Danielle Field
Fairfax Surgical Center
Burke,VA
18
years of professional experience
Dedicated healthcare insurance verification specialist with experience supporting pre-certification and authorization processes in a high-volume ambulatory surgery setting, combined with more than 14 years of expertise in insurance verification, patient access, and revenue cycle operations. Demonstrated success in verifying insurance eligibility, interpreting payer guidelines, identifying pre-certification requirements, resolving coverage discrepancies, and ensuring compliance with billing requirements to facilitate timely reimbursement. Proficient in Athena and other electronic medical record systems, with a strong commitment to delivering exceptional patient service while collaborating effectively with clinical staff, providers, and insurance carriers.
Work History
Insurance Verification Specialist
5 Years 9 Months- Independently process 30-50 outpatient surgical cases daily, verifying insurance eligibility, benefits, and authorization requirements to ensure readiness for scheduled procedures, prevent delays in patient care, and support timely reimbursement.
- Review scheduled cases to determine whether prior authorizations, referrals, or pre-certifications are required based on payer guidelines and procedure codes.
- Ensure required authorizations have been obtained and documented prior to the date of surgery to prevent delays in patient care and reduce reimbursement risk.
- Collaborate with physician offices, scheduling staff, and authorization teams to follow up on pending or missing authorizations.
- Utilize payer websites, electronic verification systems, and direct communication with insurance representatives to confirm eligibility, benefits, and authorization status.
- Identify and resolve insurance discrepancies, coverage limitations, and eligibility issues that could impact scheduled procedures.
- Notify appropriate departments of authorization concerns, denials, or outstanding requirements requiring follow-up before the date of service.
- Accurately document verification findings and authorization status in the electronic medical record and other designated systems.
- Maintain compliance with HIPAA regulations and organizational policies while supporting efficient patient throughput in a fast-paced surgical environment.
Insurance Verification Representative
9 Years 1 Month- Verified patient insurance eligibility and benefits to ensure coverage for scheduled services and minimize claim denials.
- Contacted insurance carriers and utilized payer websites and electronic verification systems to determine coverage, eligibility, and payer requirements.
- Identified, investigated, and resolved insurance-related discrepancies to facilitate timely and accurate claim processing.
- Reviewed and updated patient demographic and insurance information to ensure compliance with payer billing requirements and timeframes.
- Trained patient service representatives on insurance verification workflows and the use of Athena and payer websites.
- Maintained accurate documentation while adhering to HIPAA guidelines and organizational policies.
Patient Service Representative
2 Years 9 Months- Performed patient registration, check-in/check-out procedures, and collected copayments while providing exceptional customer service.
- Verified insurance information and maintained accurate patient demographic and guarantor records to support efficient clinical operations.
- Managed a high volume of incoming calls related to scheduling, rescheduling, and confirming appointments across multiple practice locations.
- Assisted patients with patient portal registration and directed inquiries to appropriate departments for timely resolution.
Education
High School Diploma - Healthcare Management
Coursework in Healthcare Management
High School Diploma
Skills
Insurance Verification and Eligibility
Pre-Certification Support
Commercial
Medicare
and Medicaid Plans
Electronic Medical Records (Athena
IDX
Just Claims)
Payer Websites and Insurance Portals
Revenue Cycle Operations
HIPAA Compliance
Medical Terminology
Customer Service Excellence
Problem Resolution
Attention to detail
Timeline
Insurance Verification Specialist
Fairfax Surgical Center
09.2020 - CurrentRead More
Insurance Verification Representative
Capital Area Pediatrics
02.2011 - 03.2020Read More
Patient Service Representative
Capital Area Pediatrics
05.2008 - 02.2011Read More
Lake Braddock Secondary School
High School Diploma
Read More
Northern Virginia Community College
High School Diploma from Healthcare Management
Read More