Gayle Crutcher
Lumberton
Summary
Detail-oriented professional with a strong background in insurance verification and medical coding. Proven ability to ensure regulatory compliance and resolve complex issues, supporting efficient operations and enhancing customer satisfaction. Dynamic administrative professional with extensive experience in customer service and office management. Recognized for strong communication skills and problem resolution abilities, effectively managing tasks to enhance operational efficiency and client experience.
Overview
21
21
years of professional experience
Work History
Medical Records Clerk
Neuromedical Center
Baton Rouge
03.2016 - 06.2016
- Processed medical charts for accuracy and completeness.
- Verified patient information for admissions and treatments.
- Assisted in filing and retrieving medical documents efficiently.
- Responded to record requests from patients and providers promptly.
- Organized and updated medical files according to regulations.
- Processed incoming medical records requests.
- Tracked and processed release of information requests. Fill out forms from patients for insurance, work and other doctors.
Eligibility Specialist
Spindletop Centers
Beaumont
02.2012 - 08.2015
- Assessed client eligibility for various programs and services offered by Spindletop Centers.
- Reviewed and processed applications to ensure compliance with regulatory standards.
- Conducted interviews to gather necessary information from clients for eligibility determination.
- Provided guidance to clients regarding program benefits and eligibility requirements.
- Trained new staff on eligibility assessment procedures and documentation practices.
- Explained reasons behind application denials and recommended further action.
- Managed intake of new claims and performed routine follow-ups.
- Verified applicant's identity and other relevant documents such as birth certificates or Social Security cards.
- Researched case histories, court decisions, legal articles, statutes, codes, and other data pertinent to determination of eligibility.
Receptionist
Spindletop Centers
Beaumont
06.2008 - 08.2011
- Greeted visitors and directed them to appropriate departments.
- Managed incoming calls and routed them to relevant staff members.
- Scheduled appointments and maintained the reception calendar efficiently.
- Assisted clients with forms and provided necessary information about services.
- Handled incoming mail and distributed it to appropriate personnel promptly.
- Answered incoming calls, took messages, and transferred calls to appropriate departments or personnel.
- Scheduled and confirmed appointments. Verified insurance benefits, obtained pre certs if needed.
Administrative Assistant
Spindeltop Centers / FEMA
Beaumont
04.2006 - 05.2008
- Managed incoming calls and directed them to appropriate departments.
- Scheduled and organized meetings for team members and executives.
- Maintained filing systems for office documents and records.
- Assisted in preparing reports and presentations for management review.
- Supported daily administrative operations by performing clerical tasks efficiently.
- Conducted research, compiled and typed statistical reports, synthesized information and provided excellent communication to disseminate information throughout organization.
Medical Coder
Beaumont X-ray
Beaumont
05.2005 - 10.2005
- Utilized coding software to assign appropriate codes to diagnoses and procedures.
- Reviewed medical records for accurate coding and compliance with regulations.
- Coordinated with healthcare providers to clarify documentation and ensure accuracy.
- Maintained up-to-date knowledge of coding guidelines and industry standards.
- Collaborated with billing department to resolve discrepancies in claims submissions.
- Maintained current working knowledge of CPT and ICD-10 coding principles, government regulation, protocols and third-party billing requirements.
- Maintained up-to-date knowledge of coding changes, updates, and new rules.
- Verified proper coding, sequencing of diagnoses, and accuracy of procedures.
- Read through patient health data, histories, physician diagnoses and treatments to gain understanding for coding purposes.
Insurance Verification Specialist
Scenic Mountain Medical Center
Big Spring
09.1998 - 11.2000
- Verified insurance eligibility for patients using electronic medical records systems.
- Communicated with insurance providers to obtain authorization for services.
- Reviewed patient information for accuracy and completeness before verification.
- Coordinated with healthcare providers to resolve discrepancies in insurance details.
- Assisted patients in understanding their insurance benefits and coverage options.
- Maintained confidentiality of patient information during verification processes.
- Verified that patients had proper insurance coverage prior to procedures or appointment scheduling.
- Called insurance companies to ascertain pertinent information regarding policies and payment benefits for patients.
- 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.
- Reviewed medical records to ensure accuracy of required information needed for pre-authorization requests.
- Contacted patients to arrange payment arrangements for deductible and out-of-pocket liability.
- Determined estimated self-pay portion by calculating charges, co-insurance and deductibles. Billed second insurance.
- Assisted in resolving claim issues related to billing and reimbursement inquiries.
- Provided timely follow up with payers regarding payment status of claims.
- Monitored and tracked the status of pending insurance verifications and authorizations.
Receptionist
Scenic Mountain Medical Center
Big Spring
07.1995 - 1998
- Greeted visitors and directed them to appropriate departments.
- Monitored office supplies and coordinated orders for replenishment.
- Handled incoming mail and distributed it to appropriate personnel promptly.
- Answered incoming calls, took messages, and transferred calls to appropriate departments or personnel.
- Processed payments and updated accounts to reflect balance changes.
- Assisted in maintaining office supplies inventory by checking stock to determine inventory level; anticipating needed supplies; placing orders for supplies; verifying receipt of supplies.
- Delivered administrative support to team members by making copies, sending faxes, organizing documents and rearranging schedules.
- Assisted with special projects assigned by management when required.
Education
High School Diploma -
West Columbia High School
West Columbia Texas05-1995
Skills
- Insurance verification
- Medical coding
- Filing systems
- Appointment scheduling
- Regulatory compliance
- Customer service
- Data entry
- Record management
- Problem resolution
- Effective communication
- Research skills
- Recordkeeping and bookkeeping
- Multi-line telephone operation
- Multi-line telephone systems
- Information protection
Timeline
Medical Records Clerk
Neuromedical Center
03.2016 - 06.2016
Eligibility Specialist
Spindletop Centers
02.2012 - 08.2015
Receptionist
Spindletop Centers
06.2008 - 08.2011
Administrative Assistant
Spindeltop Centers / FEMA
04.2006 - 05.2008
Medical Coder
Beaumont X-ray
05.2005 - 10.2005
Insurance Verification Specialist
Scenic Mountain Medical Center
09.1998 - 11.2000
Receptionist
Scenic Mountain Medical Center
07.1995 - 1998
High School Diploma -
West Columbia High School