Amanda Poumele
Oceanside
Summary
Experienced in insurance eligibility verification and prior authorization processing, with a strong background in patient communication and data entry. Skilled in financial counseling and insurance billing, ready to leverage expertise in supporting efficient healthcare operations. Eager to contribute as an Insurance Verification Specialist, utilizing analytical thinking and HIPAA compliance knowledge.
Overview
18
18
years of professional experience
Work History
Insurance Verification Specialist
North Coast Surgery Center
11.2016 - 10.2021
- Perform insurance verification. Responsibilities include but not limited to heavy phone contact with managed care companies, communicate with insurance companies authorization department regarding any CPT code discrepancies (as assigned), and contact patient prior to appointment if there is any insurance/authorization issues.
- Accurately enter insurance information into computer system.
- Responsible for verifying active pre-certification/authorization and insurance verification for all patients.
- Research, follow up and resolve open & pending authorizations in a timely manner.
- Calculate cash estimates for patients on upcoming visits/procedures.
- Contact patients regarding financial obligations.
- Documents activity in the patient accounts.
- Concisely, precisely and accurately document all information.
- Maintain clear communication with patients as well as insurance companies.
- Answer phone for incoming calls, make outgoing calls daily as needed to Insurance carrier, Patient and Referring MD.
- Maintain strict confidentiality of patient and center related business.
- Obtain prior authorization for procedures.
- Scanning medical documents into patient accounts.
- Perform other responsibilities as assigned to support.
Intake Coordinator
Rady Children’s Hospital Homecare
03.2016 - 11.2016
- Monitor fax queue for all incoming orders.
- Attach orders and all pertinent documentation to patients chart.
- Notify Pharmacy and Nursing staff of all new Homecare admissions.
- Notify Pharmacy and Pharmacy BA of new orders for existing patients.
- Attend daily morning meetings and update clinical staff on status of internal and external referrals.
- Notify Homecare Liaison of any new patients, and update her when there are any changes or issues with staffing or authorizations for patients currently admitted to Rady Children’s Hospital.
- Enter complete and accurate demographic, clinical and payor information.
- Notify ordering Physicians when unable to staff or provide services to their patients.
- Verify current and ongoing payor eligibility via telephone, internet.
- Notify patient of financial responsibility. Verbally and written.
- Collect copayments and deductibles.
- Notify Nursing staff of contracted payors in a timely manner.
- Obtain authorizations and reauthorizations from third party payors.
- Notify billing and clinical staff of authorizations received and services which may not be covered in a timely manner.
- Review dispensed patient medical supplies and amend/request authorizations in a timely manner.
- Respond to billing Department when reimbursement issues occur.
- Function as the primary point of contact between the Homecare Department and referral sources.
- Notify referral sources in a timely manner when we are able to staff or unable to staff.
- Greet all Homecare patients and family as they enter the office.
- Assist patients and family in a timely, friendly manner.
- Comply with HIPPA guidelines.
Inpatient Coordinator
Applecare Medical Management
04.2011 - 12.2015
- Requests initial admission and concurrent reviews and follow up calls as required.
- Authorizes selected services per explicit criteria and guidelines.
- Collects data for clinical review and submits data to licensed clinical services staff for decision making.
- Run productivity, utilization and turnaround time reports for health plan submission.
- Support On Call Nursing staff for admissions, concurrent review and follow up care.
- Front line contact for all in and out of network ER admissions.
- Provides feedback to Manager of Inpatient Services regarding process improvement.
- Prepare and distribute inpatient reports.
- Prepare denial letters.
- Perform data entry.
- Make post discharge calls within 72 hours to members.
- Schedule all post discharge PCP and Specialist appointments.
- File, faxing, mailing of appointment letters.
- Schedule patient appointments for outpatient follow up services.
- Verify eligibility and benefits.
- Other duties as assigned.
Health Services Specialist
Primary Provider Management Company, Inc
10.2008 - 02.2011
- First line phone responsibilities for Health Services calls.
- Verify eligibility, benefits and address other referral related inquiries from providers, their office staff, hospitals and members.
- Intake and data entry of referral requests.
- Process referrals within scope per UM Guidelines Quota of 100/day.
- Assist in obtaining and documenting discharge dates for inpatient stays.
- Understand and utilize benefit, contractual and delegation information.
- Orientation and training of new department staff.
- Computer literate with daily use of Microsoft Windows and proprietary systems.
- Function as a resource for the Provider Contracts department.
Clerical Lead & National Intake Coordinator/UR Clerical Specialist
Corvel Corporation
08.2006 - 10.2008
- Sort and assign work to nonclinical staff.
- Intake, data entry and process inpatient and outpatient National Account referral requests.
- Assist UM and CM nurses in obtaining additional clinical information from Providers.
- Key contact for Medical Claims Adjusters, Providers and Attorney’s.
- Open all appeal files, research and obtain all necessary documentation.
- Department lead for nonclinical staff.
- Orientation and training of new department staff.
- Function as department supervisor.
- Computer literate with daily use of Microsoft Windows and proprietary systems.
- Tracking of productivity and timeliness.
- Scan and upload medical information.
- Faxing and filing.
Customer Service Representative
EZ Copy
06.2005 - 05.2006
- Request medical records.
- Verify all receipt of complete medical records.
- Review charts for accuracy of patient and physician demographic information.
- Reopen special cases and prepare for medical review.
Sales Associate
Best Buy
10.2004 - 12.2004
- Create in store displays.
- Assist customers in the Audio/Visual Department.
- Stock merchandise.
Courtesy Clerk/Floral Clerk
Albertsons
03.2004 - 06.2004
- Price checks.
- Grocery bagging.
- Customer assistance.
- Stock merchandise.
- Create floral and balloon arrangements.
- Create in store displays.
Telephone Operator
I.A.C.S
11.2003 - 03.2004
- General Reception duties.
- Answer phones, transfer calls to appropriate party, accurate messages.
Education
Associates - Human Development
Santa Ana College
Santa Ana, CaPsychology
Fullerton College
01.2006
High School Diploma - undefined
El Camino Real High School
06.2003
Skills
- Executed insurance billing processes to ensure timely and accurate claims submission
- Utilized medical terminology to enhance communication and documentation accuracy
- Assisted in data entry and verification tasks Supported team members in maintaining accurate records Contributed to the review process to ensure data integrity
- Implemented follow-up procedures to ensure task completion and accountability
- Assisted in processing coverage requests and authorizations Supported team members in managing documentation for insurance claims Helped maintain accurate records of coverage approvals
- Facilitated referral coordination to streamline patient care processes
- Assisted patients with inquiries and concerns Provided support during appointments and procedures Facilitated communication between patients and healthcare providers
- Assisted teams in managing project timelines and deliverables Supported project coordination to meet client expectations Contributed to documentation and reporting processes
- Cultivated strong patient rapport to enhance trust and communication
- Applied analytical thinking to evaluate complex problems and develop effective solutions
- Ensured adherence to HIPAA regulations to protect patient privacy and confidentiality
- Facilitated effective communication with patients to address concerns and provide support Assisted in clarifying treatment plans and answering questions Collaborated with healthcare teams to enhance patient understanding of medical procedures
- Ensured strict adherence to patient confidentiality protocols and regulations
- Executed prior authorization processing to ensure compliance with healthcare regulations
- Assisted in managing electronic medical records to support healthcare teams Maintained accurate patient information to facilitate efficient care delivery Provided training on electronic systems to enhance user proficiency
- Executed insurance coverage verification processes to ensure compliance and accuracy
- Mastered insurance terminology to enhance communication and understanding within the team
- Facilitated electronic authorization processing to ensure seamless transaction approvals
- Assisted in calculating deductibles and co-pays for clients Supported team members in understanding insurance policies Provided guidance on billing processes and patient inquiries
- Executed cash handling procedures to ensure accurate financial transactions
- Oversaw meticulous medical recordkeeping to ensure compliance with healthcare regulations
- Assisted in organizing payment schedules and collecting outstanding invoices Helped maintain accurate records of payment transactions Supported team efforts in ensuring timely collections
- Assisted in performing outpatient procedures to support patient care Collaborated with healthcare teams to facilitate efficient workflow Provided necessary support to ensure patient comfort during procedures
- Facilitated patient referral processes to ensure timely access to specialized care
- Conducted patient interviews to gather essential health information Assisted healthcare professionals in understanding patient needs Supported patients in articulating their concerns effectively
- Assisted teams in completing projects on schedule and within budget Supported project management efforts by coordinating tasks and resources Contributed to team collaboration to achieve project goals
- Assisted in managing cases and coordinating utilization efforts Supported teams in implementing effective case management strategies Aided in monitoring resource allocation to optimize service delivery
- Executed insurance eligibility verification processes to ensure compliance and accuracy
- Conducted comprehensive benefits assessments to evaluate employee satisfaction and program effectiveness
- Delivered comprehensive financial counseling services to clients, enhancing their financial literacy and decision-making skills
- Executed data verification processes to ensure accuracy and integrity of information
PERSONAL INFORMATION
Work Permit: Authorized to work in the US for any employer
Timeline
Insurance Verification Specialist
North Coast Surgery Center
11.2016 - 10.2021
Intake Coordinator
Rady Children’s Hospital Homecare
03.2016 - 11.2016
Inpatient Coordinator
Applecare Medical Management
04.2011 - 12.2015
Health Services Specialist
Primary Provider Management Company, Inc
10.2008 - 02.2011
Clerical Lead & National Intake Coordinator/UR Clerical Specialist
Corvel Corporation
08.2006 - 10.2008
Customer Service Representative
EZ Copy
06.2005 - 05.2006
Sales Associate
Best Buy
10.2004 - 12.2004
Courtesy Clerk/Floral Clerk
Albertsons
03.2004 - 06.2004
Telephone Operator
I.A.C.S
11.2003 - 03.2004
Associates - Human Development
Santa Ana College
Psychology
Fullerton College
High School Diploma - undefined
El Camino Real High School