Diana Wulforst
West Winfield,NY
Summary
Patient-focused Insurance Specialist with 25 years of excellent customer service and health insurance experience. Conducts client interviews, responds to telephone and email inquiries and analyzes client requirements. Commended for exceeding agency goals while maintaining 100% client satisfaction rate. Proactive and friendly professional proficient in Epic. Has experience in Patient Registration, Scheduling and insurance coding. Enthusiastic and eager to contribute to team success through hard work, attention to detail and excellent organizational skills. Motivated to learn, grow and excel . Skilled in working under pressure and adapting to new situations and challenges to best enhance the organizational brand.
Overview
14
14
years of professional experience
3
3
years of post-secondary education
2
2
Certifications
Work History
Health Insurance Specialist
Optum
Cooperstown, New York
07.2021 - Current
- Verified insurance coverage by telephone and online to guarantee proper reimbursement of benefits and estimate patients' financial responsibilities.
- Used Epic and New York State of Health to maintain new and existing accounts.
- Work closely with Case Management to asses and enroll patients in Medicaid or other insurance options
- Answered inbound calls from existing and future policyholders to answer inquiries and discuss insurance options.
- Determined financial needs by assessing existing coverage and aligning new products and services with long-term goals.
- Conducted annual reviews of existing policies to update information.
- Met with customers to provide information about available products and policies.
- Remained impartial in order to advise clients based on circumstances.
- Screen patients and help apply for Financial Assistance.
- Offer excellent customer service always!
Health Insurance Eligibility Specialist
Bassett Medical Center
Cooperstown, NY
06.2017 - Current
- Scanned, received and sent faxes to insurance claims, co-pay assistance information and patient documentation.
- Verified insurance coverage by telephone and online to guarantee proper reimbursement of benefits and estimate patients' financial responsibilities.
- Explained features, disadvantages and advantages of policies to promote insurance sales.
- Contacted insurance companies to discuss and resolve unpaid claims and incorrectly paid claims.
- Remained impartial in order to advise clients based on circumstances.
- Conducted annual reviews of existing policies to update information.
- Determined financial needs by assessing existing coverage and aligning new products and services with long-term goals.
- Created sources for continuous client referrals within community and with businesses using extensive networking skills.
- Met with customers to provide information about available products and policies.
- Displayed consistent, positive attitude towards customers, peers and other personnel, even during high-stress situations.
- Utilized direct marketing strategies such as mailings and phone contracts to approach potential clients and increase sales by [Number]%.
Patient Access Representative
Bassett Medical Center
Cooperstown, NY
01.2014 - Current
- Contributed to reduction of accounts receivables by adhering to predetermined policies and procedures to recover amounts due from patients.
- Determined patient financial needs and referred eligible patients to proper county, state or federal agencies to obtain financial assistance.
- Collected and entered patient demographic and insurance data into computer database to establish patient's medical record.
- Performed patient scheduling and registration functions to serve as initial contact point for medical office visits.
- Secured patient information and confidential medical records in compliance with HIPAA privacy rule standards to protect patient's privacy.
- Resolved patient financial problems with guidance from documented guidelines and procedures.
- Attended weekly facility meetings to discuss logistical issues and obtain updated procedural and insurance-related instructions.
- Received patient deductibles and co-pay amounts and discussed options to satisfy remainder of patient financial obligations.
- Utilized knowledge of electronic medical record systems and medical terminology to perform diverse data entry tasks.
- Identified insurance payment sources and listed payers in proper sequence to establish chain of payment.
- Obtained patient's insurance information and determined eligibility for benefits for specific services rendered.
- Helped address client complaints through timely corrective actions and appropriate referrals.
- Facilitated communication between patients and various departments and staff.
- Offered simple, clear explanations to help clients and families understand hospital policies and procedures.
- Followed document protocols to safeguard confidentiality of patient records.
Education
High School Diploma -
Walt Whitman High School
Huntington Station, NY 09.1978 - 06.1981
Skills
- Policy renewals
Accomplishments
- Used Microsoft Excel to develop tracking spreadsheets.
Certification
- Licensed Application Counselor
Patient Access CHAA
I was Certified on 4/18/2015 with the National Association of Healthcare Access Management to become a Certified Healthcare Access Associate.
Timeline
Health Insurance Specialist
Optum
07.2021 - Current
Health Insurance Eligibility Specialist
Bassett Medical Center
06.2017 - Current
- Licensed Application Counselor
04-2017
- CHAA
01-2016
Patient Access Representative
Bassett Medical Center
01.2014 - Current
High School Diploma -
Walt Whitman High School
09.1978 - 06.1981
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