LiveCareer-Resume

medicaid eligibility specialist resume example with 3+ years of experience

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

Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.

Skills
  • Resource information
  • Appointment Scheduling
  • Effective communication skills
  • Program knowledge
  • Applicant engagement
  • Application Review
Education
Southeastern College Charlotte, Expected in 07/2021 Certified Electronic Medical Billing And Coding : Electronic Medical Billing And Coding Specialist - GPA :
West Stanly High School Oakboro, NC Expected in 06/2012 High School Diploma : - GPA :
Work History
Cbiz, Inc. - Medicaid Eligibility Specialist
Clearwater, FL, 08/2021 - Current
  • Communicated with people from various cultures and backgrounds on application process.
  • Documented all communication with applicants and inputted information into system using Centene.
  • Followed guidelines when reviewing applicant data to determine eligibility for economic assistance.
  • Scheduled appointments with applicants to gather information and explain benefits processes.
  • Reviewed applications for different aid programs and determined which qualification criteria for individuals.
  • Inputted all gathered information and researched data on applicants into computer system using EDS .
  • Assessed information gleaned from interviews, educational, and medical records, consultation with other professionals and diagnostic evaluations to identify clients' abilities, needs and eligibility for services.
  • Developed extensive fact-checking and research skills as result of continuously reviewing different programs and options.
North American Construction Group - Medical Billing Customer Service Specialist
Fargo, ND, 08/2019 - 08/2020
  • Examined patients' insurance coverage, deductibles, insurance carrier payments and remaining balances not covered under policies when applicable.
  • Posted and adjusted payments from insurance companies.
  • Located errors and promptly refiled rejected claims.
  • Precisely evaluated and verified benefits and eligibility.
  • Identified and resolved patient billing and payment issues.
  • Trained new employees on multiple medical billing programs and data entry software.
  • Researched CPT and ICD-9 coding discrepancies for compliance and reimbursement accuracy.
  • Communicated effectively and extensively with other departments to resolve claims issues.
  • Precisely completed appropriate claims paperwork, documentation and system entry.
  • Communicated with patients for unpaid claims for HMO, PPO and private accounts and delivered friendly follow-up calls for proper payments to contracts.
  • Determined prior authorizations for medication and outpatient procedures.
  • Performed billing and coding procedures for ambulance, emergency room, impatient and outpatient services.
Teletech - United Health Care Medicare and Retirement
City, STATE, 03/2016 - 03/2018
  • Reviewed and verified addresses, phone numbers, names, ages, and values.
  • Responded to inquiries from callers seeking information.
  • Checked documentation for accuracy and validity on updated systems.
  • Processed and recorded new policies and claims.
  • Calculated adjustments, premiums, and refunds.
  • Collected premiums and issued accurate receipts.
  • Generated, posted and attached information to claim files.
  • Maintained strong knowledge of basic medical terminology to better understand services and procedures.
  • Assured timely verification of insurance benefits prior to patient procedures or appointments.
  • Maintained confidentiality of patient finances, records and health statuses.
  • Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
  • Communicated effectively with staff members of operations, finance and clinical departments.
Meineke - Mechanic
City, STATE, 01/2016 - 02/2018
  • Replaced damaged, missing or defective parts with new and refurbished components.
  • Performed diagnostic and troubleshooting procedures to find and identify root causes of mechanical issues.
  • Completed full vehicle inspections to check for leaks, damage or other issues of concern.
  • Inspected and tested vehicles and completed preventive maintenance such as engine tune-ups, oil changes, tire rotations, wheel balancing and filter replacement.
  • Kept equipment in good working order by following operating instructions, troubleshooting breakdowns and maintaining supplies.
  • Inspected and tested equipment to locate worn and damaged parts.
  • Serviced vehicles according to OEM recommended maintenance schedules for oil changes, engine tune-ups and fluid changes.
  • Analyzed and located malfunctions in brakes, motors, switches and control systems.
  • Ordered repair parts quickly to prevent delays in projects and repair work.
  • Inspected vehicles and evaluated condition of systems, equipment, lights and accessories.
  • Disassembled defective parts to make proper repairs.
  • Consulted manuals, technical documentation and repair tree charts for further information prior to conducting fixes.
  • Maintained accurate records of time and materials required to perform repairs and service.
  • Followed established safety procedures and techniques when working under lifted vehicles.
  • Utilized diagnostic equipment to evaluate mechanical problems in vehicles.
  • Maintained functionality and reliability of engines, machines and systems through regular diagnostic checks.
  • Tested newly installed equipment to determine proper functionality and compliance with regulations.
  • Examined new and replacement parts to uncover defects.
  • Corrected unsafe conditions in work areas and immediately reported correctable conditions to supervisor.
  • Demonstrated process of preventive maintenance and visual inspections to junior mechanics.
  • Performed basic electric repairs such as resetting circuit breakers and fitting lighting fixtures.
  • Managed inventory through computerized inventory control system.
  • Diagnosed electrical malfunctions using oscilloscope.

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Resume Overview

School Attended

  • Southeastern College
  • West Stanly High School

Job Titles Held:

  • Medicaid Eligibility Specialist
  • Medical Billing Customer Service Specialist
  • United Health Care Medicare and Retirement
  • Mechanic

Degrees

  • Certified Electronic Medical Billing And Coding
  • High School Diploma

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