KATHLEEN PENNINGTON

• Processed claims and forwarded information to Medicare, Medicaid and commercial insurance companies.
• Identified potential billing errors or issues that may result in delayed payments or rejections by payers.
• Checked claims coding for accuracy with ICD-10 standards.
• Provided prompt and accurate services through knowledge of government regulations, health benefits and healthcare terminology.
• Submitted claims to insurance companies.
• Processed medical claims according to established guidelines, including verifying authorization and coding requirements.
• Answered customer questions to maintain high satisfaction levels.
• Executed account updates and noted account information in company data systems.
• Collaborated with other departments such as Accounts Payable, Billing and Collections or Claims Processing to resolve any conflicts quickly.
• Protected medical office operations and integrity by keeping patient information confidential.
• Identified discrepancies and carrier issues regarding billing and reimbursements.
• Assessed billing statements for correct diagnostic codes and identified problems with coding.
• Recognized by management for providing exceptional customer service.
• Promoted high customer satisfaction by resolving problems with knowledgeable and friendly service.
• Corrected, completed and processed claims for payer codes.

• Assisted with scheduling outpatient appointments.
• Performed pre-registration functions such as verifying demographic information, obtaining authorizations, and collecting deposits and co-payments.
• Created new patient accounts in EMR system as needed.
• Collaborated with clinical and administrative staff to meet patient needs.
• Obtained informed consent and payment documentation from patients and filed in system.
• Handled high volume of incoming calls, providing exceptional customer service to patients and families.
• Guided patients through the completion of consent and other required medical forms.
• Communicated financial obligations to patients and collected fees at time of service.
• Actively participated in team meetings and training sessions.
• Maintained confidentiality of patient information in compliance with HIPAA regulations.
• Scanned documents into electronic medical records system.
• Managed incoming faxes related to patient registration processes.
• Kept patient appointments on schedule by notifying providers of patients' arrival and reviewing service delivery compared to schedule.

• Organized timely and accurate referrals to help patients obtain health care services and access available resources.
• Processed credit card payments accurately and securely.
• Verified patients' insurance and payment methods during admissions or check-in processes.
• Obtained informed consent and payment documentation from patients and filed in system.
• Advocated for patient rights when dealing with third-party payers.
• Performed follow up calls to collect outstanding balances from patients who were unable to make payments at time of service.
• Documented all interactions with patients regarding billing issues in a timely manner.
• Counseled patients on financial obligations associated with their medical care.
• Taught volunteers how to relate to guests, uphold patients' rights and respond to specific issues.
• Received patient inquiries or complaints and directed to appropriate medical staff members.
• Recognized by management for providing exceptional customer service.
• Assisted with customer requests and answered questions to improve satisfaction.
• Completed day-to-day duties accurately and efficiently.
• Worked effectively in team environments to make the workplace more productive.

• Researched current payer policies related to specific services or diagnoses as needed.
• Identified opportunities for improvement within the precertification process and recommended solutions accordingly.
• Explained eligibility details and affordability options to patients with kindness and respect.
• Provided follow-up on pending precertification requests to ensure timely processing.
• Utilized various software applications such as electronic medical record systems for data entry purposes.
• Adhered to HIPAA requirements to safeguard patient confidentiality.
• Transmitted medical records and other correspondence by mail, e-mail, or fax.
• Resolved any discrepancies identified during the precertification process.
• Adhered to applicable laws, regulations, policies, and procedures governing the healthcare industry.
• Maintained detailed documentation of all activities related to the precertification process.
• Entered client information and files into databases for further review and tracking.
• Assisted with answering provider inquiries regarding preauthorization requirements and processes.
• Compiled and submitted precertification requests for review by payers in accordance with established timelines.
• Compiled and coded patient information or data in appropriate computer system.
• Explained reasons behind application denials and recommended further action.
• Verified insurance eligibility, coverage levels, and benefit parameters prior to submission of precertification requests.
• Ensured compliance with all HIPAA regulations pertaining to protected health information.
• Reviewed patient medical records to determine medical necessity for requested services and procedures.
• Evaluated clinical criteria against existing health plan guidelines to determine authorization status.
• Prepared reports, invoices, letters, or medical records using word processing, spreadsheet, or other software applications.
• Demonstrated strong problem-solving skills, resolving issues efficiently and effectively.
• Completed day-to-day duties accurately and efficiently.
• Recognized by management for providing exceptional customer service.

1. In Patient-Registered/Pre

Registered Patients. Entered

new and updated information

on account. Collected Copays,

Initiated Authorizations with

Insurance Companies. Visited

patients rooms before

discharge: explained

benefits, set up payment

arrangements with patients,

Evaluated patient for Financial

Assistant Application.

Explained form and assisted

with completing form if

needed.

Retro Authorization follow up.

2. Out Patient-Pre Register out

patient tests etc. Verify

Demographics/Insurance

information. Obtaining all

information required is in

place.

Instruct patient money due at

time of service/where to

check

in and what is required from

patient at check in.

3. Other duties-filled in for

Cashier, registration ER as well

as Patient Access. Entered IV

Infusions into system, Daily

deposits for Hospital, entered

FCOA payments.

4. Train new employees-Patient

Access, Switchboard