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surgical counselor insurance resume example with 20+ years of experience

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

Highly-motivated employee looking to obtain a challenging and stable position. Self-motivated, strong work ethic, proven adaptability, and exceptional interpersonal skills. Adept at working effectively unsupervised and talent to quickly comprehend and excel. Devoted to giving every patient a positive and memorable experience like they are my own family. Possess an intense desire to utilize and develop skills and venture forward to a productive future.

Skills
  • Excel, Microsoft Word, SAP, Ten key, Reflections, Power Point, Kronos, Horizon, Paragon, Clinstar, Nova, Passport, FSS, GPNet, Integrity, EyeMed, Medevolve.
Experience
07/2010 to Current Surgical Counselor/ Insurance Mast Roofing & Construction | Oley, PA,
  • I obtain several thousand dollars in collections whether for upcoming or past due appointments
  • Verify insurance, get prior authorizations, and make appointments for surgical procedures, office procedures, and Radiology accordingly
  • Developed relationship with DARS to assist patients who did not have insurance or could not afford surgery, to ensure patients who did not think they would see again, can see.
  • Established and set up insurance verification for Triwest/ VA patients to ensure all visits would be covered.
  • Planned with TAPS/VA/ and Medicaid patients for transportation as needed
  • Schedule, review, order medications, and work with patients to set them up for surgery and ensure they understand every aspect of what they are going through before and after surgery
  • Have caught thousands of dollars in errors of collections and helped to make those errors corrected
  • Disputed with insurance companies many times throughout my career to helping patients ensure their medical claims were being processed correctly
  • Complete all paperwork involved with ASC procedures, including coversheets, H&P, operative consent, and instruction sheets, and operative reports
  • Daily review of charts to determine if patient qualifies for the planned surgery and that documentation is complete supporting the need for that surgery.
  • I assisted in the opening of a new surgery center, being a main point of contact ensuring the proper op reports, paperwork, pre and post op instructions, and any other information was needed to provide patient care
  • Audited accounts after each surgery to ensure when billing was done each entity would be paid correctly
  • I am the main point of contact when the doctors need to find assistance for patients or have any other “out of the ordinary” situations come up
  • Main point of contact for several outside sources that need patient information, need to get a patient in for an appointment, and any other information that is needed.
  • I was able to establish a relationship and organize the system/ paperwork for Choctaw Nation Durant and Talihina, whom we are contracted with for seeing patients and completing surgery.
  • Examined patients' medical history, medication allergies, physical condition and test results to verify necessity of operations and determine proper procedures.
  • Worked successfully with diverse group of coworkers to accomplish goals and address issues related to our products and services.
  • Demonstrated leadership by making improvements to work processes and helping to train others.
  • Provided excellent service and attention to customers when face-to-face or through phone conversations.
  • Scheduled tests, lab work or x-rays for patients based on physician orders.
  • Completed relevant insurance,claim forms, and disability forms.
  • Prepared reports, invoices, letters, or medical records using word processing, spreadsheet, or other software applications.
  • Managed front office customer service, appointment management, billing and administration tasks to streamline workflow.
  • Liaised between physician, site of service and billing department to obtain appropriate documentation.
  • Checked documentation for appropriate coding, catching errors and making revisions.
  • Contacted patients to confirm demographic information, communicate financial responsibilities, and discuss payment arrangements in easy-to-understand terminology.
  • Communicated with insurance carrier, patient and third party or employer to verify patient insurance benefits.
  • Offered diverse clerical support to office team members, managed correspondence, answered telephone calls and tracked documentation.
  • Monitored calendars and scheduled appointments based on availability and established load limits. Scheduled and confirmed patient's appointments and consultations.
  • Encouraged and improved cross-department internal communication.
02/2010 to 07/2010 Triage Tech Point32health, Inc | Quincy, MA,
  • Identified and reported observations and clinical symptoms to appropriate healthcare professionals, driving timely intervention.
  • Greeted patients and their families, determined purpose of visit and directed to appropriate staff.
  • Monitor vital signs on patients while they wait in the waiting room
  • Assisted with patient admissions, discharges and transfers.
  • Liaison between nurses and family members
  • Performed variety of delegated basic patient care services to support nursing functions and activities of daily living.
10/2001 to 02/2010 Office Manager Mhm Services, Inc. | Lawtey, FL,
  • Supervise clerical duties and ensures all office functions are completed in a timely and accurate manner
  • Assists with obtaining benefits and eligibility from insurance companies as needed
  • Assist with the auditing and billing of discharged patients ensuring patient charges are accurate before sending final claim
  • Ensure all 485s and MD orders are sent out and received within the Medicare guidelines
  • Transmit all Medicare/ Medicaid patient account oasis to state
  • Implements systems to facilitate the flow of work in the office continuously looking for areas of operational efficiency improvement
  • Reviewed and reported discrepancies with completed staff documentation to verify consistency, quality, and conformance.
  • On an on-going basis, learns all aspects of Horizon computer system continually updating when necessary, advising staff of problems and or changes to the system
  • Assists with training of new staff on ongoing issues
  • Assist with incoming phone calls.
  • Managed office inventory and placed new supply orders.
  • Administered payroll and maintained proper documentation of employee personnel.
07/2008 to 03/2009 Claims Processor Kroger | Decatur, IL,
  • Examines and processes paper claims and/or electronic claims
  • Determines whether to return, pend, deny, or pay claims within policies
  • Determines steps necessary for adjudication
  • Follows established departmental policies and procedures, operating memos, and corporate policies to resolve claims and claim issues
  • Compares claim application and/or provider statement with policy file and other records to evaluate completeness and validity of claim
  • Interacts with agents and claimants by mail or phone to correct claim form errors or omissions and to investigate questionable entries.
07/1998 to 07/2001 Administrative Assistant MEMCSW | City, STATE,
  • Research, collect, analyze data
  • Ensure purchase requests are input into SAP and received
  • Keep track of data and timesheets for supervisors
  • Track expenditures for wages and hours
  • Assist in budget preparation
  • Track and monitor monthly expenditures for four manufacturing areas and make cost reduction recommendations
  • Maintain employee files and headcount (approx 400 employees)
  • Contribute to Payroll by monitoring, sorting, and keeping track of time input
  • Develop and conduct presentations on subjects such as: Employee Incentive Programs, Time Keeping, Cost Reduction, etc
  • Assumed temporary supervisory role in various positions
  • Support the manufacturing engineers by initiating Inventory Request Forms
  • Work with all support groups including Finance, Shipping/Receiving, Storeroom, and Engineering to help keep the manufacturing line running smooth and without interruption
  • Perform general office duties: filing, paperwork, composing memos, etc
  • Talk with outside vendors
  • Frequently responsible for the instruction/training of others.
04/1995 to 07/2000 Front-end Supervisor Super K-Mart | City, STATE,
  • Ten key skills
  • Managed customer complaints and rectified issues to complete satisfaction.
  • Emphasized customer service excellence through ongoing training of front-line team members to improve customer service ratings.
  • Top percent of key rings per minute
  • Supervised up to twenty-five cashiers
  • Simultaneously ran the Service Desk, assisted customers, answered multi-line phone system, etc.
  • Monitored cash drawers in checkouts to verify adequate cash supply and that they were balanced.
Education and Training
Expected in 05/1996 to to High School diploma | S & S High School, Sadler, TX GPA:
Expected in to to | Grayson County College, Denison, TX GPA:
Have taken some classes. Looking to pursue a Business degree.

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Resume Overview

School Attended

  • S & S High School
  • Grayson County College

Job Titles Held:

  • Surgical Counselor/ Insurance
  • Triage Tech
  • Office Manager
  • Claims Processor
  • Administrative Assistant
  • Front-end Supervisor

Degrees

  • High School diploma

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