Dawnmarie Lombardi
New Jersey
Summary
Dedicated and results-driven medical professional seeking a full-time position in a hospital or medical office, committed to delivering exceptional patient care. Proven ability to engage effectively with diverse teams and individuals at all organizational levels, fostering collaboration and enhancing the patient experience. Recent graduate of Medical Sales College, equipped with the latest industry knowledge and skills to positively contribute to healthcare environments while pursuing continuous professional growth. Eager to leverage expertise in a dynamic setting that values quality care and teamwork.
Overview
27
27
years of professional experience
1
1
Certification
Work History
Insurance Verification Specialist
Children's Specialized Hospital
Somerset, NJ
03.2023 - Current
- Complied with HIPAA guidelines and regulations for confidential patient data.
- Assisted patients with understanding personalized insurance coverage and benefits.
- Assured timely verification of insurance benefits prior to patient procedures or appointments.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- Managed high-volume insurance verifications within pressured timeframes for productive medical operations.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Achieved insurance pre-authorizations to enable timely patient procedures.
- Updated patient records with accurate, current insurance policy information.
- Established and maintained relationships with insurance providers for productive communications.
- Coordinated referrals through insurance and other medical specialists and documented details in patient charts.
Unit Secretary
Southern Ocean Medical Center
07.2021 - Current
- Support facility/medical staff by organizing charts and equipment.
- Answer phones, patient transport, hospitality with patients, maintain patient records.
- Managed incoming calls and directed to appropriate department.
- Maintained patient confidentiality in line with HIPAA regulations.
- Answered telephone calls to offer office information, answer questions, and direct calls to staff.
- Organized paperwork such as charts and reports for office and patient needs.
- Maintained rapport with physicians, nurse, and other healthcare personnel.
- Supported office staff and operational requirements with administrative tasks.
- Maintained current and accurate medical records for patients.
- Provided information for patient admissions and discharges to foster timely processing.
- Executed administrative duties to facilitate unit tasks and meet team goals.
- Enhanced office productivity by handling a high volume of callers per day.
- Processed lab paperwork and requests according to physicians' orders.
- Monitored inventory levels and advised management of the need for replenishment.
- Scheduled appointments and maintained department master calendar to facilitate efficient patient flow.
- Performed various administrative tasks by filing, copying and faxing documents.
- Placed new supply orders, managed inventory, and restocked clerical spaces.
- Organized and maintained patient chart filing system to promote quick data finding for staff.
- Answered phone calls and messages for Number-physician Type medical facility, scheduling appointments, and handling patient inquiries.
- Frequently double-check patient histories and current information while scheduling follow-ups and other appointments.
Reimbursement Specialist
Summit Medical Group
05.2011 - 03.2023
- Monitor and complete claim workflow dashboard; process an average of 600 claims daily.
- Manage coding and charge entry based on assigned primary care providers.
- Correct and manage items in denied claims HOLD bucket.
- Investigate denials and prepare appeals for insurance company submission.
- Run and summarize daily reports for quality assurance and communication of claims submitted.
- Utilize Quick view and SMG patient registration data for information as needed.
- Proficient in AthenaNet; research and reference EOB's as needed.
- Proficient in NaviNet, IngeniousMed and DocuShare
- Followed up on denied and unpaid claims to resolve problems and obtain payments.
- Coordinated with insurance providers to verify customer's policy benefits in relation to claims.
- Employed clinical and billing codes expertise to correct billing inconsistencies.
- Prevented delays and claim denials by correcting information prior to submission.
- Delivered timely information to insurance representatives to resolve common and complex issues.
- Compiled department-specific reports to help senior managers identify trends and improve progress.
- Created documents in accordance with payer guidelines and submitted them to appropriate parties.
- Monitored and documented accounts receivable trends and account-specific profitability.
- Helped minimize escalations by reaching out to clients in advance of expected problems.
- Guided office staff on how to effectively complete prior authorization forms and appeals documentation to achieve positive results.
- Billed and collected for claims submitted on client's behalf with sales totaling Number.
- Contributed knowledge to help improve financial management, billing, and tracking systems.
- Served people of different backgrounds with polished people skills and advanced Language abilities.
- Responded to customer concerns and questions on daily basis.
- Audited and corrected billing and posting documents for accuracy.
- Reconciled accounts receivable to general ledger.
- Collaborated with customers to resolve disputes.
- Generated monthly billing and posting reports for management review.
- Generated accounts payable reports for management review to aid in financial and business decision making.
Sales Associate
Consultant at Small Group, Horizon BCBSNJ
10.1999 - 07.2009
- Work day to day supporting Master Brokers in preserving and obtaining new business
- Review underwriting regulations.
- Review and approve new business
- Convert existing products.
- Employee clinical and billing codes expertise to correct billing inconsistencies.
- Prevented delays and claim denials by correcting information prior to submission.
- Delivered timely information to insurance representatives to resolve common and complex issues.
- Trained department employees in proper billing and accounting procedures.
- Compiled department-specific reports to help senior managers identify trends and improve progress.
- Created documents in accordance with payer guidelines and submitted them to appropriate parties.
- Monitored and documented accounts receivable trends and account-specific profitability.
- Helped minimize escalations by reaching out to clients in advance of expected problems.
- Guided office staff on how to effectively complete prior authorization forms and appeals documentation to achieve positive results.
- Billed and collected for claims submitted on clients' behalf with sales totaling $Number.
- Contributed knowledge to help improve financial management, billing, and tracking systems.
- Served people of different backgrounds with polished people skills and advanced Language abilities.
- Responded to customer concerns and questions on daily basis.
- Audited and corrected billing and posting documents for accuracy.
- Reconciled accounts receivable to general ledger.
- Collaborated with customers to resolve disputes.
- Generated monthly billing and posting reports for management review.
- Generated accounts payable reports for management review to aid in financial and business decision making.
- Assist with escalated enrollment and claims issues.
- Specialized in reviewing and adjusting complex medical bills in accordance with established policies and procedures.
- Worked closely on providers appeals and disputes and assist in identifying possible insurance fraud and /or abuse.
- I have worked on large, midsize, national, traditional, PPO, POS and indemnity accounts.
- Advance knowledge of claim processing, data entering and adjustments
- Advance knowledge of Blue Card Home and Host claims and calls
Education
High School Diploma -
Union High School
Union, NJ06-1991
Skills
- Nursing Unit Operations
- Medication Inventory
- Incoming Call Management
- Patient Database Management
- Attention to detail
- Patient confidentiality
- HIPAA compliance
- Insurance coverage verification
Certification
- Medical sales College - Orthobiologics and Regenerative Medicine
Timeline
Insurance Verification Specialist
Children's Specialized Hospital
03.2023 - Current
Unit Secretary
Southern Ocean Medical Center
07.2021 - Current
Reimbursement Specialist
Summit Medical Group
05.2011 - 03.2023
Sales Associate
Consultant at Small Group, Horizon BCBSNJ
10.1999 - 07.2009
High School Diploma -
Union High School
QUALIFICATIONS
I have strong people skills that will allow me to make a positive contribution relating to problem solving for my customers. Through advanced sales training, I am able to deal with rejection and irate customers without losing sight of my overall objective: to satisfy my customers. I pride myself on my positive attitude and my ability to learn new skills very quickly.