines
10/2018 to 04/2019 Customer Service Associate Walgreens | City, STATE,
  • Politely assisting customers and responding resourcefully to requests and request concerns.
  • Issuing credit(s) and refunds after approval by management. Placing items in correct area for reporting on defective or damage items resulting from shipping process.
  • Processing and managing over 100 purchases per day and handling transactions through POS system.
  • Increasing customer service by decreasing waiting times.
  • Stocking, rotating, and removing items near expiration date from all locations to ensure items are used within recommended time frames.
  • Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns.
  • Maintained clean personal appearance of store when by stocking shelves, organization and arrangement of merchandise.
06/1991 to 10/2017 Records Clerk Dodge County Court | City, STATE,
  • Developed and initiated monthly payment plans for customers on outstanding accounts, both small and large accounts.
  • Communicating with customers about their account(s) and collecting outstanding balances.
  • Researched and resolving any questions or concerns on account balances for customers immediately.
  • Posting payments, providing change back when necessary and issuing receipts.
  • Clerical duties and tasks, including: scheduling, directing phone calls, filing, batching mail, weekly postage outgoing mail for office, taking messages for appropriate staff members, and greet visitors.
  • Maintaining attorney database accounts weekly by keeping accounts in good standing.
  • Bi-weekly attorney billing.
  • Cashiered, balancing daily cash drawer, and cash handling.
  • Receiving and routing medical records to appropriate files for scanning.
  • Maintained current and accurate medical records for over 300 juvenile court cases per year.
  • Creating and preparing legal drafts by organizing and assembling information for legal documents and forms.
  • Professional customer service in friendly, efficient manner ,
  • Scanned paper documents into computer and assigned identification numbers to simplify tracking process updating records with new information.
  • Sorted all paperwork and documents alphabetically and according to dates and significance.
  • Updated records with new information.
  • Assisting with typing, data entry and answering incoming calls as required.
Education
Expected in to to Bachelor of Science | Business Administration And Management Midland Lutheran College, Fremont, NE, GPA:
Expected in 08/2022 to to Certification | Medical Billing Specialist American Academy of Professional Coders, Cincinnati, OH, GPA:
  • ANTICIPATION COMPLETION OF CERTIFICAITON of Medical Billing Specialist expectation of August, 2021.
  • Medical terminology certification.
  • Continuing course work in Medical Billing Training.
  • ICD-10 Book Course
  • On-line Course work
Accomplishments
  • Saving the county large amounts of funds by implementing cost-saving initiatives that addressed long standing problems, after approval from the County Attorney and Judge for reimbursement court costs.
Skills
  • Medical records documentation
  • :
  • Insurance verifying
  • :
    Intermediate
  • Medical insurance knowledge
  • :
  • Payment collection
  • :
    Expert
  • Ability to follow up with 3rd party payors for claims and appeals
  • :
  • Patient demographics & Patient care and confidentiality
  • :
  • Skill in interpreting UB04/CMS claim data
  • :
  • Ability to audit accounts and payor Explanation of Benefits
  • :
  • Documentation review
  • :
  • Organization and time management
  • :
  • Communication Skills
  • :
  • Knowledge and understanding of Health Insurance
  • :
  • Self-Motivated
  • :
  • Resolving Issues
  • :
  • Customer Service
  • :
  • Problem Solving
  • :
  • Self-Management
  • :
  • Phone Calls
  • :
  • Account Management
  • :
  • Decision Making
  • :
  • High Attention to Details
  • :
  • Customer Relationship Management
  • :
    Certifications
    • Medical Terminology Certification December 3, 2019

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    Resume Overview

    School Attended

    • Midland Lutheran College
    • American Academy of Professional Coders

    Job Titles Held:

    • Insurance Validation
    • Third Party Liability Claims Researcher
    • Customer Service Associate
    • Records Clerk

    Degrees

    • Bachelor of Science
    • Certification

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