Healthcare professional with strong experience in reimbursement processes including billing, coding, and insurance verification. Proven ability to manage complex billing issues, ensure compliance, and maximize revenue recovery. Proactive and goal-oriented professional with excellent time management and problem-solving skills. Known for reliability and adaptability, with swift capacity to learn, quickly evolving needs in fast-paced environment. Committed to leveraging these qualities to drive team success and contribute to organizational growth.
Overview
18
18
years of professional experience
Work History
Reimbursement Specialist/Authorization Specialist
RemX McKesson
10.2023 - Current
Enter data, including patient records, physician profiles, and insurance contracts
Used data entry skills to accurately document and input statements.
Increased accuracy by diligently reviewing and verifying patient eligibility, coverage, and benefits information.
Demonstrated adaptability with changing insurance requirements, maintaining up-to-date knowledge through continuous education efforts.
Ensured compliance with HIPAA regulations while managing sensitive patient information during the verification process.
Assured timely verification of insurance benefits prior to patient procedures or appointments.
Updated patient records with accurate, current insurance policy information.
Made contact with insurance carriers to discuss policies and individual patient benefits.
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.
Insurance Specialist/Department Lead
Baylor Surgicare at Fort Worth
Fort Worth
08.2019 - 10.2023
Processed eligibility and benefits verification and authorization requests.
Tracked pending authorizations to resolve discrepancies and avoid revenue loss.
Acted as subject matter expert, answering internal, and external questions and inquiries.
Ensured regulatory compliance through diligent monitoring of company practices and adherence to guidelines.
Trained new hires on company policies and procedures, ensuring a seamless transition into the Insurance Specialist role.
Determined client needs and financial situations by listening and scheduling fact-finding appointments.
Monitored changes in insurance industry to stay compliant with relevant laws and regulations.
Collected premiums on or before effective date of coverage.
Mentored new hires within the department, providing guidance on company policies and procedures as well as job-specific tasks.
Led team to achieve high performance standards through consistent coaching and feedback.
Oversaw daily operations of the department, ensuring smooth workflow and adherence to deadlines.
Identified areas for improvement within the department, developing action plans to address those needs effectively.
Optimized customer experience by delivering superior services and effectively troubleshooting issues.
Evaluated staff performance and provided coaching to address inefficiencies.
Collected, arranged, and input information into database system.
Enhanced customer satisfaction by addressing insurance-related inquiries and resolving issues promptly.
Communicated effectively with members of operations, finance, and clinical departments.
Streamlined policy management by regularly updating client information and tracking policy changes.
Labor and Delivery Nurse at Texas Health Harris Methodist Hospital Fort WorthLabor and Delivery Nurse at Texas Health Harris Methodist Hospital Fort Worth