Dedicated employee with a strong commitment to overcoming challenges. Exhibits adaptability and a robust work ethic, along with outstanding interpersonal abilities. Skilled in independent work and quick learning of new skills.
Overview
8
8
years of professional experience
Work History
Follow Up Workers Compensation
R1RCM - Through St. John's Health System
01.2024 - Current
Reviewed denied bills and analyzed chart notes for discrepancies.
Conducted follow-ups on bill reviews related to denials.
Communicated with adjusters to obtain updates on claim statuses.
Prepared letters for patients requesting additional information.
Facilitated fax submissions for reconsiderations and appeals with necessary documentation.
Insurance Verification Specialist
New England Life Care
12.2022 - 01.2024
Ensured eligibility and benefits verification for home infusion services.
Verified requirement of PCP referral and authorization for patients.
Maintained up-to-date electronic records of patient insurance information.
Collaborated with healthcare teams to streamline insurance processing.
Assisted patients in navigating their benefits and coverage options.
Resolved verification issues through effective communication with insurance providers.
Coordinated claim submissions with billing departments for accuracy.
Analyzed and interpreted insurance policies for accuracy and compliance.
Insurance Verification Specialist
Shared Services Center Sarasota
06.2021 - 12.2022
Verified insurance coverage and eligibility for healthcare services in compliance with policies.
Reviewed patient information thoroughly to uphold regulatory and organizational standards.
Discussed payment options with patients to enhance clarity in financial matters.
Insurance Verification/Billing
AAMC Orthopedics Sports Medicine Center
01.2018 - 06.2021
Verified eligibility and benefits for orthopedic outpatient services efficiently.
Determined necessity of PCP referral or authorization for patient treatment.
Quoted self-pay patients and provided detailed billing information.
Reviewed EOBs to ensure accurate claim processing and reimbursement.
Re-billed corrected claims to maximize revenue recovery.
Contacted patients regarding collections notices and payment plans.
Collaborated with team members to enhance service outcomes and performance.
Utilized software tools to optimize database management and streamline workflows.