Donna VanEtten
Nazareth,PA
Summary
Highly knowledgeable, efficient, and experienced Dental Office Coordinator and Insurance Claims Specialist with over 30 years of experience in the dental administrative and insurance claims arena. Versatile and friendly with pleasant speaking voice and professional demeanor. Adept at in reception work, insurance claims, practice/office management, and procedures. Excellent verbal and written communication abilities.
Overview
1
1
Certification
40
40
years of professional experience
Work History
Accounts Receivable Specialist
St. Luke’s University Health Network
Allentown , PA
11.2023 - Current
- Verified insurance information for patient admissions and procedures.
- Reviewed patient files for accuracy and completeness of insurance details.
- Coordinated with billing departments to resolve discrepancies in coverage.
- Maintained up-to-date knowledge of insurance policies and regulations.
- Documented verification processes in electronic health record systems.
- Collaborated with team members to streamline verification workflows.
- Updated patient and insurance data and input changes into company computer system.
- Called insurance companies to ascertain pertinent information regarding policies and payment benefits for patients.
- Communicated with insurance carrier, patient and third party or employer to verify patient insurance benefits.
- Navigated through multiple online systems to obtain documentation.
- Accessed third-party insurance databases to identify coverage of benefits.
- Maintained accurate documentation on all pre-authorization requests, denials and appeals.
- Developed a working knowledge of insurance plans, including Medicare and Medicaid regulations and requirements.
- Contacted patients to confirm demographic information and communicate financial responsibilities.
- Checked documentation for appropriate coding, catching errors and making revisions.
- Identified discrepancies in patient's insurance coverage or benefits, ensuring accuracy of data entered into system.
- Reviewed medical records to ensure accuracy of required information needed for pre-authorization requests.
- Retained strong medical terminology understanding in effort to better comprehend procedures.
- Evaluated policies and procedures related to Insurance Verification activities.
- Collaborated with internal staff members such as Billing Specialists, Medical Coders to resolve any discrepancies in patients' insurance information.
- Interpreted Explanation of Benefits statements from various insurers and communicated relevant information with other departments as needed.
- Participated in training sessions on new software programs used for verification purposes.
- Examined claims, records and procedures to grant approval of coverage.
- Researched third party payer guidelines related to prior authorizations, coding and billing processes.
- Assisted in resolving claim issues related to billing and reimbursement inquiries.
- Provided timely follow up with payers regarding payment status of claims.
- Performed daily audits of submitted claims to ensure compliance with industry standards and regulations.
- Conducted regular audits of patient accounts for accuracy of demographic data.
- Instructed clients on amounts covered under benefits plans in easy-to-understand terminology.
- Ensured that the most current version of provider contracts were stored in the database.
- Monitored changes in government regulations affecting healthcare reimbursement systems.
- Maintained confidentiality of patient information in accordance with HIPAA regulations.
- Utilized electronic medical records (EMR) systems for documenting verification processes.
- Assisted in training new staff on insurance verification procedures and best practices.
- Resolved insurance-related issues and discrepancies to prevent claim denials.
- Liaised with insurance companies to obtain pre-authorizations for procedures and medications.
- Coordinated with the billing department to ensure correct insurance information is applied to claims.
- Maintained up-to-date knowledge of insurance policies, including Medicare and Medicaid.
- Monitored and tracked the status of pending insurance verifications and authorizations.
- Adhered to HIPAA requirements to safeguard patient confidentiality.
- Conducted follow-ups with insurance companies to expedite verification processes.
- Compiled and coded patient information or data in appropriate computer system.
- Transmitted medical records and other correspondence by mail, e-mail, or fax.
- Prepared reports, invoices, letters, or medical records using word processing, spreadsheet, or other software applications.
- Reviewed insurance claims for accuracy and compliance with industry standards.
- Analyzed claim data to identify discrepancies and resolve issues promptly.
- Maintained organized records of claims, ensuring easy access and retrieval.
- Assisted customers in filing new insurance claims and provided status updates on existing ones.
- Maintained detailed records of all claim activities including correspondence, decisions, payments.
- Reviewed customer insurance claims to ensure accuracy and completeness of information.
- Analyzed claim records, policy provisions, and other relevant documents to determine validity of claims.
- Resolved customer complaints related to insurance claim processing.
- Determined liability, compensability, and benefits due on each claim.
- Supported efficient handling of complex claims and followed up on open, denied, or suspended claims to complete required line items.
- Ensured compliance with state laws governing insurance practices as well as company policies and procedures.
- Prepared reports summarizing claim activity for senior management review.
- Organized information by using spreadsheets, databases or word processing applications.
- Corresponded with insured or agent to obtain information or inform of account status or changes.
- Transcribed data to worksheets and entered data into computer to prepare documents and adjust accounts.
Insurance Claims Specialist
Amedeo DiEdwardo D.D.S.
Bethlehem, PA
05.1986 - Current
- Supported efficient handling of complex claims and followed up on open, denied or suspended claims to complete required line items.
- Determined liability, compensability and benefits due on each claim.
- Monitored reports to identify claims issues and worked with adjusters to resolve problems.
- Maintained knowledge of policies and procedures and insurance coverage benefit levels, eligibility systems and verification processes.
- Planned and conducted investigations of claims to confirm coverage and compensability.
- Resolved claims by approving or denying documentation, calculating benefits due and determining compensation settlement.
- Documented specific claims by completing and recording forms, reports and logs.
- Made appointments, contacted patients for follow-ups, coordinated with insurance companies and settled billing issues.
- Conducted financial consultations with patient and set up payment plans.
- Coordinated payment with insurance companies and discussed dental benefits with patients.
- Assisted Managing Dentist in helping patients determine optimal treatment options.
- Functioned as Team Leader and organized all treatment and placement activities
- Organized day-to-day activities for all 5 office personnel.
- Scheduled evaluations and procedures for patients.
- Communicated with patients to ensure quality of care and develop care plans.
- Completed insurance verifications and claim forms for patient intake and processing.
- Provided administrative support for patient care staff.
- Troubleshot and resolved complex customer service issues to enhance patient and family experience.
- Demonstrated flexibility during changes to patient care practice.
Dental Office Coordinator
Amedeo DiEdwardo D.D.S.
Bethlehem, PA
05.1986 - Current
- Checked patients in and out, verified insurance and collected co-pays to keep business administrative and financial records current.
- Prepared new patient files and updated existing records with new personal, insurance and medical information.
- Handled telephone and in-person requests for assistance from new and established dental practice patients.
- Educated patients about post-operative and at-home care for optimal outcomes.
- Set up appointment times and handled canceled appointments.
- Greeted patients and provided them with necessary paperwork to complete upon arrival.
- Processed payments, maintained accurate financial records, and balanced daily accounts receivable transactions.
- Reviewed patient records to check accuracy of information and implement updates.
- Answered incoming calls from patients regarding insurance coverage or billing inquiries.
- Managed patient accounts by verifying insurance benefits and submitting claims for reimbursement.
- Took customer payments and billed insurance companies for remaining balance.
- Answered and managed incoming calls and emails.
- Arranged documents for insurance claims.
- Maintained master calendar and scheduled new appointments based on provider availability.
- Demonstrated proficiencies in telephone, e-mail, fax and front-desk reception within high-volume environment.
- Prepared reports, invoices, letters, or medical records using word processing, spreadsheet, or other software applications.
- Adhered to HIPAA requirements to safeguard patient confidentiality.
- Managed front office customer service, appointment management, billing and administration tasks to streamline workflow.
- Scheduled and confirmed patient appointments and consultations.
Dental Assistant
Amedeo DiEdwardo D.D.S.
Bethlehem, PA
05.1986 - 08.1998
- Sanitized equipment and instruments, cleaned treatment rooms and restocked supplies after each patient's treatment to maintain cleanliness and prepare for next patient.
- Provided chair-side assistance during dental examinations and procedures to boost efficiency and calm nervous patients.
- Took preliminary impressions of patient teeth to prepare for custom impressions and fabrication of permanent dental work.
- Took bitewing, periapical, panoramic and occlusal X-rays and prepared for dentists to review.
Education
Certificate - Dental Assisting
Northampton Community College
Bethlehem, PASkills
- Patient/Customer Service Oriented
- Knowledge of Dental Procedures
- Problem-Solving
- Time Management
- Office Opening and Closing
- Patient Scheduling
- Critical Thinking
- Verbal and Written Communication
- Organization and Time Management
- Dental Terminology
- Phone and Email Etiquette
- Detail-Oriented
- HIPAA Compliance
- Insurance Verification
- Patient Flow Management
- Data Entry
- CPR/BLS Certified
- Insurance Claims Issue Resolution
- Payment Processing
- Administrative Support
- Dental Staff Support
- Taking Client Histories
- Data Entry Software
- Electronic Dental Record (EDR)
- Advising Patients
- Mail Sorting and Distribution
- Equipment Troubleshooting and Maintenance
- Easy Dental and Dentrix Practice Management proficient
- Outlook and Microsoft Word Proficient
Certification
- Certified BLS Provider, American Heart Association - 2022
- Dental Radiography Certification, PA State Board of Dentistry
Timeline
Accounts Receivable Specialist
St. Luke’s University Health Network
11.2023 - Current
Insurance Claims Specialist
Amedeo DiEdwardo D.D.S.
05.1986 - Current
Dental Office Coordinator
Amedeo DiEdwardo D.D.S.
05.1986 - Current
Dental Assistant
Amedeo DiEdwardo D.D.S.
05.1986 - 08.1998
Certificate - Dental Assisting
Northampton Community College