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insurance verification specialist resume example with 20+ years of experience

Jessica Claire
, , 609 Johnson Ave., 49204, Tulsa, OK 100 Montgomery St. 10th Floor
Home: (555) 432-1000 - Cell: - resumesample@example.com - : - -
Summary
Highly motivated Sales Associate with extensive customer service and sales experience. Outgoing sales professional with track record of driving increased sales, improving buying experience and elevating company profile with target market.
Skills
  • Skills
  • Customer Service
  • Electronic Medical Records
  • Insurance Terminology
  • Communication and Interpersonal Skills
  • Secure Data Practices
  • Insurance Coverage Verification
  • Fraud Detection
  • • Takes responsibility
  • • Fast paced
  • • Conflict resolution/Problem solving skills • Very reliable
  • • Microsoft Office experience
  • • Assertiveness
  • • Policy coverage expert
  • • Customer service/retention
  • • Detailed oriented
  • • Medicare/Medicaid guidelines
  • • DME intake experience
  • • Quick learner
Experience
07/2021 to Current
Insurance Verification Specialist Francisan Health Rensselaer, IN,

Knowledgeable of billing guidelines and resources for Medicare and Private Insurances.

Compile pre-certification information to submit prior authorization requests thoroughly via outbound phone calls and/or web-based sites (familiarity with payors).

Perform regular follow-up calls with insurance companies checking status of prior authorization request. Submit additional documentation, if required.

Maintain ongoing knowledge of job product and services, as they may require working in other departments

conduct outbound and/or inbound calls to patients, doctor’s offices, insurance companies as necessary or required to complete tasks

Detailed oriented, quick learner, excellent documentation skills, and ability to follow through.

Ability to perform in a fast-paced environment with high level of accuracy

Ensure proper documentation is received/recorded before processing additional supplies to patient in compliance to guidelines.

Ensure accurate update & entry of changes are recorded as requested by physicians and/or patients

Ability to comprehend and work through process instructions

Ability to work independently and complete assignments timely and accurately with high level of productivity.

Provide patients with accurate, timely, and satisfactory solutions to potential & arising complaints or concerns pertaining to prior approval, orders, and/or required documentation

Participate in special projects as needed or required.

Adapt & adjust to changes in job requirements &/or volume or work as needed or required

Willingness & ability to cooperate in a team-oriented work environment, be crossed trained across the department functions and assist other teams as requested or needed.

Respond to patient inquiries, questions, complaints, and concerns (inbound and/ or outbound calls) with urgency by offering one call resolution & high quality of professionalism to ensure patient retention

All other duties as assigned.

  • Updated patient and insurance data and input changes into company computer system.
  • Called insurance companies to ascertain pertinent information regarding policies and payment benefits for patients.
04/2018 to 06/2021
DME Coordinator Breg, Inc. Oxford, MS,

Receive/ review new referrals for DME request

  • Verify eligibility and determine criteria per Medicaid/Medicare guidelines
  • Direct contact with physician's office, hospitals and health plans
  • Contact patient directly to schedule services
  • Follow up constantly on incomplete request
  • Customer retention
  • Building long standing relationships with liaison's from both physicians' offices and health plans •

Process referrals for up to 5 health plans at a time

  • Immediate intake coordinator requested for extension.
  • Trained new and existing employee on guidelines • Point of contact for providers use by insurance •

Processed copayments based on health plan • Knowledge of CPT/ICD9 Codes(Used Daily)

08/2015 to 03/2018
Utilization Management Coordinator Anthem, Inc. Cartersville, GA,
  • Verify member eligibility
  • Find DME providers for equipment being requested
  • Remained up-to-date on various benefit plans, medical policies and state-specific clinical guidelines or criteria.
  • Referred cases to secondary review for failure to meet medical criteria.
  • Contacted insurance carriers to obtain authorizations for services delivered to patients.
  • Communicated with patients with compassion while keeping medical information private.
  • Create LOA (Letter of Agreement) when requesting provider is non par/ non contracted •

Answer calls and provide customer service from start to finish

  • Verify with provider that all clinical and authorization was received
  • Stay in compliant for member satisfaction
07/1998 to 08/2015
DME Intake Coordinator III Univita Healthcare City, STATE,

Receive/ review new referrals for DME request

  • Verify eligibility and determine criteria per Medicaid/Medicare guidelines
  • Direct contact with physician's office, hospitals and health plans
  • Contact patient directly to schedule services
  • Follow up constantly on incomplete request
  • Customer retention
  • Building long standing relationships with liaison's from both physicians' offices and health plans •

Process referrals for up to 5 health plans at a time

  • Immediate intake coordinator requested for extension.
  • Trained new and existing employee on guidelines • Point of contact for providers use by insurance •

Processed copayments based on health plan • Knowledge of CPT/ICD9 Codes(Used Daily)

Education and Training
Expected in 06/1985 to to
High School Diploma:
Miami Northwestern Senior High School - Miami, FL
GPA:

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Resume Overview

School Attended

  • Miami Northwestern Senior High School

Job Titles Held:

  • Insurance Verification Specialist
  • DME Coordinator
  • Utilization Management Coordinator
  • DME Intake Coordinator III

Degrees

  • High School Diploma

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