LiveCareer-Resume

research resolution specialist resume example with 9+ years of experience

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

A highly motivated healthcare administrator specializing in revenue cycle. With 10years of experience, I am able to provide new efficient strategies to the team and stellar customer service to each patient/client. While incorporating southern hospitality in each interaction, I aim to create a positive and memorable experience one encounter at a time.

Skills
  • Time Management
  • Multitasking and Organization
  • Attention to Detail
  • Analytical Thinking/ Problem Solving
  • Understanding of Medical Terms
  • Insurance Information Oversight
  • Telephone Etiquette
  • Microsoft Office
  • Database Research
  • Verbal and Written Communication
  • Teamwork and Collaboration
  • Administrative Support
  • Invoice Preparation
  • Data Entry Software
  • Epic Systems
  • Appointment Scheduling
  • Educating Patients
  • Copay Collecting
  • Checking in Patients
  • Insurance Pre-Certifications
  • Patient Health Information Access
  • Payment Scheduling and Collection
  • HIPAA Compliance
  • Scheduling Tests and Procedures
  • Patient Billing
  • Medical Records Verification
  • Outpatient Procedures
  • Payment Plan Options
Education and Training
Benjamin E. Mays High Scool Atlanta, GA, Expected in 05/2011 High School Diploma : - GPA :
Experience
Aveanna Healthcare - Research & Resolution Specialist
Rochester, MN, 02/2021 - Current
  • Answered customer invoice questions and resolved issues discovered during invoicing and collection process.
  • Investigated and resolved issues to maintain billing accuracy.
  • Processed and sent invoices, adjustments and credit memos to customers.
  • Managed numerous client accounts to track and collect money owed.
  • Input payment history and other financial data to keep customer accounts up-to-date in system.
  • Researched and resolved billing inconsistencies and errors through individual and collaborative analysis.
  • Managed account receivables to maintain payments within net terms.
  • Completed billing audits in identified timeframes to report and investigate findings.
  • Reviewed vendor documentation to comply with payment guidelines.
  • Answered customer questions to maintain high satisfaction levels.
  • Managed all payments processing, invoicing and collections tasks.
  • Monitored past due accounts and pursued collections on outstanding invoices.
  • Investigated past due invoices and delinquent accounts to generate revenues and reduce number of unpaid and outstanding accounts.
  • Collected, posted and managed patient account payments.
  • Trained new team members on company policies and accounting systems to keep team operations productive and efficient.
  • Developed strong professional rapport with vendors and clients.
  • Input statement information, reconciled accounts and resolved discrepancies.
  • Gathered information to produce accounts payable reports for review.
  • Participated in workshops, seminars and training classes to gain stronger education in industry updates and federal regulations.
  • Maintained accounting ledgers by verifying and posting account transactions.
  • Created receiving reports and updated vendor balance sheets to record accounts payable.
Oregon Medical Group - Prior Authorization Specialist
Eugene, OR, 07/2019 - 01/2021
  • Performed detailed medical reviews of prior authorization request, following established criteria and protocols.
  • Contacted insurance companies to obtain necessary preauthorizations needed for upcoming tests and procedures.
  • Provided accurate information to all parties, including patients, insurance providers, healthcare staff and office personnel by using effective written and verbal communication skills.
  • Identified reasons behind denied claims and worked closely with insurance carriers to promote resolutions.
  • Coordinated resolutions for issues and appealed denied authorizations.
  • Clarified patient inquiries and questions to update patient account information in computer system.
  • Collaborated with internal departments to provide account status updates.
  • Applied knowledge of Medicare, Medicaid and third-party payer requirements utilizing on-line eligibility systems to verify patient coverage and policy limitations.
  • Scheduled peer to peer reviews for physicians to discuss medical necessity with insurance providers.
  • Scheduled patient appointments, diagnostic specialty appointments, tests and procedures.
  • Answered questions and responded to inquiries to deliver high level of service to patients.
  • Explained eligibility details and affordability options to patients with kindness and respect.
Providence Health & Services - Surgery Scheduling Coordinator
Tigard, OR, 04/2015 - 07/2019
  • Booked surgeries according to physician volume and maintained prompt turnaround times.
  • Collaborated and established strong working relationships with physicians, supervisors and colleagues.
  • Scheduled follow-up appointments as designated by physician.
  • Checked patient insurance and collected pre-authorizations from providers.
  • Gathered current medical information and reviewed histories to gather details for surgeons.
  • Coordinated work processes and routed paperwork to appropriate physicians and staff members.
  • Located scheduling barriers and implemented appropriate solutions.
  • Managed patient check-in and check-out procedures and processed payments.
  • Adhered to HIPAA requirements to safeguard patient confidentiality.
  • Scheduled and confirmed patient appointments and consultations.
  • Communicated with patients with compassion while keeping medical information private.
  • Managed front office customer service, appointment management, billing and administration tasks to streamline workflow.
  • Transmitted medical records and other correspondence by mail, e-mail, or fax.
  • Scheduled tests, lab work or x-rays for patients based on physician orders.
  • Prepared reports, invoices, letters, or medical records using word processing, spreadsheet, or other software applications.
  • Compiled and coded patient information or data in appropriate computer system.
  • Arranged hospital admissions for patients as required.
  • Performed bookkeeping duties, preparing and sending financial statements or bills.
Genesis Health Group - Patient Account Specialist
Clinton, IA, 10/2013 - 04/2015
  • Collaborated with relevant parties to resolve billing issues, insurance claims and patient payments.
  • Processed refunds, disbursements and payments.
  • Reached out to patients once insurance was billed in order to obtain payments due.
  • Generated detailed reports outlining billing, flagged items and other important data.
  • Answered customer questions regarding account discrepancies or problems.
  • Accepted and processed customer payments and applied toward account balances.
  • Recorded information about status of collection efforts.
  • Investigated billing discrepancies and implemented effective solutions to resolve concerns and prevent future problems.
  • Completed month-end and year-end closings, kept records audit-ready and monitored timely recording of accounting transactions.
  • Spoke with customers to learn reasons for overdue payments and to review terms of credit contract.
  • Contacted customers with delinquent accounts to solicit payment.
  • Arranged debt repayment or established schedules for repayment based on customer's financial situation.
  • Worked closely with delinquent account holders to collect and reconcile accounts through approved channels.
  • Negotiated credit extensions and waivers when necessary.
  • Encouraged customers to pay due amounts on credit accounts, claims or overdrawn checks.
  • Notified credit departments and turned over records to attorneys when customers failed to respond to collection attempts.

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Resume Overview

School Attended

  • Benjamin E. Mays High Scool

Job Titles Held:

  • Research & Resolution Specialist
  • Prior Authorization Specialist
  • Surgery Scheduling Coordinator
  • Patient Account Specialist

Degrees

  • High School Diploma

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