Julia Whetten, CPC
Tucson,AZ
Summary
Enthusiastic individual with superior skills working in both team-based and independent capacities. Bringing strong work ethic and excellent organizational skills to any setting. Excited to begin new challenges with successful teams.
Overview
10
10
years of professional experience
1
1
Certification
Work History
Insurance Verification Representative
Surgical Care Affiliates Inc.
03.2024 - Current
- Performed outbound calls to verify patient's insurance coverage status.
- Researched insurance plans to determine coverages and benefits available.
- Followed up on pending cases with appropriate parties as needed.
- Verified patient eligibility and benefits for insurance coverage.
- Maintained accurate records of patient data in the system.
- Adhered to HIPAA guidelines when handling confidential information.
- Reviewed medical files for completeness before submitting them to insurers.
- Called insurance companies to ascertain pertinent information regarding policies and payment benefits for patients.
- Developed and maintained professional relationships with insurance representatives.
- Collaborated with healthcare providers to communicate insurance coverage and authorization details.
- Retained strong medical terminology understanding in effort to better comprehend procedures.
Insurance Verification Specialist
Fresenius Medical Care NA / Azura / CVC
06.2021 - 03.2024
- Verified proper insurance coverage for patients prior to procedures or appointment scheduling.
- Maintained accurate and up-to-date patient and insurance records by consistently updating company database.
- Entered timely updates for referral and authorization information in the system.
- Coordinated with insurance carriers to secure necessary approvals and notifications for patients.
- Collaborated with internal departments for account status updates.
- Implemented effective measures to uphold patient confidentiality in accordance with HIPAA guidelines.
Revenue Cycle Collections Specialist I
Titan Health
Tucson, AZ
06.2020 - 06.2021
- Work towards meeting client goals by ensuring collection is completed within 45 days of initial activity.
- Maintained collection action/activity/frequency targets in accordance with client requirements and employer policy
- Ensured accurate data entry and tracking of follow-up and payment information
- Ensured prompt retrieval of outstanding appeals/grievances
- Ensured prompt resolution of short pay or denial by proactively contacting the relevant health insurance plan.
- Assisted in submitting appeal letters to insurance plans/payors.
- Ensured timely submission of materials necessary for resolving appeals/grievances according to the insurance plan/payor's requirements.
- Successfully addressed denials through appropriate escalation processes.
- Identified payments and provided assistance with Client-specific invoice processes when necessary.
- Perform progressive action on every contact with an account, ensure that every time an account is worked the collection moves forward.
- Meet or exceed production and quality standards as defined by employer and hospital client.
Prior Authorization Specialist
Pima Heart & Vascular
Tucson, AZ
12.2017 - 06.2020
- Applied knowledge of Medicare, Medicaid and third-party payer requirements in verifying patient coverage and policy limitations through online eligibility systems.
- Contacted insurance carriers to secure necessary approvals for scheduled medical tests and procedures.
- Conducted comprehensive medical evaluations for prior authorization submissions, adhering to established criteria and protocols.
- Provided prompt notification to ordering providers regarding denied authorizations.
- Facilitated the coordination of issue resolutions and appeals for denied authorizations.
- Streamlined spreadsheet and document filing systems.
- Effectively communicated daily processes and procedures to new employees, enhancing clarity and comprehension of job responsibilities.
- Established a reputation for reliability and dedication through consistent attendance and diligent efforts.
Medical Office Administrator
Hanger, Inc
Tucson, AZ
10.2014 - 10.2016
- Managed and prioritized patient insurance verification and prior authorization, submitted diagnosis and procedure codes, communicated patient's financial responsibility, and billed medical items/products.
- Reviewed medical records to confirm appropriate documentation of diagnosis and medical necessity as required by CMS guidelines for custom prosthetics and orthotics.
- Produced accurate monthly revenue reports by physician, skillfully extracting data to spreadsheets and thoroughly documenting both positive and negative revenues.
- Delivered outstanding patient care with compassionate and personable communication.
- Managed appointment scheduling, check-ins, and patient concerns in a busy durable medical practice.
Education
Professional Medical Coding And Billing
CareerStep
Online2017
Bachelor of Science - Business Information Systems
University Of Phoenix
Tucson, AZ1998
Skills
- Customer Service
- Medical Billing & Coding
- Medical Terminology & Anatomy
- MS Office
- Organization and prioritization
- Patient insurance authorizations
- Planning and coordination
- Process improvement
- Relationship development
- Review medical records
- Insurance collaboration
- Paperwork management
- Records coordination
- Claims review
- Collecting payments
- Account monitoring
- Investigative methods knowledge
- Interpersonal communication skills
Certification
Certified Professional Coder (CPC)
Affiliations
- Certificate of Graduation with Honors - CareerStep
- Exemplary Work Ethic Award
Timeline
Insurance Verification Representative
Surgical Care Affiliates Inc.
03.2024 - Current
Insurance Verification Specialist
Fresenius Medical Care NA / Azura / CVC
06.2021 - 03.2024
Revenue Cycle Collections Specialist I
Titan Health
06.2020 - 06.2021
Prior Authorization Specialist
Pima Heart & Vascular
12.2017 - 06.2020
Medical Office Administrator
Hanger, Inc
10.2014 - 10.2016
Professional Medical Coding And Billing
CareerStep
Bachelor of Science - Business Information Systems
University Of Phoenix