Summary
Overview
Work History
Education
Skills
Accomplishments
Timeline
Generic

Dawn Nelson

Baltimore,MD

Summary

Friendly Insurance Verification Specialist promoting a background in keeping sensitive patient data confidential while maintaining knowledge of Medicaid and Commercial policy benefits. Possessing great relationship building and communication skills. Looking to tackle new challenges with a company that values dynamic skills and a strong work ethic with extensive experience in insurance verification and patient access roles, Excelled in utilizing EMR and ADT systems, ensuring HIPAA compliance, and enhancing customer relationships.

demonstrating exceptional experience in verifying insurance coverage, understanding policies, and processing claims. Strengths include strong analytical skills, attention to detail, and ability to work under timely resolution of disputes and issues.

Overview

26
26
years of professional experience

Work History

Insurance Verification Specialist

Acorn Health.
Coral Gables, FL
05.2022 - 01.2025
  • Utilized electronic medical records (EMR) systems for documenting verification processes.
  • Adhered to HIPAA requirements to safeguard patient confidentiality.
  • Resolved insurance-related issues and discrepancies to prevent claim denials.
  • Updated patient accounts with insurance verification information to ensure accurate billing.
  • Responded promptly to customer inquiries regarding their benefits and eligibility status.
  • Contacted patients to confirm demographic information and communicate financial responsibilities.
  • Communicated with insurance carrier, patient and third party or employer to verify patient insurance benefits.
  • Assisted in training new staff on insurance verification procedures and best practices.
  • Navigated through multiple online systems to obtain documentation.
  • Interpreted Explanation of Benefits statements from various insurers and communicated relevant information with other departments as needed.
  • Conducted follow-ups with insurance companies to expedite verification processes.
  • Analyzed and interpreted insurance coverage policies to determine patient eligibility for services.
  • Entered data in EMR database to record payer, authorization requirements and coverage limitations.
  • Maintained confidentiality of patient information in accordance with HIPAA regulations.

Insurance Eligibility Specialist

Gladstone Psychiatry and Wellness
Baltimore, MD
07.2021 - 01.2022
  • Communicate with physicians and front desk staff Regarding Schedules
  • Communicate with Patients via phone or email periodically to explain services of cost when needed
  • Call payers and verify each client's insurance benefits
  • Obtain all verification from insurance companies via phone/website to insure proper billing
  • Enter all documents, client data, new payer data, or responses regarding medical Benefits into company systems Document what the benefits are for each patient, obtain updated information when necessary, and make sure there is a current referral on file if needed
  • Update frequent changes made by patient or provider in the system and access the best options available to the providers Schedule
  • Update patient insurance cards into patient chart and excel spreadsheet
  • Send out emails to patient regarding appointments/Copay/Deductible/Coinsurance

Patient Access Representative

University of Maryland Midtown
Baltimore, MD
02.2020 - 11.2020
  • Performs accurate and complete Registration/Preregistration and & Admissions to provide information that Ensures financial protocols and requirements are met
  • Contact insurance companies for patient benefits and authorization approval for patient care
  • Confirm all Inpatient and Outpatient elective procedures using EMR system Utilize the web /IVR systems
  • When necessary, pursue actual approval and authorization number from the insurance based upon diagnosis
  • Ensures that all required documents are scanned into the correct individual patient record
  • Performs departmental administrative functions as required
  • Answers all incoming telephone calls according to departmental standards

Insurance Verification Specialist

MedStar Health Inc
Baltimore, MD
05.2004 - 06.2019
  • Obtains authorizations, referrals for Inpatient/Outpatient surgeries and specialty based on the patient’s needs
  • Verifies eligibility for medical procedure and CPT codes and document it in a shared database
  • Scan referrals/ authorization with DOS in database that has been sent from Insurance company to assure visits
  • To generate authorizations (Availity, care first Allscripts, Emdeon and any other approved for authorization processing
  • Serve as liaison between the physician, insurance company and patient to ensure all services are financially cleared prior to the date of service
  • Notify clinics/ staff on all special insurance concerns

Collection Representative

Multi-Specialty Health Care
Baltimore, MD
02.2004 - 05.2004
  • Maintain documentation for NF and WC Attorney’s to resolves settlements for outstanding balances
  • Utilize scanning software for documents received/approved referrals and authorizations for review
  • Use clear communications with insurance carriers about benefit inquiries to reduced processing time for follow up
  • File all reports when needed

Collection Representative

Signature Health Inc
Long Island, NY
06.2000 - 04.2003
  • Provide customer service handle all incoming/outgoing calls for all patients
  • Research Insurance information for outstanding claims & Balances
  • Evaluates patient financial status and establishes payment plans for collection based upon financial Level
  • Follow up with Payers to assure a timely turn-around to avoid appeals/denial and resolution for reimbursement
  • Maintain documentation into a shared database

Patient Service Representative

Maimonides Hospital
N.Y.C
02.1999 - 01.2001
  • Greet Patient upon arrival in a friendly manner
  • Handle incoming and outgoing calls to schedule patients' appointments using EMR systems
  • Prepare patients consent forms for visits in advance to capture any demographic changes
  • Places appointment reminder calls, and No Show in shared database
  • Reschedule appointments, as necessary
  • To Assisted physicians with basic office techniques and to organized charts daily

Education

Medical Assistant/billing -

Ramos, Gartner & co.

Pharmacy Technology -

Urban Employment School

Office Technology -

TECHNICAL CAREER INSTITUTE

High School -

Springfield Gardens High School
Queens, New York

Skills

  • Collections
  • Billing
  • Medical Insurance Form
  • Medical Manager
  • Skilled in [Microsoft]
  • Navi Net Systems
  • IDX
  • Centricity
  • EPIC
  • ADT Systems
  • Availity
  • Electronic authorization processing
  • Insurance plan verification
  • Power chart
  • Emdeon Medicare
  • Medicaid
  • Customer relationship management
  • Carefirst Direct
  • Eligibility determination
  • Allscripts
  • HIPAA compliance
  • Deductible & co-pay calculation

Accomplishments

  • Beth Israel Medical Center -Dept of Professional Billing-Certificate of training
  • Ramos Gardner & CO.INC Medical Assistant /billing clerk-Certificate
  • AAHAM- American Assoc. of HealthCare Administrative Management- Certificate membership CPAT
  • Certified Revenue Cycle Specialist- CRCS-l

Timeline

Insurance Verification Specialist

Acorn Health.
05.2022 - 01.2025

Insurance Eligibility Specialist

Gladstone Psychiatry and Wellness
07.2021 - 01.2022

Patient Access Representative

University of Maryland Midtown
02.2020 - 11.2020

Insurance Verification Specialist

MedStar Health Inc
05.2004 - 06.2019

Collection Representative

Multi-Specialty Health Care
02.2004 - 05.2004

Collection Representative

Signature Health Inc
06.2000 - 04.2003

Patient Service Representative

Maimonides Hospital
02.1999 - 01.2001

Medical Assistant/billing -

Ramos, Gartner & co.

Pharmacy Technology -

Urban Employment School

Office Technology -

TECHNICAL CAREER INSTITUTE

High School -

Springfield Gardens High School

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Dawn Nelson