Lakeeshia Cole
Berwyn,IL
Summary
Experienced twelve years in healthcare industry, and customer focused background in various hospital/office, outpatient, and medical settings. Attentive to insurance verifications, patient service, billing/collections, CPT/ICD-9, reimbursement, customer service, clinical, and hospital/outpatient treatment services. Recognized for excellent ability to work within a team, exceptional relationship-building, problem-solving expectations talents. Adapts well within any environment while learning new technologies, analysis and interpretation medical documentation coordination with medical providers to ensure care.
Overview
8
8
years of professional experience
1
1
year of post-secondary education
Work History
Insurance Benefit Coordinator
Magna Surgical Center (ASC)
Bedford Park, IL
09.2018 - Current
- • Coordinate and prioritize all outpatient’s (ASC) facility medical eligibility benefits of coverage care of services.
- • Keep current with all commercial and governmental insurance medical policies, billing, and authorizations requirements.
- • Timely processes/verifies medical insurance benefits, for new and existing patients with changes in insurance.
- • Demonstrates knowledge operations and medical office and/or outpatient facility settings.
- • Reviews and cascade medical records/policies of coverage, plan limitations/exclusions, and payor requirements.
- • Contributes excellent effort in remote, team and independently work environment.
- • Communicate to patients benefits cost share in timely manner, following appropriate prior scheduled procedure.
- • Responds to all inquiry’s multiple communication channels (phone, email, text, etc.).
- • Review and update patient benefits account, including coverage changes with appropriate documentation.
- • Call WC/Adjusters or attorney to obtain additional information prior to procedure.
- • Participate in weekly meeting to review product supply cost review, clinical, and financial requirements.
- • Establish relationships with physician offices, and colleagues, how prior authorization functions impact billing, clinical teams, quality of care and patient experience.
- • Resolves denials pertaining to Prior Authorizations, for reviewing missing/inaccurate information in expedient manner.
- • Meets and exceed department quality, to ensure scheduled procedures/admissions related to insurance and prior authorizations.
- Saved 80% by implementing cost-saving initiatives that addressed long-standing problems.
Patient Benefits Specialist
Option Care Health- Contract
Lombard, IL
12.2017 - 09.2018
- • Managed Verification of benefit coverage for Home Infusion Services for all patient’s insurance for pharmacy services.
- • Initiated documentations required to service patient per policy and payer guideline.
- • Determined estimated patient financial responsibility from insurance and payer contracts and/or self-pay guidelines.
- • Obtained and documented related to coinsurance, copay, deductibles, and authorization information.
- • Reviewed physician orders from pharmacy to determine authorization is required on changes/additions to therapy.
- • Initiated and follow up on authorization prior to admitting patients for all services rendered.
- Produced weekly reports to support smooth medical operations and internal career progression
Insurance Authorization Coordinator
HRS Home Health
Lombard, IL
11.2016 - 12.2016
- • Conducted detailed benefit & eligibility verification of all insurance benefits for plan participants.
- • Managed different health plans & requirements for all home health services & referrals.
- • Validated demographic & reimbursement information for all patients in All Script.
- • Advised all financial obligations to patient, and internal parties prior to services.
- • Managed initial & ongoing authorization and follow-up with internal/outgoing communications.
- • Communicated medical plan provision for services regarding contracts and physician orders.
Insurance Verification Specialist
Byram Healthcare- Contract
Downers Grove, IL
12.2015 - 10.2016
- • Processed patient’s insurance eligibility coverage for DME, home services and products.
- • Contacted all major medical insurance providers for verification of benefits & authorization of services.
- • Initiated authorization with proper CPT codes and DX codes that are valid and billable.
- • Follow up on authorization by phone also through insurance portals Fast Track.
- • Consulted doctor’s offices for medical documentation on patient medical necessity approvals.
- • Ensured all documentation to patients account is updated in 72 hours of referral verification.
- Reviewed seventy-five patient cases per week and verified insurance coverage information
Patient Service Billing Specialist
Adventist Health Hospital- Contract
Bolingbrook, IL
06.2015 - 12.2015
- • Managed & billed inpatient & outpatient insurance claims for (4) hospital locations.
- • Reviewed payments for hospital/insurance contract agreement billing report.
- • Posted payments, interpreted EOB & follow-up on denied claims to reduce outstanding balances.
- • Investigated timely filing rejected claims, to re bill once primary has paid with necessary documentation.
- • Followed up calls for past due patients/carrier’s collection payments on account.
Billing Specialist
Legacy Healthcare- Contract
Skokie, IL
01.2015 - 06.2015
- • Reviewed/verified health insurance coverage PPO, HMO’s, Medicaid, Medicare Part A/B, C.
- • Processed billing and follow up on medical claims for skilled nursing patients.
- • Analyzed patient records to determining the legitimacy of treatment & diagnostic testing.
- • Responsible for billing third-party sources under Medicare, private, Medicaid insurances.
- • Focused on disputes/denied claims on all bills not processed under proper reimbursements.
- Produced, distributed and tracked more than eighty monthly invoices for revenue business.
- Performed targeted collections on past due accounts aged over sixty days.
Insurance Reimbursement Specialist
Xerox
Schaumburg, IL
10.2012 - 05.2014
- Managed timely filing aging reports of unpaid insurance claims correspondence and rejections
- Maintained thorough knowledge of third party billing and collection requirements for payers
- Utilized all resources, including electronic inquires to verify eligibility, benefits and claim status
- Analyzed accurate primary & secondary payers based on case facts COB and accounts receivable
- Re bill denials reviewed and determined financial responsibilities account resolution
- Documented all case activity, communication and correspondence to ensure outstanding claims issues.
Produced reports to support smooth reimbursement operations and internal career progression.
Education
High School Diploma -
Malcolm X College
11.1997 - 01.1999
Skills
Customer Service
undefinedWork Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Timeline
Insurance Benefit Coordinator
Magna Surgical Center (ASC)
09.2018 - Current
Patient Benefits Specialist
Option Care Health- Contract
12.2017 - 09.2018
Insurance Authorization Coordinator
HRS Home Health
11.2016 - 12.2016
Insurance Verification Specialist
Byram Healthcare- Contract
12.2015 - 10.2016
Patient Service Billing Specialist
Adventist Health Hospital- Contract
06.2015 - 12.2015
Billing Specialist
Legacy Healthcare- Contract
01.2015 - 06.2015
Insurance Reimbursement Specialist
Xerox
10.2012 - 05.2014
High School Diploma -
Malcolm X College
11.1997 - 01.1999
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