Gelida Adams
Tampa,FL
Summary
Motivated to maintain customer satisfaction and contribute to company success. Specialize in quality, speed and process optimization. Articulate, energetic and results-oriented with exemplary passion for developing relationships, cultivating partnerships and growing businesses.
Overview
6
6
years of professional experience
Work History
Benefits Verification Specialist
Aston Carter
Tampa, FL
10.2023 - Current
- Collaborated with medical staff to ensure accuracy of patient records and eligibility for services.
- Initiating benefits verification by reviewing patient data and insurance material, including identifying missing information and following up with points of contact to resolve information gaps
- Verifying benefits for each assigned patient case and detailing any requirements for reimbursement including copays, coinsurance, utilization management requirements, qualifications / restrictions, and prior authorization requirements
- Monitoring potential delays or pended cases, and identifying and documenting lessons learned and potential leading practices resulting in shorter processing times or higher success rates
- As required, supporting new initiatives and process improvement activities
- Understanding, and adhering to, government regulations and company policies such as HIPPA Interpret complex policy language from insurance providers to determine benefits coverage
Documentation Specialist - Remote
Maximus Federal Services
06.2020 - 09.2023
- Managed electronic clinical documentation and uploaded changes or updates using internal database
- Communicated with physicians, nurses and other caregivers to explain importance of accurate and clear documentation.
- Audited and reviewed patient information via EMR management to verify accuracy and completeness.
- Reviewed medical records and data after locating, retrieving and sending it to appropriate places.
- Accurately scanned, indexed and inputted documents into electronic health record system.
Medical Claims Processor
Walgreens Pharamcy
07.2018 - 04.2020
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
- Verified patient RX insurance coverage and benefits for medical claims.
- Paid or denied medical claims based upon established claims processing criteria.
- Identified and resolved discrepancies between patient information and claims data.
- Responded to correspondence from insurance companies.
- Maintained confidentiality of patient finances, records, and health statuses.
Education
Central Sterilization
Brewster Technical Center
Tampa, FL05.2020
High School Diploma -
Bloomingdale High School
Valrico, FL06.2018
Skills
- Documentation Oversight
- Claims Analyst
- Complex Technical Information
- Data Input
- Records Management
- Word Processing
- Project Deadlines
- Inbound/ Outbound Calling
- Customer Service Excellence
- Information Retrieval
- Company Guidelines
- Benefits Guidelines
- Health Insurance Industry Knowledge
- Customer Satisfaction
- Telephone Etiquette
- Thorough Claims Reviews
- Medical Terminology
- ICD Codes
- Meticulous Recordkeeping
- Provider Relations
- Fee Billing
- Electronic Health Records
- Data Entry Software
- Accuracy Verification
- Advanced Excel Spreadsheet Functions
- Payment and Investigation Escalations
- Excellent Administrative Abilities
- Work Organizing and Prioritizing
Timeline
Benefits Verification Specialist
Aston Carter
10.2023 - Current
Documentation Specialist - Remote
Maximus Federal Services
06.2020 - 09.2023
Medical Claims Processor
Walgreens Pharamcy
07.2018 - 04.2020
Central Sterilization
Brewster Technical Center
High School Diploma -
Bloomingdale High School
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