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medical biller insurance verifier scheduler 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 - -
Objective
  • Outgoing Ambulatory Facility Billing Specialist/ Insurance Verifier with 22 years of experience within the medical field out of which 4 years as a surgical coordinator, 2 years as patient coordinator and 16 years as billing specialist. Seeking to leverage my experience and professional expertise to advance in my field as part of your organization.
  • Experienced with Advantix, Surgical Notes, Waystar-Zirmet, MS Office, Medics Elite, Medics Cloud, EMR and PCN Medical Network.
Skills and Qualifications
  • Excellent interpersonal skills and flexibility.
  • Demonstrate ability to thrive in a professional setting.
  • Excellent oral and written communication skills.
  • Work effectively with physicians, physician assistants, and other clinical and support staff.
  • Ability to focus detailed concentrated efforts to multiple projects and re-establish priorities as necessary.
  • Effectively respond to time sensitive and confidential issues.
  • Initiative and ability to work both independently and as a member of a functional team.
  • Ability and durability to work under stress due to deadline, volume of work and range of activities.
  • Comfortable with technology, have a willingness to learn and have troubleshooting and problem-solving ability.
  • Proficiency of medical terminology.
Experience
05/2019 to Current
Medical Biller/Insurance Verifier/ Scheduler Regions Hospital Saint Louis Park, MN,

May 2020 to present as Biller/ Verifier


May 2019 - May 2020 Scheduler/ Verifier

  • Communicate and receive daily bookings by email or fax from offices of seventeen orthopedic, pain medicine doctors and one colorectal surgeon ranging at around 400 cases per month.
  • Setting up monthly already assigned procedure blocks for three rooms into our schedule for affiliated doctors and accommodate additional surgical blocks based on doctors and facility and staff availability when needed.
  • Review each scheduled case for their accuracy and time requested.
  • Maintain frequent change on the schedule of cancelled and added cases and inform the appropriate involved departments to keep open communication to avoid confusion and loos of funds of equipment.
  • Confirming daily schedule with doctors office and assuring the accuracy of booked cases with business office manager, material manager and clinical manager to assure validity and appropriateness of all cases. Release the final schedule to all clinical staff, front desk, anesthesiologist group , management and the doctors office.
  • Advising the equipment vendors the start time of scheduled surgical cases daily.
  • Verify all cases for Insurance effectiveness and patient financial responsibility. Communicate the in and out of network disclosure and set up payment plan with the patient.
  • Print monthly report of canceled cases and send email to doctors offices in hopes to bring them back.
  • Sent out monthly report of captured cases to USPI management. and set up White board agenda plan report with administrators help for monthly schedulers meeting with USPI.
  • Report to USPI management monthly by email how many cases were performed by selected Newmans challenge doctors.
04/2012 to 05/2019
Orthopedic Spine Surgical Coordinator / Doctors Assistant The Center For The Functional Restoration Of The Spine, LLC City, STATE,
  • I effectively worked with three hospital surgical medical settings personnel as well as with outside agencies and institutions to schedule surgical cases which include Epidural, Facet or SI joint injections, inpatient and same day spine surgeries with and without fusion.
  • I scheduled outpatient testing requested by surgeons for patients follow-up or post-operative care and coordinated both office and upcoming surgical schedules and made changes as necessary to accommodate their availability.
  • Scheduled all operative cases using detailed knowledge of surgeon's schedule, the operating room schedule, the time involved in each procedure and special equipment needed.
  • Scheduled pre-admission testing appointments, all required testing, land clearances needed prior to surgery and assured that all the results were were reviewed by the surgeon and delivered to the appropriate facility of service.
  • Communicated the process with patients, all surgeons involved, case nurse managers and all necessary vendors.
  • Obtained insurance benefits eligibility, in and mostly out of network prior authorizations for surgery or other noninvasive procedures and any special testing requirements.
  • Communicated to patients their financial responsibility and made payment arrangements.
  • Worked closely with work injury (WC) and motor vehicle (MVA) adjusters and nurse case managers to maintain uninterrupted care for patients with accident injuries.
  • Maintained OR surgical Google calendar and office schedule to include constant updating of all surgeons and patient’s availability.
  • Filed appeals to commercial and MVA designated insurance parties to reverse denials of treatment requests.
  • Set up Peer to Peer disputes as needed between physician with involved insurance company medical directors.
  • Coordinated IMEs, and other such legal work, which involves sending invoices, tracking payments and records.
  • Set up phone and in office depositions with attorneys.
  • Performed all other office duties including making appointments, scanning records into patient’s accounts, checking patients in for their appointment and also checking them out.
08/1999 to 06/2012
Medical Billing Specialist Cedarbridge Medical Associates P.A City, STATE,
  • Currently known as Meridian Primary Care in Brick
  • Collecting, posting, and managing account payments, including preparation and submission of clearinghouse claims to payers via paper and electronic submission.
  • Reviewing claims denials and correspondence from Medicare and commercial carriers to aggressively resolve payment issues; performing claim corrections and follow up activities to ensure timely reimbursement, performing daily EDI checks, posting payments.
  • Managing collection of past due balances through follow up with payors and patients.
  • Interface with the doctor’s office in an organized and professional manner to obtain all information necessary and give guidance as needed regarding reimbursement issues.
  • Updated all new fee schedules, ICD-9 and CPT Codes in the PCN system master tables for Medicare, HMO, PPO and POS plans retrieved from Navinet network or appropriate websites.
  • As needed; obtained necessary authorizations for MVA and work-related injury accounts.
  • Performed daily and monthly close of all office transactions and run the reports.
Education and Training
Expected in
: Medical Sciences
Ocean County Community College - Toms River, NJ,
GPA:

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Resume Overview

School Attended

  • Ocean County Community College

Job Titles Held:

  • Medical Biller/Insurance Verifier/ Scheduler
  • Orthopedic Spine Surgical Coordinator / Doctors Assistant
  • Medical Billing Specialist

Degrees

  • Some College (No Degree)

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