Joseph Wilson
Lansdowne,PA
Summary
Accomplished Patient Service Representative with a proven track record at Children Hospital of Philadelphia, adept in insurance verification and patient registration. Leverages strong clinical background and HIPAA training to enhance patient care. Known for exceptional records management and efficient, accurate data entry skills (15,000 KSPH), ensuring high-quality support to medical staff and patients alike.
Overview
32
32
years of professional experience
Work History
Patient Services Representative
Children's Hospital of Philadelphia, CHOP
Philadelphia, PA
05.2022 - Current
- Provided administrative support to physicians, nurses, and other healthcare professionals as needed.
- Responded to incoming calls, scheduling and rescheduling appointments as requested.
- Reviewed appointment requests from external sources such as online portals.
- Followed up on any outstanding referrals or authorizations needed for care.
- Managed physician calendars by scheduling appointments at appropriate times.
- Processed insurance verifications and authorizations to ensure coverage of services.
- Cultivated positive relationships with patients to help facility meet satisfaction scores and patients obtain best possible care.
- Updated reference materials with Medicare, Medicaid and third-party payer requirements, guidelines, policies and list of accepted insurance plans.
- Obtained necessary signatures for privacy laws and consent for treatment.
- Instructed patients on policies and required actions for different types of appointments and procedures.
- Handled high volume of incoming calls, providing exceptional customer service to patients and families.
- Verified documentation methodically to avoid critical errors impacting care delivery and payments for services.
- Processed patient responsibility estimate determined by insurance at pre-registration.
- Explained various admission forms and policies, acquiring signatures for consent.
- Communicated financial obligations to patients and collected fees at time of service.
- Greeted patients upon arrival and ensured they had the necessary paperwork completed.
- Verified patients' insurance and payment methods during admissions or check-in processes.
- Assisted with patient registration, insurance verification, and appointment scheduling.
- Demonstrated ability to work independently as well as collaboratively within a team environment.
- Processed patient co-pays, deductibles, and other payments, ensuring accurate financial records.
- Processed payments through cash register accurately and efficiently.
- Verified demographics and insurance information to register patients in computer system.
- Scheduled follow-up visits as needed based on physician instructions.
- Provided excellent customer service at all times while interacting with both internal and external customers.
- Provided information regarding billing procedures and payment options to patients.
- Collected copayments from patients at time of service.
Patient Surgical Scheduler
Childrens Hospital of Philadelphia
Philadelphia, PA
01.2021 - 05.2022
- Developed a comprehensive tracking system for all scheduled surgeries, ensuring timely completion of paperwork.
- Provided assistance with post-operative follow up visits when needed.
- Greeted patients, determined purpose of visit and directed to appropriate staff.
- Scheduled and confirmed patient appointments and consultations.
- Answered telephones and directed calls to appropriate medical or adminstrative staff.
- Organized patient records to ensure accuracy of information in the system.
- Managed patient check-in and check-out procedures and processed payments.
- Communicated with patients with compassion while keeping medical information private.
- Checked patient insurance and collected pre-authorizations from providers.
- Managed incoming calls from physicians' offices requesting surgical services.
- Transcribed recorded practitioners' diagnoses and recommendations into medical records.
- Used accurate procedure codes for billing purposes and to help operating teams be correctly prepared for each operation.
- Verified insurance eligibility and coverage prior to surgery.
- Completed relevant insurance and other claim forms.
- Responsible for scheduling and coordinating surgeries, procedures, and appointments for the operating room.
- Participated in weekly meetings with department heads to discuss upcoming surgeries or issues that may arise during them.
- Reviewed daily OR schedule for accuracy before posting it publicly.
- Coordinated work processes and routed paperwork to appropriate physicians and staff members.
- Ensured that all necessary documentation was completed accurately prior to surgery date.
- Adhered to HIPAA requirements to safeguard patient confidentiality.
- Scheduled tests, lab work or x-rays for patients based on physician orders.
- Communicated with patients and family members to provide updates on scheduled dates and times of operations.
- Scheduled follow-up appointments as designated by physician.
- Booked surgeries according to physician volume and maintained prompt turnaround times.
- Demonstrated strong problem-solving skills, resolving issues efficiently and effectively.
- Worked with cross-functional teams to achieve goals.
- Updated and maintained databases with current information.
- Worked successfully with diverse group of coworkers to accomplish goals and address issues related to our products and services.
- Prioritized and organized tasks to efficiently accomplish service goals.
Patient
Thomas Jefferson Hospital
Philadelphia, PA
09.2020 - 01.2021
- Communicated directly with doctors' offices via telephone, fax, and email.
- Extended patient engagement with extra counseling and follow-up adherence calls.
- Answered patient questions regarding medications.
- Efficiently answered multi-line phone and processed high volume of Prior Authorizations requests from nurses, doctors, and pharmacists.
- Supported the pharmacist in preparing peer-to-peer review for denied prior authorization requests.
- Communicated with insurance companies in reference to status review of Prior Authorizations.
- Correctly input data demographics for both Member and Provider for Discount Card for filed prescriptions after they were filled.
- Ensured compliance with HIPAA regulations when handling sensitive information.
- Managed patient check-in and check-out procedures and processed payments.
- Conducted follow-up calls for missed or cancelled appointments.
- Explained treatment procedures and physicians' instructions.
- Adjusted appointments according to priority and tracked appointment durations.
- Answered phone calls and took messages for staff members.
- Followed up with patients and confirmed appointments.
- Coordinated appointments with customers and staff members according to availability.
- Answered office phones and emails.
- Resolved customer service issues quickly and efficiently in a professional manner.
- Greeted patients and guests upon entering lobby areas.
- Processed payments from patients including cash, credit cards, checks.
- Performed data entry for new patient profiles and updated existing patient information.
Prior Authorization Representative
OptumRx
Philadelphia, PA
01.2002 - 07.2020
- Coordinated, scheduled, and executed large data entry projects in reference to Accounts Payable via checks.
- Organized billing and invoice data, and prepared accounts receivable and expected revenue for controllers.
- Verified that information in the computer system was up to date and accurate.
- Performed a wide range of clerical tasks, including imaging, transcription, and verifying work.
- Identified errors in data entry and related issues to supervisors.
- Documented data entry completions in corresponding logbooks.
- Gathered data to formulate appropriate replies for information requests.
- Determined which party would be liable for payment on medical services by thoroughly reviewing patient insurance coverage.
- Contacted insurance carriers to obtain authorizations, notifications and pre-certifications for patients.
- Collaborated with typists and executives to meet customer and writer requests.
- Followed up on pending prior authorization requests to ensure timely processing.
- Clarified patient inquiries and questions to update patient account information in computer system.
- Coordinated resolutions for issues and appealed denied authorizations.
- Provided timely feedback to physicians regarding authorization status.
- Reviewed and processed prior authorization requests for medical procedures and medications according to established guidelines.
- Assisted healthcare providers with appeals for denied authorizations, including gathering additional information and documentation.
- Coordinated with pharmacy staff to ensure medications requiring prior authorization are processed correctly.
- Collaborated with internal departments to provide account status updates.
- Assessed insurance benefits and determined eligibility criteria.
- Provided accurate information to all parties, including patients, insurance providers, healthcare staff and office personnel by using effective written and verbal communication skills.
- Researched and compiled information for reports.
- Submitted prior authorization requests electronically or by phone to payers.
- Maintained high level of professionalism when speaking to doctors and insurance companies.
- Processed appeals for denials in accordance with established procedures.
- Made outbound calls to insurance companies, patients and physicians to perform eligibility checks for patients.
- Collaborated with insurance companies to clarify coverage details and resolve issues related to prior authorization.
- Maintained accurate records on all prior authorizations requested, received, and denied.
- Scheduled peer to peer reviews for physicians to discuss medical necessity with insurance providers.
- Developed and implemented process improvements to enhance efficiency and accuracy of prior authorization workflows.
- Notified ordering providers of denied authorizations.
- Performed quality assurance reviews on completed work products before submission to payers.
- Contacted insurance companies to obtain necessary preauthorization needed for upcoming tests and procedures.
- Identified reasons behind denied claims and worked closely with insurance carriers to promote resolutions.
- Reviewed prior authorization requests for completeness and accuracy.
- Communicated authorization decisions, including approvals and denials, to healthcare providers and patients.
- Worked successfully with diverse group of coworkers to accomplish goals and address issues related to our products and services.
- Collaborated closely with team members to achieve project objectives and meet deadlines.
- Completed day-to-day duties accurately and efficiently.
Data Entry Clerk
Independence Blue Cross
Philadelphia, PA
06.2000 - 01.2002
- Verified that information in the computer system was up to date and accurate in reference to the Request form for Prior Authorizations.
- Identified errors in data entry and related issues to supervisors.
- Coordinated, scheduled, and executed large data entry projects for correspondence to both Members and Providers for decisions made for review for Prior Authorizations.
- Verified and logged in deadlines for responding to daily inquiries in reference to Medicare Review of Prior Authorizations.
- Performed outbound phone calls to both Members and Providers for status updates for the review process of Prior Authorizations.
- Entered patient data into computer system to maintain accurate records.
- Communicated with insurance companies for billing purposes.
- Answered telephone calls promptly and assisted customers by directing calls to appropriate personnel.
- Performed administrative tasks such as filing paperwork, answering phone calls, responding to emails.
- Demonstrated strong problem-solving skills, resolving issues efficiently and effectively.
Data Entry Clerk
First Union Bank
Philadelphia, PA
01.1998 - 06.2000
- Maintained database by entering new and updated customer and account information.
- Reviewed data for deficiencies or errors, corrected any incompatibilities and checked output.
- Checked source documents against entered data to ensure accuracy.
- Collected and organized information for entry, prioritizing entries to increase efficiency.
- Identified and corrected data entry errors to prevent duplication across systems.
- Inputted customer data into computer database accurately and quickly.
- Emailed completed documents to supervisors and co-workers to confirm accuracy.
- Answered incoming phone calls and directed callers to appropriate departments and personnel.
- Completed day-to-day duties accurately and efficiently.
- Promoted high customer satisfaction by resolving problems with knowledgeable and friendly service.
Data Entry Operator
Advance Staffing Temporary Agency
Philadelphia, PA
09.1992 - 06.1998
- I was employed by Agency as a temporary contracted employee. I was assigned to United Parcel Services for 6 years, during which I worked within the Billing Department and performed the following duties:
- Identified errors in data entry and related issues to supervisors.
- Organized billing and invoice data, prepared accounts receivable and expected revenue reports for controllers, and shipping records and Manifest Reports.
- Reviewed database entries to verify regulatory compliance.
- Identified, corrected, and reported data entry errors for billing to clients.
- Input client information into spreadsheets and the company database.
Education
Data Entry/Business Software
PSI Institute Business School
Philadelphia, PA01-1992
High School Diploma -
Edward Bok High School
Philadelphia06-1990
High School Diploma -
Benjamin Franklin Adult Night School
Philadelphia, PASkills
- Confidentiality
- Transcription
- Insurance knowledge
- Records management
- Appointment scheduling
- Office workflow support
- Verifying orders
- Resolving Customers' Issues
- Supporting medical staff
- Proficient in Epic
- Strong decision-making ability
- Efficient and accurate
- Strong clinical background
- HIPAA trained
- Excellent telephone etiquette
- Quality assurance and control
- Strong data entry skills (15,000 KSPH)
- Insurance verification
- Copay collecting
- Patient registration
- Healthcare knowledge
- Medical terminology
- Checking in patients
- Insurance pre-certifications
- Verifying insurance
- Meticulous attention to detail
- Data accuracy
- Administrative support specialist
- Professional and mature
- Certified in 10-key
- Collecting information
- File management
- Data entry
- Numerical data entry
- Accuracy and attention to detail
- Team collaboration
- Independent worker
Timeline
Patient Services Representative
Children's Hospital of Philadelphia, CHOP
05.2022 - Current
Patient Surgical Scheduler
Childrens Hospital of Philadelphia
01.2021 - 05.2022
Patient
Thomas Jefferson Hospital
09.2020 - 01.2021
Prior Authorization Representative
OptumRx
01.2002 - 07.2020
Data Entry Clerk
Independence Blue Cross
06.2000 - 01.2002
Data Entry Clerk
First Union Bank
01.1998 - 06.2000
Data Entry Operator
Advance Staffing Temporary Agency
09.1992 - 06.1998
Data Entry/Business Software
PSI Institute Business School
High School Diploma -
Edward Bok High School
High School Diploma -
Benjamin Franklin Adult Night School