Lakisha Mccall
Princeton Junction,NJ
Summary
Personable and dedicated customer service representative with extensive experience in industry. Solid team player with upbeat, positive attitude and proven skill in establishing rapport with clients. Motivated to maintain customer satisfaction and contribute to company success. Articulate, enthusiastic and results-oriented with demonstrated passion for building relationships, cultivating partnerships and growing businesses. Self-motivated insurance verification specialist proudly offering several years' experience building an understanding of medical terminology while tracking patient coverage. A poised professional with benefits explanation and administration expertise. Offering time management and interpersonal skills.
Overview
17
17
years of professional experience
Work History
Insurance Verification Specialist- Work From Home
Radiology Affiliates of Central NJ
Lawrenceville, NJ
06.2018 - Current
- Maintained accurate documentation on all pre-authorization requests, denials and appeals.
- Developed a working knowledge of insurance plans, including Medicare and Medicaid regulations and requirements.
- Provided timely follow up with payers regarding payment status of claims.
- Assisted in resolving claim issues related to billing and reimbursement inquiries.
- Identified discrepancies in patient's insurance coverage or benefits, ensuring accuracy of data entered into system.
- Researched third party payer guidelines related to prior authorizations, coding and billing processes.
- Processed manual claims when necessary due to incorrect or incomplete information from providers or patients.
- Interpreted Explanation of Benefits statements from various insurers and communicated relevant information with other departments as needed.
- Updated patient and insurance data and input changes into company computer system.
- Verified that patients had proper insurance coverage prior to procedures or appointment scheduling.
- Responded promptly to customer inquiries regarding their benefits and eligibility status.
- Participated in training sessions on new software programs used for verification purposes.
- Determined estimated self-pay portion by calculating charges, co-insurance and deductibles.
- Contacted patients to confirm demographic information and communicate financial responsibilities.
- Instructed clients on amounts covered under benefits plans in easy-to-understand terminology.
- Verified patient eligibility for insurance coverage by contacting insurance carriers and obtaining the necessary authorization numbers.
- Reviewed authorization requests for accuracy and completeness.
- Verified insurance authorizations with payers via telephone or web-based systems.
- Processed prior authorization requests in accordance with departmental guidelines.
- Tracked authorization statuses using electronic databases or manual filing systems.
- Entered client information and files into databases for further review and tracking.
- Reviewed applications to verify client information and resolve discrepancies.
- Utilized computer systems to access accounts for research purposes.
- Adhered to company policies and procedures while assisting customers with their needs.
- Assisted customers with product selection based on individual needs.
- Provided customer service support to customers over the phone, responding to inquiries and addressing concerns.
- Resolved customer complaints by identifying problems, researching solutions, and providing corrective action plans.
- Processed orders accurately according to established guidelines and timelines.
- Verified accuracy of data entry into company database system.
- Troubleshot technical issues related to products or services.
- Kept records of customer interactions or transactions, thoroughly recording details of inquiries.
- Provided technical assistance to customers through online chat or telephone support.
- Followed established protocols for escalation of unresolved customer issues to appropriate personnel.
Surgical Coordinator
TOG@ Rothman Institute
Township of Hamilton, NJ
09.2017 - 06.2018
- Organized patient charts for surgical procedures and ensured accuracy of all documents.
- Scheduled pre-operative appointments with patients, obtained consent forms and collected necessary insurance information.
- Maintained inventory of supplies in the operating room and ordered new supplies as needed.
- Managed scheduling of multiple surgeries on a daily basis, coordinating availability of surgeons and anesthesiologists.
- Acted as liaison between physicians, vendors, insurance companies, patients and their families regarding surgical procedures.
- Provided assistance with post-operative care plans according to physician's orders.
- Verified patient eligibility for particular types of surgeries based on health plan guidelines or coverage limitations.
- Entered data into electronic medical record system accurately and timely using ICD-10 coding standards when applicable.
- Gathered current medical information and reviewed histories to gather details for surgeons.
- Collaborated and established strong working relationships with physicians, supervisors and colleagues.
- Checked patient insurance and collected pre-authorizations from providers.
- Coordinated work processes and routed paperwork to appropriate physicians and staff members.
- Worked with operating facilities to schedule procedures on behalf of surgeons.
- Communicated with patients with compassion while keeping medical information private.
Medical Billing/Collections Specialist
Trenton Orthopaedic Group
Township of Hamilton, NJ
03.2013 - 09.2017
- Performed follow-up calls to collect past due amounts from customers.
- Negotiated payment arrangements with delinquent customers in accordance with company policy.
- Analyzed aged accounts receivable reports to identify trends in collections activity.
- Responded promptly to customer inquiries about their accounts via phone or email.
- Worked closely with other departments within the organization to resolve billing issues quickly and efficiently.
- Investigated complaints concerning billing errors or discrepancies and provided resolution recommendations.
- Reviewed customer contracts for accuracy prior to generating invoices for services rendered.
- Processed refunds when applicable based on customer requests or contract terms.
- Compiled data into weekly, monthly, quarterly reports summarizing current accounts receivable status.
- Developed strategies for improving collections performance while maintaining excellent customer service standards.
- Identified areas of improvement in existing processes related to billing and collections activities.
- Ensured compliance with all state laws pertaining to debt collection practices.
- Attended training sessions as necessary to stay up-to-date on changes in regulations affecting the industry.
- Provided customer service to internal and external customers regarding billing inquiries.
- Maintained accurate records of all billing and collection activities in the company's database system.
- Researched discrepancies between invoices and payments received.
- Assisted with month-end closing procedures related to accounts receivable functions.
- Received payment and posted to appropriate customer accounts.
- Arranged for debt repayment and established repayment schedule based on customer finances.
- Notified customers of delinquent accounts with attempt to collect outstanding amounts.
- Recorded and updated customer personal accounts with accurate contact information.
- Remained calm, stayed professional, and provided exceptional service on calls, even when interacting with difficult individuals.
- Negotiated payment plans with delinquent account holders to facilitate debt resolution.
- Prepared and sent out demand letters and collection notices to delinquent accounts.
- Used excellent verbal skills to engage customers in conversation and effectively determine needs and requirements.
- Answered customer questions regarding account discrepancies or problems.
- Received payments and posted amounts to customer accounts.
- Arranged debt repayment or established schedules for repayment based on customer's financial situation.
- Contacted insurance companies to check status of claim payments.
- Monitored overdue accounts using automated information systems.
- Wrote appeal letters to insurance companies for denial of claims.
- Monitored daily cash receipts, bank deposits, and journal entries related to collections activity.
Medical Receptionist
Rednor-Risi Family Medicine
Robbinsville, NJ
10.2007 - 02.2013
- Greeted and checked in patients, updating patient information in computer system.
- Verified insurance coverage for appointments and collected co-payments as required.
- Scheduled patient appointments, verifying accuracy of appointment times with providers.
- Answered incoming calls, responding to inquiries from patients and other medical offices.
- Prepared charts for new patients, ensuring all necessary forms were completed correctly.
- Assisted with filing of medical records and documents, maintaining accurate electronic files.
- Provided support to clinical staff during patient visits, including rooming patients, collecting vital signs and documenting chief complaints.
- Performed data entry tasks related to billing and collections procedures.
- Processed referrals for specialist care when requested by physicians or patients.
- Maintained supply inventory for office area, ordering items as needed and stocking shelves.
- Checked patients in and out for appointments and collected co-payments.
- Scheduled and followed up on patient appointments, collected and processed patient payments and maintained patient files.
- Managed office phone lines by checking voicemail, returning calls and directing messages to team members.
- Provided excellent customer service to resolve customer complaints in a timely manner.
- Maintained detailed records of customer interactions, transactions and comments for future reference.
- Promoted high customer satisfaction by resolving problems with knowledgeable and friendly service.
- Remained calm and professional in stressful circumstances and effectively diffused tense situations.
- Informed customers about billing procedures, processed payments, and provided payment option setup assistance.
- Collected deposits or payments and arranged for billing.
- Conducted outreach to community providers for referrals and resources.
- Performed data entry related to referrals into electronic health record systems.
- Ensured compliance with applicable laws and regulations regarding referrals.
- Updated existing policies as necessary based on changes in regulations or standards of care.
Education
Diploma -
Hightstown High School
Hightstown, NJ01.1995
Skills
- Insurance Coverage Verification
- Medical Billing
- Documentation and Correspondence
- Database Management
- Medicaid knowledge
- Eligibility Determination
- Data Entry and Review
- Customer Service
- Insurance benefits verification
- Prior authorization processing
- Electronic authorization processing
- Referral Coordination
- Insurance knowledge
- Process evaluation
- Insurance Billing
- Data entry proficiency
- Data review
- Radiology Knowledge
- Deductible & co-pay calculation
- Patient Communication
- Skilled in Athena Health, Ramsoft
- HIPAA Compliance
- Application assessment
- Data Entry
- Microsoft Office
- Proficiency in Microsoft, Excel
- Call Management
- Scheduling
- Appointment Scheduling
- Complaint resolution
- Paperwork Processing
- Call escalation
- Process Optimization
- Documentation
- Order Processing
- Call center procedures
- Multi-line telephone operations
- Filing
- Spreadsheets
Timeline
Insurance Verification Specialist- Work From Home
Radiology Affiliates of Central NJ
06.2018 - Current
Surgical Coordinator
TOG@ Rothman Institute
09.2017 - 06.2018
Medical Billing/Collections Specialist
Trenton Orthopaedic Group
03.2013 - 09.2017
Medical Receptionist
Rednor-Risi Family Medicine
10.2007 - 02.2013
Diploma -
Hightstown High School
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