Insurance Verification And Eligibility Specialist resume example with 5+ years of experience

Jessica Claire
, , 100 Montgomery St. 10th Floor (555) 432-1000,

Self-Motivated Insurance Verification Specialist promoting a background in keeping sensitive patient data confidential while maintaining knowledge of Medicaid and private policy benefits. Possessing great relationship building and communication skills. I'm also a precise & efficient medical billing professional with experience in inpatient, outpatient, and physician medical billing. I specialize in filing accurate claims, adjusting rejected claims, and understanding insurance contracts, appeals, and EOBs. Additional expertise in quality control, reimbursements, and implementing improved processes to enhance accuracy of business, billing, and medical records departments. I'm looking to tackle new challenges with a company that values dynamic skills and a strong work ethic.

  • Microsoft Office Suite: Excel, PowerPoint, and Word
  • Customer Services
  • Medisoft Proficient
  • CPT
  • Insurance Verifications
  • HCPCS Training
  • Medical Collections
  • ICD-10
  • Medical Billing
  • Medical Records
  • LOA's
  • Customer Services
  • Forms
  • Hiring
  • ICD-9
  • EMR systems
  • Medisoft
  • Organizational Skills
  • Receiving
  • Researching
  • Scheduling
  • Spreadsheets
  • Time Management
08/2020 to Current Insurance Verification and Eligibility Specialist Hca | Richfield, OH,
  • Determine If re-authorization needed for new order.
  • Verify Medicaid eligibility.
  • Called insurance companies to ascertain pertinent information regarding policies and payment benefits for patients.
  • Instructed clients on amounts covered under benefits plans in easy-to-understand terminology.
  • Retained strong medical terminology understanding in effort to better comprehend procedures.
  • Followed specific security rules and guidelines to protect sensitive data, including patient medical records and payment card information.
  • Signed payment approvals accepted claims.
  • Updated all patient and insurance data regularly and carefully inputted changes into company's computer system.
  • Handled billing related activities focused on medical specialties.
  • Examined claims, records and procedures to grant approval of coverage.
  • Checked documentation for appropriate coding, catching errors and making revisions.
  • Verified that patients had proper insurance coverage prior to any procedures or appointment scheduling.
  • Created and maintained accurate and confidential patient files according to regulatory mandates.
  • Updated patient financial information to promote accurate record keeping.
06/2018 to 06/2020 Medical Collections Specialist People Incorporated | Swansea, MA,
  • Reviewed accounts for insurance of patient follow-up.
  • Prepared, reviewed, and transmitted claims using billing software, including electronic and paper claim processing.
  • Called insurance companies regarding any discrepancy in payments if necessary.
  • Updated cash spreadsheets, and running collection reports.
  • Identified and billed secondary or tertiary insurances Medical Billing- Respiratory Consultants Of Ga.
  • Oversaw daily collections and accounts receivable activities, developing robust strategies to maximize collections and reduce aged accounts.
  • Worked closely with delinquent account holders to collect and reconcile accounts through approved channels.
  • Accepted and processed customer payments and applied toward account balances.
  • Routinely contacted account holders with balances over 30, 60, & 90 days past due to resolve delinquencies.
  • Investigated billing discrepancies and implemented effective solutions to resolve concerns and prevent future problems.
  • Interfaced with customers to bring accounts current with suitable repayment plans.
  • Improved profit margins by streamlining operations and workflow.
  • Juggled multiple projects and tasks to ensure high quality and timely delivery.
  • Provided excellent service and attention to customers when face-to-face or through phone conversations.
12/2016 to 01/2018 Medical Billing Specialist Great Expressions Dental Centers | Lithia, FL,
  • Researching and appealing denied claims.
  • Followed up on unpaid claims within standard billing cycle timeframe.
  • Set up patient payment plans and work collection accounts.
  • Contacted insurance providers to verify insurance information and obtain billing authorization.
  • Reviewed and verified benefits and eligibility with speed and precision.
  • Demonstrated analytical and problem-solving ability by addressing barriers to receiving and validating accurate HCC information.
  • Contacted patients for unpaid claims for HMO, PPO and private accounts and performed friendly follow-ups to ensure proper payments were made according to contracts.
  • Analyzed and interpreted patient medical and surgical records to determine billable services.
  • Prepared billing statements for patients, ensuring correct diagnostic coding.
  • Remained up-to-date with all insurance requirements, including details of patient financial responsibilities, fee-for-service and managed care plans by participating in training programs.
  • Maintained current working knowledge of CPT and ICD-10 coding principles, government regulation, protocols and third-party billing requirements.
  • Collaborated closely with other departments to resolve claims issues.
  • Applied payments, adjustments and denials into medical manager system.
  • Meticulously tracked and resolved underpayments.
  • Posted charges, payments and adjustments.
  • Posted and adjusted payments from insurance companies.
  • Precisely completed appropriate paperwork and system entry regarding claims.
  • Consistently informed patients of financial responsibilities prior to services being rendered.
02/2015 to 01/2017 Insurance Verification Specialist MetroDerm PC | City, STATE,
  • Experience maintaining A/R accounts
  • Insurance Verifications, Claims review, posting payments and doing EFT's payments Multi-Channel Sales Associate and Customer Services.
  • Handled billing related activities focused on medical specialties.
  • Proficient experience obtaining LOA's
  • Worked heavily with EMR systems such as Epic, AllScripts, etc.
  • Verified that patients had proper insurance coverage prior to any procedures or appointment scheduling.
  • Answered 100-150 average daily phone calls to schedule appointments and address patient inquiries.
  • Called patients to schedule appointments, consistently double-checking information and availability.
  • Resolved inquiries from patients, families and external payers.
  • Processed refunds, disbursements and payments.
  • Collaborated with all relevant parties to resolve billing issues, insurance claims and patient payments.
  • Reviewed flagged items daily and resolved issues in accurate and efficient manner.
Education and Training
Expected in 2014 High School Diploma | Medtech College, Atlanta, GA GPA:
Expected in 2002 | Garden High School, Kingston, GPA:
Expected in | Medical Suburban Technical School, New York, NY GPA:

By clicking Customize This Resume, you agree to our Terms of Use and Privacy Policy

Your data is safe with us

Any information uploaded, such as a resume, or input by the user is owned solely by the user, not LiveCareer. For further information, please visit our Terms of Use.

Resume Overview

School Attended

  • Medtech College
  • Garden High School
  • Medical Suburban Technical School

Job Titles Held:

  • Insurance Verification and Eligibility Specialist
  • Medical Collections Specialist
  • Medical Billing Specialist
  • Insurance Verification Specialist


  • High School Diploma

By clicking Customize This Resume, you agree to our Terms of Use and Privacy Policy

*As seen in:As seen in: