Pragmatic Insurance Verification Specialist touting 11 years of expertise in benefits explanation and coverage tracking. A team player with a vast knowledge of medical terms and working with all types of personalities effectively. Offering dynamic organizational skills and attention to detail.
Overview
11
11
years of professional experience
1
1
Certification
Work History
Medical Office/Insurance Verification Specialist
Corpus Christi Heart Clinic
Corpus Christi, Texas
11.2022 - 10.2023
Managed multi-provider surgery schedules for up to 150 patients daily
Verified patient eligibility and benefits package information via phone or online services
Explained co-pays, co-insurance, and deductible amounts to patients or applicable customers and collect if possible
Handling payments for services not covered by insurance
Initiated, tracked and finalized all prior authorizations and referrals when required
Manage multiple fee schedules
Processed insurance claims for private and employer insurance reimbursement
Processed claims to Managed Care Organizations, Medicare, and other payers
Processed and followed up on payer denials, rebilling, and submitting adjustments as needed
Obtained referrals and authorizations
Updating patient information/keeping records.
Administrative Assistant/Intake Coordinator
Altus Hospice - Corpus Christi
Corpus Christi, Texas
04.2021 - 09.2022
Prepared patient charts, pre-admissions, and consent forms as necessary for new hospice patients
Worked closely with Clinical Liaisons, nurses, and aides to confirm the best transition and care for patients
Maintained office staff by recruiting, selecting, orienting, and training employees
Collect, maintain and submit data for monthly, quarterly, and annual reports to Program Director
Tracked PTO, FMLA, Workman's Compensation
Coordinating office activities and operations to secure efficiency and compliance with company policies
Manage workflow by assigning tasks to other administrative employees daily, ensuring that deadlines are met, and work is completed correctly
Schedule office repairs and maintenance
Managed the scheduling of 10 CNAs/Aides for 120 patients and the scheduling of on-call staff
AP/AR and processed medical claims
Ordered medical supplies and maintained monthly budget
Answer/screened incoming telephone calls and routed to appropriate individual.
Medical Office Specialist
Here or There Heathcare
Corpus Christi, Texas
09.2020 - 03.2021
Managed all front office functions including patient relations, check-in/check out, scheduling, insurance verification, and answering phones
Collected personal, medical, and insurance information
Scheduled, rescheduled, and verified patient appointments
Initiated, tracked and finalized all prior authorizations and referrals when required
Collected copays, coinsurance, and deductibles
Maintained House Calls and Clinic patients for three providers
Worked closely with Home Health nurses and patient caregivers
Processed insurance claims for private and employer insurance reimbursement
Processed claims to Managed Care Organizations, Medicare, and other payers.
Medical Office /Lead Insurance Verification Specialist
Texas Precision Surgery Center
Corpus Christi, Texas
06.2019 - 03.2020
Managed multi-provider surgery schedules for up to 150 patients daily
Verified patient eligibility and benefits package information via phone or online services
Explained co-pays, co-insurance, and deductible amounts to patients or applicable customers and collect if possible
Handling payments for services not covered by insurance
Obtained prior authorizations and referrals when required
Manage multiple fee schedules
Processed insurance claims for private and employer insurance reimbursement
Processed claims to Managed Care Organizations, Medicare, and other payers
Processed and followed up on payer denials, rebelling, and submitting adjustments as needed
Found financial solutions for patients or customers who may need payment assistance
Obtained authorizations from referring physicians and any other information needed
Updating patient information/keeping records
Filled in for other departments, Front desk, PACU, Pre Admit, and Medical Records when needed.
Medical Office Specialist
Dr. Blair Krell / Mischer Neuroscience Associates
Lake Jackson, Texas
02.2018 - 08.2018
Managed all front office functions including patient relations, check-in/Check out, scheduling, insurance verification, and answering phones
Scheduled, rescheduled, and verified patient appointments for high-volume office
Prepared patient charts, pre-admissions, and consent forms as necessary
Obtain MRI approvals and prescription authorizations
Verified patient insurance and obtain referrals when needed
Checked-out patients, and collect copays, coinsurance, and deductibles
Direct patients on how, when, and where to get Labs, X-rays, EEGs, and MRIs done
Explain how to access the Everyday Well patient portal to patients
Maintain HIPAA compliance and patient confidentiality
Export patient data from Practice Fusion EMR to Cerner Millennium EHRs and updated records
Reached out to patients to obtain the new and correct information
Transferred patient data for paper records into Cerner EHRs.
Medical Office Specialist
Lake Jackson Dermatology & Aesthetics
Lake Jackson, Texas
03.2014 - 08.2017
Managed all front office functions including patient relations, check-in/Check out, scheduling, insurance verification, and answering phones
Collect copays, coinsurance, and deductibles
Scheduled, rescheduled, and verified patient appointments for high volume, multi-provider office
Created financial breakdowns and payment plans for Superficial Radiation Therapy patients
Aided in the maintenance of medical charts and/or electronic medical records
Obtained pre-authorizations and referrals as needed
Precisely completed appropriate claims paperwork, documentation, and system entry
Entered orders into the EMR system efficiently and without errors
Maintained Insurance Fee Schedules
Prepared patient charts, pre-admissions, and consent forms as necessary
Trained new employees on multiple medical billing programs and data entry software
Manage workflow by assigning tasks to other administrative employees daily, ensuring that deadlines are met, and work is completed correctly.
Medical Office Specialist
The Eye Contact
Lake Jackson, Texas
09.2012 - 03.2014
Managed all front office functions including patient relations, check-in/Check out, scheduling, insurance verification, and answering phones
Collect copays, coinsurance, and deductibles
Scheduled, rescheduled, and verified patient appointments for high volume, multi-provider office
Created financial breakdowns and payment plans for Superficial Radiation Therapy patients
Aided in the maintenance of medical charts and/or electronic medical records
Obtained pre-authorizations and referrals as needed
Precisely completed appropriate claims paperwork, documentation, and system entry
Entered orders into the EMR system efficiently and without errors
Maintained Insurance Fee Schedules
Prepared patient charts, pre-admissions, and consent forms as necessary
Trained new employees on multiple medical billing programs and data entry software
Manage workflow by assigning tasks to other administrative employees daily, ensuring that deadlines are met, and work is completed correctly.
Education
Skills
Medical Billing
ICD-9/ICD-10
Insurance Verification
Several EMR Systems
Medical Records
Medical Scheduling
Customer Service
Medical terminology
Microsoft Office
Patient Scheduling
HIPAA Compliance
Certification
CPR Certified, Present
Assessments
Customer service, Proficient, January 2021, Identifying and resolving common customer issues
Medical billing, Proficient, October 2022, Understanding the procedures and forms used for medical billing
HR: Compensation & benefits, Proficient, October 2022, Knowledge of compensation and benefits programs
Personal Information
Title: Medical Office Specialist
Timeline
Medical Office/Insurance Verification Specialist
Corpus Christi Heart Clinic
11.2022 - 10.2023
Administrative Assistant/Intake Coordinator
Altus Hospice - Corpus Christi
04.2021 - 09.2022
Medical Office Specialist
Here or There Heathcare
09.2020 - 03.2021
Medical Office /Lead Insurance Verification Specialist
Lead Medical Receptionist/Insurance Verification Specialist at Angleton Cardiology Clinic: Dabaghi Salim MDLead Medical Receptionist/Insurance Verification Specialist at Angleton Cardiology Clinic: Dabaghi Salim MD
Medical Records Coordinator/Insurance Verification Specialist at Baptist Ambulatory Surgery CenterMedical Records Coordinator/Insurance Verification Specialist at Baptist Ambulatory Surgery Center