insurance verification specialist resume example with 13+ years of experience

Jessica Claire
  • , , 609 Johnson Ave., 49204, Tulsa, OK 100 Montgomery St. 10th Floor
  • Home: (555) 432-1000
  • Cell:

Hands-on individual boasting a career spent managing administrative tasks in fast-paced offices with relative ease. A well-trained Insurance Verification Specialist offering a background in contacting insurance companies for critical information and crafting patient documents for billing purposes. Friendly Insurance Verification Specialist promoting a background in keeping sensitive patient data confidential while maintaining knowledge of Medicare, Medicaid and private policy benefits. Possessing great relationship building and communication skills. Looking to tackle new challenges with a company that values dynamic skills and a strong work ethic.

  • Secure data practices.
  • Skilled in Health Quest, Epic, Cedaron, Oasis HH, Cradle Mrx, Microsoft Office applications.
  • Critical thinking, Team management, Problem resolution, analytical, multitasking, flexible, excellent Customer service
  • Medical billing 
  • Medical filing
  • Database management
  • Medical terminology.
  • Extensive experience in Insurance Coverage, benefits and authorizations.
  • Registration and admitting experience
  •  Cash Control and posting.
  •  Scheduling experience
  •  Experience on Medicare (CMS) TMHP, and Managed Care Portals
  • Bilingual (English/Spanish)
  • Experience
    Insurance Verification Specialist, 01/2012 to 09/2020
    Great Expressions Dental CentersPeachtree City, GA,
    • Conducted patient intake interviews to collect medical information and insurance details.
    • Scheduled/Rescheduled and confirmed patient appointments for Home Health Services.
    • Managed and directed patient Intake functions Registering/Admitting/Discharging patients in Cradle Mrx.
    • Accessed Insurance on-line tools and/or by phone to verify that patients had proper insurance coverage prior to any Home Health Services or any discipline appointment.
    • Initiated requests for Authorization to maximize reimbursements for the company.
    • Checked documentation for appropriate coding, catching errors and making revisions.
    • Updated all patient and insurance data regularly and carefully inputted changes into company's computer system.
    • Processed and billed HCFA 1500 or UB-92 for Medicare, Medicaid and Managed Care insurances, using ICD-10 CM and CPT coding.
    • Tracked claims to ensure timely payment and for outstanding claims.
    Patient Registration Representative, Jul2010 to Sep2011
    Banner HealthPhoenix, AZ,
    • Facilitated access to UTMB services for new and returning patients,
    • Scheduled and confirmed patient appointments for UTMB Katy Clinic.
    • Conducted patient intake interviews to collect demographics and medical insurance information to Pre-Register/Register patients in Epic System.
    • Communicating with insurance carriers on-line or by phone relating to insurance coverage, out-pocket/deductible. Obtaining all prior authorizations as appropriate, based on insurance plans. contracts/guidelines and documents in the system per policy and procedure.
    • Screening patients for financial responsibility and possible cash collections. Setting up payments
    • Notifying patients of insurance limitations or potential arrangements/collecting/posting estimated portions due at time of service.
    • Identifying non-resource patients for possible eligibility for government resource and/or UTMB charity programs.
    • Communicated with patients, about referral sources and the treatment team regarding patient access and financial issues.
    • Answered extensive daily phone calls to schedule appointments and address patient inquiries.
    • Charting and updating medical records to make sure were in compliance with Medicaid and Managed Care Insurances.
    • Created and maintained accurate and confidential patient files according to regulatory mandates.
    • HIPPAA regulations.
    Patient Access Representative, Sep2006 to May2010
    Beth Israel Deaconess Medical CenterWaban, MA,
    • Scheduled/Rescheduled patients in Health Quest/Cedaron system and updated pertinent details related to insurance, payment histories and personal or confidential information.
    • Conducted patient intake interviews to collect medical information and insurance details.
    • Verified demographics and insurance information coverage to register patients in computer system prior to any appointment scheduling.
    • Performed insurance verification, pre-certification and pre-authorization.
    • Processed/Collected/Posted patient's payments for therapy appointments.
    • Updating medical records in EMR software. Assembled registration paperwork and printing identification labels on patients registration appointment.
    • Obtained necessary signatures for privacy laws and consent for treatment.
    • Accessed patient information through variety of office software applications, maintaining strict confidentiality to remain compliant with HIPAA regulations.
    Education and Training
    Associate of Arts: Computer Applications And Technologies, Expected in 06/2004
    Los Angeles Valley College - Van Nuys, CA
    : Medical Terminology , Expected in 08/2005
    Los Angeles Valley College - Van Nuys, CA
    : Medical Insurance And Billing & Coding, Expected in 12/2008
    Katy ISD District School - Katy, TX,
    : Records And Information Management, Expected in 06/2003
    Los Angeles Valley College - Van Nuys, CA
    : CPT Outstanding Reporting , Expected in 12/2008
    Katy ISD District School - Katy, TX,

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    Resume Overview

    School Attended

    • Los Angeles Valley College
    • Los Angeles Valley College
    • Katy ISD District School
    • Los Angeles Valley College
    • Katy ISD District School

    Job Titles Held:

    • Insurance Verification Specialist
    • Patient Registration Representative
    • Patient Access Representative


    • Associate of Arts

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