ANGELA GREEN
HOUSTON,TX
Summary
Highly organized and diligent medical professional drawing upon 15 years of experience in medical insurance verification and pre-authorization and being team lead. Qualified to deal with medical insurance verification, billing and coding, get authorization for surgical procedures, and be over 5 locations managing the insurance department. Proven skills in high-paced and very stressful environments with expertise in managing provider requirements. Positive and upbeat with excellent patient communication skills and care. love to be able to solve problems and make sure patients are taken care of and being able to bring outstanding leadership to the company. Hardworking Prior Authorization Specialist with successful background working closely with insurance company representatives to gain preapproval for procedures and testing. Detail-oriented performer with over 14 years of managing documentation. Considered team player with exemplary multitasking skills. Hardworking Prior Authorization Specialist with successful background working closely with insurance company representatives to gain preapproval for procedures and testing. Detail-oriented performer with over 14 years of managing documentation. Considered team player with exemplary multitasking skills.
Overview
15
15
years of professional experience
Work History
Pre Authorization/ Insurance Verification
South Houston Retina
08.2023 - Current
- South Houston Retina is retina specialist where getting authorization for diabetic patients who need injection / also have to contact patient to inform them that will put them on special programs to help with cost of medication. have experience in working with specialty pharmacy insurance to get medication delivered to office for patient to get treatment.
- Also qualified to get authorization for any insurance company and making sure doctor is in network before office visit.
- I'm cross-trained in front desk also if needed.
- Schedule patient appointments for surgical procedures at out patient facilities
- Responded to inquiries from healthcare providers regarding prior authorization requests.
- Evaluated clinical criteria for approval or denial of services requiring pre-authorization.
- Analyzed medical records and other documents to determine approval of requests for authorization.
INSURANCE VERIFICATION SUPERVISOR
EYE CENTER OF TEXAS
01.2009 - 09.2023
- Verification of eligibility of over 40 patients and participating status of providers
- Determine member benefit coverage, co-insurance, deductibles, and co-pays.
- Called insurance to make sure doctor is in network and to check for pre-authorization for codes.
- Obtain authorization for injection and cataract surgeries/Contact patient to collect payments before surgery
- Schedule patient surgery at outpatient surgical center
- Team lead for 5 locations in insurance department
- Worked with scheduling patients with workers comp getting them approved for doctor's appointment
- Sent claims out to insurance carriers/Corrected claims that denied payment for insurance
- Educated patient about insurance and getting into programs to help them with payments.
- Explained benefits to plan participants in easy to understand terms in order to educate each on available options.
- Resolved issues and inquiries from plan participants regarding health and welfare benefits and deductions through telephone, email, and in-person interactions.
- Observed strict procedures to maintain data and plan participant confidentiality.
- Analyzed and reported on employee benefits data to identify trends and develop strategies for improvement.
- Trained new team members in policies and procedures and offered insight into best ways to manage job tasks and duties.
- Researched and evaluated new benefits programs to select cost-effective providers and coverage levels.
- Verified client information by analyzing existing evidence on file.
- Calculated adjustments, premiums and refunds.
- Modified, updated and processed existing policies.
- Determined appropriateness of payers to protect organization and minimize risk.
- Notified insurance agents and accounting departments of policy cancellations and changes.
- Coordinated and conducted employee orientations to promote understanding of coverage and options.
- Checked employees' benefits enrollment for accuracy and inputted all data into [Software]
- Resolved issues and inquiries from plan participants regarding health and welfare benefits and deductions through telephone, email, and in-person interactions
- Observed strict procedures to maintain data and plan participant confidentiality
- Trained new team members in policies and procedures and offered insight into best ways to manage job tasks and duties
- Calculated adjustments, premiums and refunds
Education
Associates in Family Studies -
American Public University
Skills
- Insurance Verification
- Emr
- Positive Team Lead
- Pre Authorization Specialist
- Microsoft Word
- Enrolling Patient in Programs
- Workers Comp
- Scheduling patient for out patient surgery
- Skilled and Billing and Coding
- Great Customer Services skills
- front office skills
- Insurance Authorizations
- Medical Terminology
- Benefit Coverage
- Understanding of Insurance Details
- Problem Resolution
- Demographics Information
- Call Transfers
Timeline
Pre Authorization/ Insurance Verification
South Houston Retina
08.2023 - Current
INSURANCE VERIFICATION SUPERVISOR
EYE CENTER OF TEXAS
01.2009 - 09.2023
Associates in Family Studies -
American Public University