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Remote Precertification /Insurance Verification Specialist Resume Example

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REMOTE PRECERTIFICATION /INSURANCE VERIFICATION SPECIALIST
Professional Summary

Pragmatic Insurance Verification Specialist touting 5 years of healthcare expertise in benefits explanation, coverage tracking and authorizations, in addition to, other administrative support roles . A team player with a vast knowledge of medical terms and the ability to work with all types of personalities effectively. Offering dynamic organizational skills and attention to detail.

Accomplishments

Certifications and Licenses

HCA Centralized Insurance Verification Core Process Training

September 2013 to October 2013

Certificate of Completion - October 17,2013

By: Sue Watson, Director of Education

Charlene Villalobos, Education Instructor

HCA Shared Services Core Training

September 2013 to September 2013

Certificate of Completion - September 10, 2013

By: Sue Watson, Director

Christine Hobafcovich, Instructor

HCA Centralized Insurance Precertification Core Process Training

September 2013 to September 2013

Certificate of Completion - September 27 ,2013

By: Kayla Henry, CIVU Team Leader

Skills

Attention to Detail, Communication, Computer Skills, Numeracy – Accuracy, Organization - Decision Making and Soft Skills

Organizational; Delivering Mail, Efficient, Filing, Management, Multitasking, Oversight, Photocopying, Collating, Planning, Sorting, Time Management.

Analytical, Making Travel Arrangements, Prioritization, Problem Solving, Reasoning, Record Keeping, Scheduling Appointments, Typing, Team building, Problem resolution.

Data Entry, Data Management, Database Fluency, MS Office, Office Machines, Word Processing, Publishing.

Customer service, Email, Faxing, Front desk, Language skills, Listening, Oral communication, Proofreading, Writing.

Prior authorization processing

Work History
September 2013-April 2016Remote Precertification /Insurance Verification Specialist | HCA Healthcare / Parallon Business Solutions | Norcross, GA
  • Provided timely notification of scheduled inpatient / outpatient admissions; utilize patient demographics verifying active coverage ensuring claims meet guidelines of insurance carriers' notification request.
  • Proficient use medical terminology; ICD-10, HCPCS, UB04, CMS 1500, CPT Coding •Follow scripted benefits verification/precertification format in Meditech benefits screen and record benefits and pre-certification information.
  • Assign I-Plans from insurance eligibility confirmation obtained for the pre-certification of admission, follow up and facility status changes.
  • Accurately inputted all patient and insurance information into company's computer system using Meditech.
  • Reviewed 440 patient admissions per week and verified insurance coverage information.
  • Admissions Follow up; track, update, and manage accounts; confirm provider and patient responsibility, monitor accounts in Meditech for claim discrepancies, non-payment, denials, appeals, collections, pre-authorization information.
  • Adhere to all policies/procedures; AIDET Policies -- Patient Interactions, Company Mission and Value Statements and Codes of Conduct providing highest level of quality care to patients.
  • Posted payments to accounts and maintained records.
  • Made contact with insurance carriers to discuss policies and individual patient benefits.
  • Maintained strong knowledge of basic medical terminology to better understand services and procedures.
  • Observed strict procedures to protect sensitive patient information, including medical records and payment data.
  • Assured timely verification of insurance benefits prior to patient procedures or appointments.
December 2008-August 2010Medical Biller / Collections Clerk | Vital Care EMS | Newnan, GA
  • Processed electronic claim submission of emergent/non-emergent EMS/Life Flight transports.
  • Managed patient accounts; assuring patient demographic, update medical records information provided by patients, healthcare and insurance providers.
  • Proficient use medical terminology; ICD-10, HCPCS, UB04, CMS 1500, CPT Coding, Verification, Eligibility, Coverage and Authorization of services; Medicare, Medicaid, Commercial/Private Payers, VA and Disability Adjudication.
  • Finance, Accounting and Billing duties; payables and receivables; receipts, checks, voucher preparation, credit cards payments, void transactions and reimbursements.
  • Reconciled invoices and reports confirming accurate processing of all claims, billing, payments and reimbursements.
  • General Office Duties: Copying, Electronic / Hard Copy Filing, Faxing, Scanning, Archiving, 10-Key, Data Entry, Mail, Notary, Order Supplies, Send/Receive Overnight Packages; FedEx, UPS and DHL.
  • Contacted clients with past due accounts to formulate payment plans and discuss restructuring options.
  • Handled high volume of in-bound calls pertaining to reconciliation of delinquent accounts.
  • Identified, researched and resolved billing variances to maintain system accuracy and currency.
  • Increased customer satisfaction by resolving account issues.
  • Managed efficient cash flow reporting, posted cash receipts and analyzed chargebacks, independently addressing and resolving issues.
  • Produced, distributed and tracked more than 150 monthly invoices for emergent/non-emergent transportation business.
June 2000-February 2008Inventory / Document Control Clerk | Don Jackson Lincoln Mercury | Union City, GA
  • Daily Maintenance and Operation of New / Preowned Vehicle Inventories; Incoming and Outgoing units for all Dealer Trades, Billing and Invoicing; Custom/Fleet ordered units.
  • Microsoft Office; Word / Excel for Accounting, Employee and Inventory Records.
  • Managed Dealer Vehicle Documentation; Tag / Title Applications, MSO Certificates.
  • General Office Duties: Copying, Electronic / Hard Copy Filing, Faxing, Scanning, Archiving, Operate Multi-Lined Switchboard, Mail, Notary, Order Supplies, Send/Receive Overnight Packages; FedEx, UPS and DHL.
  • Human Resources; maintain all employee records, schedules and meetings, Order Office Supplies, Dealer Forms / Company Letterhead, Vehicle Inventory Supplies.
  • Scanned all financial and accounting documents into a data archiving system to create a paperless method for filing and tracking all of the dealerships important records.
  • Accounting; Daily/Monthly Financial Expense; Receipts, Checks, EFT, Vouchers, Credit Cards, Reconciled Bank/Vendor Statements, Billing, Invoicing, General Ledgers, Reports, Collections.
  • Conferred with managers, sales teams and engineering personnel to revise plans and achieve demanding targets.
  • Completed [Timeframe] logs and reports detailing production data such as volume, materials used and quality assurance results, helping management make accurate operational decisions.
  • Implemented organizational systems to optimize product placement and operational productivity.
  • Recorded information, shortages and discrepancies to keep records current and accurate.
  • Accepted delivered packages, verified products and checked delivery totals to keep system records current and accurate.
  • Kept all documentation and records accurate and up-to-date with latest data to prevent errors in processing or delivery.
  • Audited and corrected discrepancies in inventory numbers.
  • Checked prices and calculated totals for accurate invoice processing.
  • Addressed internal supply problems head-on and developed creative solutions to prevent delays and missed targets.
Education
May 1987High School DiplomaNewnan High School, Newnan, GA
December 2014Associate of Arts: Organizational LeadershipPoint University, West Point, GA
Bachelor of Arts: Business Administration And ManagementPoint University, West Point, GA

Due to unforeseen circumstances, my program has not been completed and is currently in pending status with remaining courses. I am taking the opportunity to complete the online program to receive my Bachelor's Degree in Business Administration.

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Resume Overview

Companies Worked For:

  • HCA Healthcare / Parallon Business Solutions
  • Vital Care EMS
  • Don Jackson Lincoln Mercury

School Attended

  • Newnan High School
  • Point University

Job Titles Held:

  • Remote Precertification /Insurance Verification Specialist
  • Medical Biller / Collections Clerk
  • Inventory / Document Control Clerk

Degrees

  • High School Diploma
    Associate of Arts : Organizational Leadership
    Bachelor of Arts : Business Administration And Management

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