Emilio Fleming
Englewood,CO
Summary
Detail oriented Insurance/Claims Coordinator with over 5 years experience in office/administrative held professional positions. Core competencies include great problems solving skills, adaptability and effective strategic thinking/decision making skills as well as excellent communication and time management skills. All tasks are handled with accuracy and efficiency.
Overview
8
8
years of professional experience
Work History
Insurance Verification Specialist
Drason Consulting Services
Littleton, Colorado
08.2023 - Current
- Enhanced claim processing efficiency by verifying insurance coverage and obtaining pre-authorizations for procedures.
- Reduced errors in billing by accurately maintaining patient records with updated insurance information.
- Improved communication between medical staff and patients by explaining insurance benefits and financial responsibilities.
- Streamlined workflow for medical providers by obtaining necessary referrals and authorizations for services.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- Managed high-volume insurance verifications within pressured timeframes for productive medical operations.
- Trained new staff on current, correct insurance verification procedures.
- Answered telephone calls to offer office information, answer questions, and direct calls to staff.
- Achieved insurance pre-authorizations to enable timely patient procedures.
- Coordinated with care teams across various departments to ensure seamless integration of verified coverage information into overall treatment planning.
Medical Biller /Payment Posting Specialist
Colorado Arthritis Center
12.2019 - 12.2022
- Took money and cards from customers to handle payment processing.
- Posted customer payments by recording checks, cash and credit card transactions.
- Answered inquiries over telephone calls and emails to resolve clients' billing issues and questions.
- Obtaining referrals and pre-authorizations as required for procedures.
- Checking eligibility and benefits verification for treatments, hospitalizations, and procedures.
- Reviewing patient bills for accuracy and completeness, and obtaining any missing information.
- Preparing, reviewing, and transmitting claims using billing software, including electronic and paper claim processing.
- Following up on unpaid claims within standard billing cycle timeframe.
- Checking each insurance payment for accuracy and compliance with contract discount.
- Calling insurance companies regarding any discrepancy in payments if necessary
- Identifying and billing secondary or tertiary insurances.
- Reviewing accounts for insurance of patient follow-up.
- Researching and appealing denied claims.
- Answering all patient or insurance telephone inquiries pertaining to assigned accounts.
- Identified and resolved payment issues between patients and providers.
- Processed payments that had been received from insurance companies and Medicare.
Revenue Cycle Specialist
Denver Health And Hospital Authority
11.2018 - 10.2019
- Obtaining referrals and pre-authorizations as required for procedures.
- Checking eligibility and benefits verification for treatments, hospitalizations, and procedures.
- Reviewing patient bills for accuracy and completeness, and obtaining any missing information.
- Preparing, reviewing, and transmitting claims using billing software, including electronic and paper claim processing.
- Following up on unpaid claims within standard billing cycle timeframe.
- Checking each insurance payment for accuracy and compliance with contract discount.
- Calling insurance companies regarding any discrepancy in payments if necessary
- Identifying and billing secondary or tertiary insurances.
- Reviewing accounts for insurance of patient follow-up.
- Researching and appealing denied claims.
- Answering all patient or insurance telephone inquiries pertaining to assigned accounts.
- Identified and resolved payment issues between patients and providers.
Insurance/Claims Coordinator
OrthoFi Inc
07.2017 - 11.2018
- Coordinating insurance benefits when multiple plans exist
- Monitor benefit payments to ensure timely issuance
- Contact claimants, doctors, medical specialists, or employers to get additional information
- Verifying dental billing codes, document narratives and submit claims
- Report over payments, underpayments, and other irregularities
- Prepare reports to be submitted to company's data processing department
- Obtaining pre-authorizations
- Reviewing claims for errors
- Ensure policy coverage for claims
- Posting insurance payments
- Manage and protect the reputation of the company
Claims Processer / Health Insurance CSR
CNIC Health Solutions
08.2016 - 07.2017
- Examine claims and verify insurance eligibility
- Assist patients in obtaining and understanding medical benefits
- Attend to calls and correspondences, providing information with respect to insurance policies
- Resolve problems by clarifying issues; researching and exploring answers and alternative solutions; implementing solutions; escalating unresolved problems
- Receive and forward new claim for processing
- Resolving inconsistencies and reviewing data for errors using standard data entry procedures and requesting further information for documents that are deemed incomplete
- Manage and protect the reputation of the company
Education
High School Diploma -
Brockton High School
Brockton, MASkills
- Doing work with timely manner
- Responsible with all tasks assigned
- Extensive knowledge of medical terminology
- Great with analyzing and solving problems
- Strong verbal and writing skills
- High motivation
- Strong leadership and organizational skills
Additional Information
- MS Office
- Excel
- Adobe
- EPIC system
Timeline
Insurance Verification Specialist
Drason Consulting Services
08.2023 - Current
Medical Biller /Payment Posting Specialist
Colorado Arthritis Center
12.2019 - 12.2022
Revenue Cycle Specialist
Denver Health And Hospital Authority
11.2018 - 10.2019
Insurance/Claims Coordinator
OrthoFi Inc
07.2017 - 11.2018
Claims Processer / Health Insurance CSR
CNIC Health Solutions
08.2016 - 07.2017
High School Diploma -
Brockton High School