Detail-oriented Patient Access Representative skilled in insurance verification and claims processing. Committed to ensuring seamless patient experiences through effective communication and collaboration.
Overview
20
20
years of professional experience
Work History
Patient Access Representative
FMOL Health
Baton Rouge, Louisiana
09.2025 - Current
Verified insurance coverage for services provided by the facility.
Facilitated registration and insurance verification to enhance patient onboarding experience.
Calculated patient responsibility estimates based on insurance verification to prepare for pre-registration.
Analyzed eligibility responses to determine patient benefit levels and provide accurate estimates.
Collaborated with healthcare teams to ensure seamless patient experiences.
Actively participated in team meetings and training sessions.
Claim Specialist III
Blue Cross Blue Shield of Louisiana
Baton Rouge, Louisiana
03.2007 - 08.2025
Processed claims edits accurately, determined primacy for Coordination of Benefits (COB), adjusted previously paid claims, and initiated fund recovery on overpaid claims.
Processed complex regular adjustment requests accurately and timely, including escalated cases from customer service, special projects, fraud cases, reconsideration/appeal cases, audit cases, DOI cases, and presidential cases.
Assisting with developing, documenting, and testing system
changes; assisting Supervisor with job training and answering staff questions.
Facilitated resolution of complex customer issues to enhance service quality.
Assisting with developing, documenting, and testing systemchanges; assisting Supervisor with job training and answering staff questions.
Complied with all laws and regulations related to duties and responsibilities.