Dawn Nelson

• Reviewed and updated policy documents to ensure compliance with regulatory standards and company guidelines.
• Participated in audits to ensure accuracy and compliance in claims processing Communicate verification outcomes clearly to intake, clinical, and billing Departments through teams meetings to ensure timely patient onboarding & continues care.
• Analyzed policyholder data to identify trends and recommend adjustments to coverage, improving overall portfolio performance.
• Proficient in navigating electronic medical record systems and maintaining compliance with HIPAA regulations.
• Managed claims processing and ensured timely resolution for all inquiries, enhancing customer satisfaction.

• Verified insurance eligibility, benefits, and authorizations for ABA and behavioral health services across multiple payer types, including commercial, Medicaid, and managed care plans.
• Conducted detailed benefit investigations covering deductibles, copays, coinsurance, visit limits, prior authorization requirements, and medical necessity criteria.
• Utilized electronic medical record (EMR) systems to accurately document insurance verification processes and benefit determinations.
• Ensured strict compliance with HIPAA regulations to protect patient confidentiality and sensitive health information.
• Identified and resolved insurance-related issues and discrepancies proactively to reduce claim denials and billing delays.
• Updated patient accounts with verified insurance information to support accurate and timely billing.
• Responded promptly and professionally to patient inquiries regarding insurance benefits, eligibility, and coverage details.
• Contacted patients to confirm demographic information and clearly communicate financial responsibilities.
• Coordinated with insurance carriers, patients, employers, and third-party administrators to verify coverage and benefit details.
• Assisted in training and onboarding new staff on insurance verification workflows, systems, and best practices.
• Navigated multiple payer portals and internal systems simultaneously to obtain and document required insurance documentation.
• Communicated verification outcomes clearly to intake, clinical, and billing teams to ensure timely patient onboarding and continuity of care.
• Maintained accurate documentation within EHR and internal systems, ensuring compliance with pay guidelines and company policies.
• Resolved insurance discrepancies and coverage issues through direct outreach to payers, improving authorization turnaround times.
• Supported high-volume caseloads in a fully remote environment while consistently meeting productivity and accuracy.

• Coordinated with physicians and front desk staff regarding patient schedules to ensure accurate appointment planning and coverage alignment.
• Communicated with patients via phone and email to explain services, coverage details, and associated costs as needed.
• Contacted insurance payers to verify each patient's eligibility and benefit details prior to services.
• Obtained insurance verifications through payer phone lines and online portals to ensure proper and compliant billing.
• Entered and maintained client data, insurance information, payer responses, and benefit determinations within company systems.
• Documented verified benefits for each patient, obtained updated information when required, and ensured current referrals were on file when applicable.
• Updated system records to reflect frequent changes from patients or providers and identified optimal scheduling options for providers.
• Sent appointment-related communications to patients, including notifications regarding copays, deductibles, and coinsurance.
• Reviewed and validated CPT and ICD-10 codes to ensure services were accurately represented and aligned with payer coverage requirements.
• Verified authorization and medical necessity based on CPT codes, ICD diagnoses, and payer-specific guidelines.
• Communicated with clinical staff to clarify CPT/ICD coding discrepancies impacting eligibility, authorizations, or reimbursement.
• Documented verified CPT and ICD information within EMR and billing systems to support clean claim submission.

• Registered patients for outpatient and inpatient services, ensuring accurate demographic, insurance, and referral information.
• Verified insurance eligibility, benefits, and authorization requirements with commercial and government payers prior to services.
• Reviewed and documented CPT and ICD-10 codes to support medical necessity, coverage validation, and accurate billing.
• Communicated with physicians, clinical staff, and front desk teams to coordinate scheduling and resolve coverage or registration issues.
• Explained insurance benefits, copays, deductibles, and coinsurance to patients to support financial transparency.
• Maintained compliance with HIPAA and organizational policies while handling protected health information.
• Entered and updated patient data, insurance cards, and benefit details within EMR and registration systems.
• Performed accurate and complete registration, preregistration, and admissions processes to ensure all financial protocols and regulatory requirements were met.
• Contacted insurance companies to verify patient benefits and obtain authorization approvals for inpatient and outpatient services.
• Confirmed inpatient and outpatient elective procedures using EMR systems, payer websites, and IVR systems.

Obtained authorizations and referrals for inpatient and outpatient surgeries and specialty services based on patient care needs.

• Verified eligibility for medical procedures using CPT codes and documented verification details within shared databases.
• Scanned and indexed referrals and authorization approvals, including dates of service, received from insurance companies to ensure visit clearance.
• Generated and processed authorizations using payer portal and authorization platforms and other EMR systems.
• Served as a liaison between physicians, insurance companies, and patients to ensure all services were financially cleared up prior to the date of service.
• Notified clinics and clinical staff of special insurance requirements, restrictions, or coverage concerns impacting patient care.