DIANA M. FRANKLIN
Warren,OH
Summary
Healthcare financial specialist with over 10 years of experience in medical claim systems, HIPPA regulations, problem solving functional level issues, navigating multiple computer systems at once, and identifying potential issues to determine the appropriate course of action redirection within department guidelines. Proven ability to work independently and cross train teams.
Overview
12
12
years of professional experience
Work History
SR. Financial Clearance Specialist
EightElevenGroup/ Medasource
08.2022 - Current
- Developed queries and performed analysis to optimize business intelligence.
- Initiated conversations with clients to uncover financial needs, cross-sell products and services and make referrals to business partners to meet sales goals.
- Quickly learned new skills and applied them to daily tasks, improving efficiency and productivity.
- Carried out day-day-day duties accurately and efficiently.
- Demonstrated respect, friendliness and willingness to help wherever needed.
- Assured timely verification of insurance benefits prior to patient procedures or appointments.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Communicated verification and authorization status updates with Type department to facilitate decision-making for patient admissions and insurance coverage.
- Observed strict procedures to protect sensitive patient information, medical records and payment data.
- Verified client information by analyzing existing evidence on file.
- Reviewed Number patient cases per week and verified insurance coverage information.
- Coordinated referrals through insurance and other medical specialists and documented details in patient charts.
Financial Clearance Specialist
THE SURGICAL HOSPITAL AT SOUTHWOODS
01.2020 - 07.2022
- Educate patients on financial responsibilities and payment options
- Performs validation of insurance and medical necessity review
- Triages preclearance paperwork and phone calls
- Collaborates with insurance companies, physicians, and surgical staff to ensure patient success
- Assured timely verification of insurance benefits prior to patient procedures or appointments.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Communicated verification and authorization status updates with Type department to facilitate decision-making for patient admissions and insurance coverage.
- Observed strict procedures to protect sensitive patient information, medical records and payment data.
- Verified client information by analyzing existing evidence on file.
- Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
- Reviewed Number patient cases per week and verified insurance coverage information.
- Answered telephone calls to offer office information, answer questions and direct calls to staff.
- Obtained payments from patients and scanned identification and insurance cards.
- Carried out front office duties utilizing data entry skills in framework of medical database.
- Accurately completed insurance and Medicaid billing and OASIS documentation for patient visits.
- Received, recorded and addressed incoming and outgoing communication via telephone and email.
- Coordinated referrals through insurance and other medical specialists and documented details in patient charts.
- Received and routed laboratory results to correct clinical staff members.
- Organized patient files and streamlined operations to improve efficiency.
- Contacted hospitals to confirm patients medical histories and prevent inaccurate diagnoses and treatments.
Front Desk Representative
EYE CARE ASSOCIATES, INC
01.2018 - 01.2019
- Coordinated patient flow through the registration area to ensure timely registration
- Scheduled appointments and ensured accuracy of patient demographics
- Received and processed cash and credit card co-payments for services rendered
Insurance Verification Specialist
FAMILY & COMMUNITY SERVICES, INC
01.2019
- Verified patient insurance eligibility for upcoming appointments
- Collected payments for services not covered
- Answered questions from patients, insurance companies, and clinic staff to ensure comprehension
Patient Access Specialist
MERCY HEALTH PARTNERS
01.2015 - 01.2017
- Responsible for all registration and financial clearance of patient information and demographics
- Conducted all insurance requirements ensuring proper pre-certifications, referrals and other authorizations
- Answered, investigated, and directed patient inquiries/complaints to the appropriate staff member
- Coordinated admissions, testing and other procedures in their prospective settings to maximize hospital reimbursements
Customer Service Representative
WELLPOINT INC
01.2009 - 01.2015
- Responded to customer questions via telephone and written correspondence regarding insurance benefits, provider contracts, eligibility and claims
- Developed and maintained positive customer relations and coordinated with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner
- Researched, analyzed and resolved insurance issues and responded to customers in a timely manner
Education
Associates of Applied Business - Business Mgmt With Healthcare Focus
Eastern Gateway Community College
Steubenville, OH10.2022
Business Management
Kent State University
Skills
- Computer Skills & Healthcare Knowledge:
- Customer Service, Data Entry, Microsoft Office Suite (Word, Excel, PowerPoint, Outlook); Medical Terminology, Clerical, Business and Office Management, Medical Records, Accounts Receivable, Blueprint, ICD-9, ICD-10, Medical Scheduling, EPIC EMR System
- Attention to Detail
- Prior Authorization Processing
- Medical Terminology
- Equipment Troubleshooting and Maintenance
- Database Management
- Coordination and Scheduling
- Customer Relationship Management
- Data Security and Confidentiality
- Patient Rapport
- Medical Report Preparation
- Collaborative Relationships
- Advising Patents
- Invoice Preparation
- Communication and Interpersonal Skills
- Documentation and Correspondence
- Financial Counseling
- Taking Client Histories
- Medical Billing
- Data Entry and Review
- Medicare Knowledge
- Insurance Plan Verification
- Insurance Terminology
- Customer Service
- Electronic Authorization Processing
- Coverage and Authorizations
- Organization and Time Management
- Analytical Thinking
- Electronic Medical Record
- Managed Care
- Medical Coding
- Payor Procedures
- Office Management
- Referral Verification
- CPT Coding
- Medical Records Verification
- Patient Health Information Access
- Customer Database Systems
- Staff Leadership
- Office Coordination
- Teamwork and Collaboration
- Patient Eligibility Requirements
- Documentation Review
- Insurance Authorizations
- Payment Scheduling and Collection
- Adaptable and Flexible
- Computer Proficiency
- Patient Database Maintenance
- Calendar and Appointment Management
- Maintaining Financial Records
- Insurance Verification
- Health Insurance Verification
- Insurance Eligibility and Verification
Accomplishments
- Health System Payer Contracts
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Quote
"Pursue the things you love doing, and then do them so well that people can't take their eyes off you."
~Maya Angelo
Timeline
SR. Financial Clearance Specialist
EightElevenGroup/ Medasource
08.2022 - Current
Financial Clearance Specialist
THE SURGICAL HOSPITAL AT SOUTHWOODS
01.2020 - 07.2022
Insurance Verification Specialist
FAMILY & COMMUNITY SERVICES, INC
01.2019
Front Desk Representative
EYE CARE ASSOCIATES, INC
01.2018 - 01.2019
Patient Access Specialist
MERCY HEALTH PARTNERS
01.2015 - 01.2017
Customer Service Representative
WELLPOINT INC
01.2009 - 01.2015
Associates of Applied Business - Business Mgmt With Healthcare Focus
Eastern Gateway Community College
Business Management
Kent State University
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