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insurance verification specialist iii resume example with 10+ years of experience

Jessica Claire
  • , , 609 Johnson Ave., 49204, Tulsa, OK 100 Montgomery St. 10th Floor
  • H: (555) 432-1000
  • C:
  • resumesample@example.com
  • Date of Birth:
  • India:
  • :
  • single:
  • :
Professional Summary

18 years of Professional Service in Health Care Division providing assistance in outstanding customer service, appeals, providers relations, insurance follow-up, verification, obtaining referrals/authorizations, researching, patient follow-up, ten-key, medical terminology, coding and resolving all aspects of medical claims insurance. Computer skills include Microsoft Word, Excel, Epic, Availity, Navinet, different insurance web-portals, PowerPoint and remote worker. Extremely detail-oriented, highly organized, self-starter self-motivated and work very well independently and under pressure.

Skills
  • Focus
  • Adaptability
  • Organization and Time management
  • Teamwork
  • Communication
  • Detailed Oriented
  • Problem-solving abilities
  • Committed
  • Deadline-driven
  • Insurance/ Authorization Knowledge
  • Customer service
  • Self-motivated
  • Knowledge of medical insurance terminology
Work History
Insurance Verification Specialist III, 03/2021 - Current
Bhdp Architecture Columbus, OH,
  • Communicated verification and authorization status updates with EMU Inpatient and Psych ECT Outpatient department to facilitate decision-making for patient admissions and insurance coverage.
  • Decease denials by 30% within 6 months.
  • Coordinate with financial counselor, clinic, and patient or other appropriate party to identify special billing and additional information needed to secure accurate billing and/or patient financial responsibility
  • Reviews clinical documentation for CPT/diagnosis code information to support authorization / precertification according to payer guidelines.
  • Accurately monitors, reviews, data enters and processes authorizations and validate that the requests are accurate, within the required timeline, and in compliance with the applicable insurance guidelines.
  • Assured timely verification of insurance benefits prior to patient procedures or appointments.
  • Made contact with insurance carriers to discuss policies and individual patient benefits. Utilize insurance portals to verify and submit pre authorization for schedule procedures .
Central Registration Specialist - Revenue Cycle, 09/2018 - 03/2021
UT Southwestern Medical Center City, STATE,
  • Worked with clinical staff, coding coordinators and billing department to resolve patient inquiries, billing and coding questions in outpatient psychiatry.
  • Reviews, verifies, and obtains demographic, guarantor, subscriber, and payor information to successfully complete benefits verification in a timely matter.
  • Coordinates with Financial Counselor, clinic, patient or other appropriate party to identify funding source and additional information needed to secure accurate third-party billing and/or patient financial responsibility.
  • Ensures that 1) patient is aware of financial obligations, projected long term costs of care; 2) ensures that patient has access to financial education material; 3) ensures that patient has signed the appropriate financial waivers acknowledgement financial obligation.
  • Verified insurance for 100 accounts daily..
  • Ensures accuracy and compliance with system policies related to data collection, patient and family education, patient rights and responsibilities, legal consents, and release of information
  • Maintains compliance with JCAHO, patient responsibilities and rights, HIPAA, and system contracts with third-party payors.
  • Used EPIC to record and organize patient insurance and medical information.
Billing Coordinator, 12/2015 - 09/2018
UT Southwestern Medical Center City, STATE,
  • Obtain insurance authorization of specific visits/treatments; maintain accurate records of authorization data requiring ability to understand carve-outs and other issues unique to mental health and cognitive testing coverage.
  • Communicate insurance, authorization, patient balance and patient- responsibility amounts to clinic sites and/or patient/families in advance of appointments Financial: Collect all copay, coinsurance and self-pay amount due for services rendered.
  • Adhere to end of business processing standard by verifying that cash analysis and receipts balance.
  • Train/inform members on new and unique information regarding insurance policies after having information verified.
  • Resolve errors and edits, responding to requests for information; work with providers and other staff as needed to resolve errors and release corrected claims.
  • Investigate claim errors, individual patient account questions, etc.; assist Billing Specialists as needed Perform related administrative tasks such as faxing, copying, filing, running errands, interoffice mail, etc.
  • Maintain 50 to 100 accounts daily and submit accurate paper and electronic records of work as assigned.
Ambulatory Follow-Up Specialist, 04/2011 - 11/2015
Magellan Health Services City, STATE,
  • Resolve correspondence related to insurance carriers and private patient claims.
  • Follow-up with outpatient providers to assure timely outpatient follow-up appointments for patients discharged from the hospital.
  • Follow-up with members when they do not keep the scheduled aftercare appointment.
  • Identifies obstacles to member compliance with outpatient treatment plan.
  • Serves as liaison between the inpatient staffs of local hospitals and the high volume provider groups managed by Magellan to assure discharge appointments are timely.
  • Communicate with clinical team in developing and implementing discharge plans while the member is still in the hospital or higher level of care..
Education
Associate of Applied Science: Health Information TechHealth Information Tech, Expected in 12/2019
-
Minnesota State Community And Technical College - Fergus Falls, MN
GPA:
Status -

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Resume Overview

School Attended

  • Minnesota State Community And Technical College

Job Titles Held:

  • Insurance Verification Specialist III
  • Central Registration Specialist - Revenue Cycle
  • Billing Coordinator
  • Ambulatory Follow-Up Specialist

Degrees

  • Associate of Applied Science

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