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Verification of Benefits Specialist Resume Example

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VERIFICATION OF BENEFITS SPECIALIST
Professional Summary

A health care administrator responsible for the development and management of health care operations looking for the chance to become a part of reputed health organization to provide continuous health care services with exceptional analytical, problem-solving, and organizational skills. Demonstrating superior understanding of ICD-9 & 10, electronic medical records CPT coding, DME (Durable Medical Equipment), and Medicare and Medicaid billing procedures. Self-motivated, dependable and professional with 7 years of extensive experience in Pharmacy processing, Pharmacy and Medical billing, collections and medical terminology. Well-developed interpersonal communications skills. Assumes responsibilities with leadership and competence. Able to work well independently with little or no supervision also works well with others in team atmosphere. Ability to multitask with high quality organizational skills and detail oriented.

Skills
  • Proficient in all Microsoft Office Programs
  • Documentation and reporting
  • Process improvement
  • Understanding of medical terms
  • Training & Development
  • Effective communication skills
  • Proficient in Medicare & Medicaid
  • Microsoft Office software proficiency
Work History
Verification of Benefits SpecialistAug 2015 - Current
Acelis Connected Health SuppliesOrlando, FL
  • Responsible for new account acquisition and retention.
  • Subject matter expert of verification of benefits, answering internal and external questions and inquiries.
  • Communicated verification and authorization status updates with customer services and sales departments to facilitate decision-making for patient admissions and insurance coverage.
  • Contacts Primary Care or Admitting Physician to obtain authorizations, diagnosis, and procedure detail as necessary.
  • Obtained and maintained knowledge of third party billing, coding, medical terminology, prior authorizations and appeal submittals.
  • Obtain recertification for cases requiring extended treatment/coverage beyond expiration of original approval.
  • Participate in multiple conference calls with Client Sales Representatives, client management and clinics regarding status of cases, Equipment and supply orders and status of claims.
  • Coordinate 10% of activities related to contracts, single case agreements, reimbursement outcomes.
  • Organize clinical documentation, treatment plans, and referrals.
  • Investigate and resolved patient authorizations and claim issues.
  • Documented case notes daily and coordinated follow-up for seamless case management.
Senior Reimbursement SpecialistNov 2012 - Aug 2015
CuraScript Specialty DistributionLake Mary, FL
  • Conduct benefit investigations, verify insurance benefits for patient and physicians' office, and submit and obtain prior authorization as required by payer.
  • Analyzed explanation of benefits (EOB's) to detect payment discrepancies and payer trends to determine appropriate follow-up i.e., resubmissions, adjustments and or refunds for varies insurance claims, including worker's compensation, ConnectiCare, United Healthcare, Aetna, and Medicare/ Medicaid.
  • Participate in conference calls with Client Sales Representatives, client management and physicians' offices regarding status of cases, drug orders and status of alternative funding.
  • Provide coordination of order for product, shipment of product, and therapy initiation with pharmacy and patient.
  • Participate in Call Center Activities, triage and respond to incoming calls from patients, insurance companies, physicians, Sales Reps, pharmacies and homecare agencies.
  • Served as single point of contact for an assigned group of prescribers.
  • Identify and report events as required by the REMS requirements for specified medication.
  • Recognize adverse event, product quality complaint and potential risk events and forward information to the appropriate team member for reporting to the manufacturer.
  • Educate patients, prescribers, and others regarding program requirements, and facilitate referrals.
  • Perform other duties as deemed necessary by the Group Manager.
Resolution ExpertMar 2009 - Sep 2012
WalgreensOrlando, FL
  • Correct and Re-submit rejected Third Party Rejects (TPRs) by reviewing the TPR.
  • Interpret Medical Abbreviations (SIG Codes).
  • Read and Review prescriptions.
  • Handle inbound and outbound calls with pharmacists, insurance companies, and doctor's offices.
  • Process refill request.
  • Read and understand prescription data entry guidelines and procedures.
  • Assist the Pharmacists with escalated unresolved TPR.
  • Contact the pharmacists to alert them of any changes in patient's condition, compliance issues due to patient not taking medication or side effects, or to transfer a patient directly to pharmacist for counseling.
  • Complete other stages of the order process as assigned including but not limited to scanning prescriptions, imagine indexing, pre-QA, load insurance information, process claims, work issues and facilitate prior authorizations.
  • Provides typed documentation of all communications received from calls and provide notification of any urgent orders, shipping related issues and any errors.
Education
High School DiplomaMay 2004
William R Boone High SchoolOrlando, FL
  • 3.0 GPA - General High school diploma
Associate of Applied Science: Business Administration And ManagementJan 2012
Valencia CollegeOrlando, FL
Associate of Arts: Health Services AdministrationExpected in Dec 2022
Seminole State College Of FloridaSanford, FL
Certifications
  • Licensed and Trained Notary Public - 1 Year
  • Certified Notary Signing Agent and Trained - 1 Year
  • Pending Remote Online Notary License - 1 Year
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Resume Overview

Companies Worked For:

  • Acelis Connected Health Supplies
  • CuraScript Specialty Distribution
  • Walgreens

School Attended

  • William R Boone High School
  • Valencia College
  • Seminole State College Of Florida

Job Titles Held:

  • Verification of Benefits Specialist
  • Senior Reimbursement Specialist
  • Resolution Expert

Degrees

  • High School Diploma May 2004
    Associate of Applied Science : Business Administration And Management Jan 2012
    Associate of Arts : Health Services Administration Expected in Dec 2022

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