Dornies Brown
Warner,Robins
Summary
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
15
15
years of professional experience
1
1
Certification
Work History
Benefit Verification Specialist
LabCorp/Fortrea
Remote
07.2017 - 02.2024
- Performs financial clearance of patient accounts by verifying insurance eligibility and benefits and ensuring all notifications and authorizations are completed within the required timeframe.
- Completes appropriate payor forms related to notification and authorization.
- Coordinates the submission of clinical documentation from physicians to payers for authorization needs.
- Calculates accurate patient financial responsibility.
- Communicates timely with Utilization Review, and collaborates effectively with physician and facility staff to ensure financial clearance of the patients account prior to scheduled or unscheduled service during the patients hosptial stay.
- Interprets complex payer coverage information including, but not limited to, network participation status with provider, limited plan coverage and inactive benefits.
- Documents systems according to the Insurance Verification guidelines to assure accurate and timely reimbursement.
- Calls and verifies benefits, eligibility and network status for new patients.
- Notifies patient of out of network status with their insurance.
- Obtains pre-authorization with insurance company and provide CPT code for determination of authorization.
- Document in-patients’ charts all communication with insurance companies, adjusters and patients.
Prior Authorization Coordinator
ResCare Home-care Services
Hybrid
01.2012 - 07.2017
- Coordinates prior-authorizations for procedures, imaging orders, or medications by verifying the correct authorization form, gathering all necessary information to complete the authorization form, and submitting the authorization form to the insurance plan.
- Identifies any need for peer-to-peer, letter of medical necessity or other documentation to obtain treatment pre-certification and notify provider immediately.
- Interacts with patients and third-party insurance companies to secure retroactive insurance coverage and authorizations, coordination of benefits, and/or single case agreements for out of network patients, where applicable.
- Enters authorization or pre-certification information into the insurance verification system to ensure all documentation is entered timely and accurately and all insurance requirements are met.
- Tracks and follows-up on all pending authorizations or requests for additional information depending upon payer guidelines to expedite the claims process.
- Notifies appropriate staff of approved medications or if patient has no coverage or patient’s benefits do not cover a certain procedure or medication; and makes the appropriate updates to the verification system.
- Obtains and secures referrals are on file, obtains authorization renewals, verifies physician written orders are active, and ensures certification of medical necessity is in place.
- Works closely with Billing and Clinical Team to assist patients with estimate questions and/or balance inquiries, provides patient estimates for procedures, and identifies account issues and trends.
- Provides administrative support for the medical office by answering incoming calls and text messages, checking and processing incoming mail, maintaining office equipment, checking and answering daily emails.
Scheduling Specialist
Houston Medical Center
03.2009 - 01.2012
- Coordinate and schedule patient appointments for GI department using scheduling software and other relevant tools.
- Review and interpret clinical notes and other medical documentation to determine appropriate scheduling and coordination of patient care.
- Make outbound calls to patients, physicians, and other healthcare providers to schedule appointments, provide information, and address inquiries or concerns.
- Obtain necessary authorizations and verify patient coverage for procedures and office visits by collaborating with the clinical team, billing and insurance departments, and other stakeholders.
- Utilize Phreesia or other relevant tools to collect and input patient information, insurance details, and other necessary data.
- Maintain accurate and up-to-date patient records, including scheduling information, medical history, and other relevant data.
- Monitor appointment schedules and resources to ensure maximum utilization and adherence to departmental protocols and guidelines.
- Provide exceptional customer service to patients, physicians, and other stakeholders, resolving scheduling-related issues in a timely and professional manner.
- Follow established protocols and compliance standards to ensure regulatory requirements are met.
- Contribute to process improvement initiatives to optimize scheduling efficiency, patient satisfaction, and departmental performance.
- Participate in training and development opportunities to enhance knowledge and skills related to patient scheduling, GI procedures, and other relevant areas.
Education
Associate Of Applied Business - Business Administration
Central Georgia Technical College
Macon, GA05.2009
Skills
- HIPAA Compliance
- Claims Processing
- Follow-Up Skills
- Microsoft Office
- Insurance Verification
- Patient advocacy
- Multitasking
- Adaptability
- Healthcare knowledge
- Professionalism
- Active listening
- Attention to detail
- Strong communication
- Customer service
- Medical terminology
- Critical thinking
- Interpersonal skills
- Telephone etiquette
- Resourcefulness
- Conflict resolution
Certification
Health Insurance
Timeline
Benefit Verification Specialist
LabCorp/Fortrea
07.2017 - 02.2024
Prior Authorization Coordinator
ResCare Home-care Services
01.2012 - 07.2017
Scheduling Specialist
Houston Medical Center
03.2009 - 01.2012
Associate Of Applied Business - Business Administration
Central Georgia Technical College