D'Juana Queen
Newark,DE
Summary
Versatile administrative professional well-versed in healthcare practices, compliance standards and operations. Excellent problem-solver and clear communicator with positive and upbeat personality. Advanced abilities in several EMR systems and software's. Collaborative individual with expertise in providing exemplary service regarding benefits support. Multitasking Benefits Specialist knowledgeable in state and federal regulations and maintaining employee confidentiality.
Overview
6
6
years of professional experience
1
1
Certification
Work History
Benefits Verification Specialist
Pyramid Healthcare
10.2022 - Current
- Explained benefits to plan participants in easy to understand terms in order to educate each on available options.
- Checked employees' benefits enrollment for accuracy and inputted all data into [Software].
- Implemented open enrollment system to streamline benefits processes for employees.
- Utilizes all available resources to obtain and enter insurance coverage information for ordered services into patient’s file
- Verifies patient insurance coverage of medications, administration supplies and related pharmacy services
- Facilitates and completes the prior authorization process with insurance companies and practitioner offices
- Facilitates pharmacy and/or major medical claims with insurance companies and practitioner offices and investigates and facilitates prior authorization any other insurance rejections
- Manages inbound calls on the Insurance line from patients, clients, physicians, practitioners and clinics regarding inquiries about services provided, financial responsibility and insurance coverage
- Verifies and composes mental health/substance abuse benefits
- Resolved issues and inquiries from plan participants regarding health and welfare benefits and deductions through telephone, email and in- person interactions.
ACCESS CENTER SPECIALIST
Nemours Children’s Health
09.2021 - 07.2022
- Receive and respond to inbound calls
- Obtain and enter accurate demographic and insurance information
- Schedule appointments according to guidelines
- Collect patient financial responsibilities as needed
- Process phone encounters
- Document call details accurately
- Collaborate with departments' clinical and administrative teams
- Escalate urgent calls appropriately
- Timely completion of electronic requests for appointments
- Verified and updated existing patient and insurance information.
- Scanned incoming patient related documents into EHR.
- Placed outbound customer service or customer satisfaction calls to follow up on issues.
- Processed debit and credit card and electronic check payments.
- Trained new personnel regarding company operations, policies and services.
- Cross-trained and provided backup support for organizational leadership.
PATIENT ACCESS REGISTRAR
Mainline Health- Paoli Memorial Hospital
11.2020 - 06.2021
- Collected and entered patient demographic and insurance data into computer database to establish patient's medical record
- Secured patient information and confidential medical records in compliance with HIPAA privacy rule standards to protect patient's privacy
- Utilized knowledge of electronic medical record systems and medical terminology to perform diverse data entry tasks (EPIC)
- Contacted hospitals/physician’s office to confirm patient’s medical histories and prevent inaccurate diagnoses and treatments
- Maintained office supplies inventory by checking stock and ordering new supplies as needed
- Coordinated front office duties, including customer service, patient scheduling and billing
- Successfully scheduled patient appointments
- Received, recorded and addressed incoming and outgoing communication via telephone and email
- Performed patient scheduling and registration functions to serve as initial contact point for medical office visits
- Coordinated efficiently with and other staff to process paperwork and direct to appropriate departments
- Set up patients in system by documenting key data, confirming eligibility and verifying insurance benefits
- EPIC Certified
- Received patient deductibles and co-pay amounts and discussed options to satisfy remainder of patient financial obligations.
BENEFITS VERIFICATION SPECIALIST
Pyramid Healthcare
01.2019 - 04.2020
- Utilizes all available resources to obtain and enter insurance coverage information for ordered services into patient’s file
- Verifies patient insurance coverage of medications, administration supplies and related pharmacy services
- Facilitates and completes the prior authorization process with insurance companies and practitioner offices
- Facilitates pharmacy and/or major medical claims with insurance companies and practitioner offices and investigates and facilitates prior authorization any other insurance rejections
- Manages inbound calls on the Insurance line from patients, clients, physicians, practitioners and clinics regarding inquiries about services provided, financial responsibility and insurance coverage
- Verifies and composes mental health/substance abuse benefits
- Resolved issues and inquiries from plan participants regarding health and welfare benefits and deductions through telephone, email and in- person interactions.
REGISTRATION SPECIALIST
Revint Solutions, Newtown Square Outpatient Center, Hospital
05.2018 - 02.2019
- TEMP-SERVICES
- Emergency Services
- Interview’s patients and or guarantors to gather complete and accurate financial and demographic information
- Contacts other resources when necessary, such as physician's office and or other medical facilities to obtain the required admission/registration information
- Ensures third party pre-certification, insurance verification and other billing requirements are met
- Performs Medical Necessity checking when applicable, obtains signatures, educates patient on the Medical Necessity process of appeal and witnesses Advance Beneficiary Notice when applicable
- Obtains signatures and authorization for treatment, consent for release of medical information and assignment of benefits
- Provides documentation and informs patients of their rights and responsibilities as a patient
- Determines patient out of pocket amount, educates patient on their financial responsibility and when needed assist the patient or guarantor with financial assistance
- Complies with HIPAA regulations as they apply to job
- Provides and promotes professional, efficient and congenial customer service through all communication and interaction with patients, families, physicians, visitors, and co-workers
- Maintains current knowledge of compliance requirements related to order entry processes
- Assisting EMT/ and medical staff in emergent situations by verifying demographical information
- EPIC certified
MEDICAL RECEPTIONIST
Crozer Keystone Health System-Gastroenterology
09.2017 - 04.2018
- Assisting the Care Team in patient pre-visit preparations
- Scanning documents into EMR per practice process
- Assisting physician with post procedure documentation
- Always adhered to strict HIPAA guidelines to protect patient privacy
- Documented patient medical information, case histories and insurance details to facilitate smooth appointments and payment processing
- Organized paperwork such as charts and reports for office and patient needs
- Scheduled, rescheduled and handled cancelled appointments for patients
- Managed master calendar and scheduled appointments for providers based on optimal patient loads and clinician availability
- Completed clerical duties and tasks for clinic administration
- Obtained payments from patients and scanned identification and insurance cards
- Responded to correspondence from insurance companies to verify patient's coverage
- Cerner/EMR certified
Education
High School Diploma -
Brandywine High School
Wilmington, DE.06.2007
Bachelor of Science - Nursing
Widener University
Chester, PA05.2011
Bachelor of Science - Nursing
Pennsylvania Institute of Technology
Media, PA05.2012
Associate of Applied Science - Psychology
Delaware County Community College
Media05.2017
Skills
- Service Quality
- Special Projects
- Compensation and Benefits
- Verbal and Written Communication
- Open Enrollment
- Customer Care
- Performance Improvement
- Confidential Records Management
- Payment Collection
- Clerical Support
- Healthcare Administration
- Documentation
Certification
Microsoft Office (10+ years)
CPR
Certified Epic Systems
Timeline
Benefits Verification Specialist
Pyramid Healthcare
10.2022 - Current
ACCESS CENTER SPECIALIST
Nemours Children’s Health
09.2021 - 07.2022
PATIENT ACCESS REGISTRAR
Mainline Health- Paoli Memorial Hospital
11.2020 - 06.2021
BENEFITS VERIFICATION SPECIALIST
Pyramid Healthcare
01.2019 - 04.2020
REGISTRATION SPECIALIST
Revint Solutions, Newtown Square Outpatient Center, Hospital
05.2018 - 02.2019
MEDICAL RECEPTIONIST
Crozer Keystone Health System-Gastroenterology
09.2017 - 04.2018
High School Diploma -
Brandywine High School
Bachelor of Science - Nursing
Widener University
Bachelor of Science - Nursing
Pennsylvania Institute of Technology
Associate of Applied Science - Psychology
Delaware County Community College