Elizabeth Beers

Communicating with medical personnel to confirm scheduled appointments.

Retrieves medical records, (paper and electronic) from various healthcare facilities.

Performs breaking down, copying, scanning, indexing, assembling, and uploading medical records into an image data management applications.

Uploads all retrieved charts to company server daily.

Completes daily productivity and progress logs.

• Reached out to insurance carriers to obtain prior authorization for testing and procedures.
• Input all patient data regarding claims and prior authorizations into system accurately.
• Created and maintained spreadsheets detailing all medical procedures, including applicable denials and approvals.
• Reviewed insurance coverage for patients to determine which party was liable for payment.
• Researched denied claims and contacted insurance companies to resolve these issues.
• Maintained compliance with patient privacy and security regulations such as HIPPA
• Triaged unscheduled and emergency authorizations, directing submissions to appropriate personnel for rapid response.
• Tracked referral submission during facilitation of prior authorization issuance.
• Verified eligibility and compliance with authorization requirements for service providers.
• Prepared and distributed denial letters, detailing reasons for denial and possible appeal measures.

Processed referrals from hospitals, providers, and other pharmacies for IV infusions, antibiotics, and other medications.

Verified insurance benefits and contacted insurances for prior authorization.

Discussed cost to patients once insurance benefits have been reviewed.

Entered in Salesforce, medications, dosages, frequency, HCPCs codes, ordering physicians and delivery instructions for same day delivery.

Prepared packages for shipment, pickup and courier services for prompt delivery to customers.

Performed quality review of discharged records for completion

Arranged rapid office equipment repair and maintenance with vendors.

Performed general office duties, including answering multi-line phone system, routing calls, delivering messages to staff and greeting visitors.

Reviewed medical documentation from charts faxed or mailed to office.

Performed quality review on records to ensure documentation is legible and contained customer identifying: such as name and dob

Entered measure specific or testing information to a database by keeping a tracking log.

Contact physicians offices for additional missing information for Hedis Project.

Maintained confidentiality by following HIPPA guidelines in accordance with federal and local requirements at Cigna.

Reviewed patients insurance plans prior to appointment.

Screened and discussed financial options to determine assistance choices with patients.

Contacted insurances for prior authorizations for chemotherapy, infusion therapy, oral medications, and injection

Applied to pharmaceutical manufacturing, patient programs for assistance in paying for treatment due to high deductibles with insurances or patient was not insured

Enrolled patients in Medicare, Medicaid,disability and social security.

Coordinated program referrals for community-based resources.

Appealed denied claims in a timely manner for reimbursements.

Set up peer to peer meetings with providers to overturned denials for treatment.

• Reviewed outpatient records and interpreted documentation to identify all diagnoses and procedures.
• Applied official coding conventions and rules from American Medical Association and Centers for Medicare and Medicaid Services to assign diagnostic codes.
• Accurately selected proper descriptive code when more than one anatomical location was indicated.
• Applied charges and updated patient records by using Meditech
• Entered orders into EMR system efficiently and without errors.
• Verified signatures and checked medical charts for accuracy and completion.
• Processed insurance company denials by auditing patient files, researching procedures and diagnostic codes to determine proper reimbursement.
• Resourcefully used various coding books, procedure manuals and on-line encoders.
• Interacted with physicians and other healthcare staff to ask questions regarding patient services.
• Initiated, performed and documented quarterly coding audits for physicians.

Created first Tumor Registry at Mercy Hospital in 1998.

Communicated with Medical Directors from medical management to expedite approvals to start treatment.