Marie Petoia
Tampa,FL
Summary
Detail-focus HEDIS Specialist at Premier Physician Services with a proven track record in insurance and claims processing and denial management. Expert in medical insurance, coding, billing and quality assurance, I enhance operational efficiency while ensuring HIPAA compliance. My strong attention to detail and effective communication skills drive successful collaboration with providers and patients, resulting in improved access to care.
Overview
24
24
years of professional experience
Work History
Healthcare Insurance Specialist
Premier Physician Services
Remote, FL
05.2002 - Current
- Oversaw insurance claims processing, ensuring prompt submissions to relevant agencies.
- Collaborated with healthcare providers to verify patient coverage and eligibility details.
- Assisted patients with inquiries regarding insurance benefits and claim statuses.
- Managed denials, late payments, and special circumstances through effective follow-up.
- Tracked details such as authorizations, pre-certifications or referrals required prior to service delivery.
- Identified trends in denials and worked collaboratively with clinic staff to reduce denials.
- Responded promptly to requests from insurance companies regarding clarification on claim submissions.
- Reviewed medical records to meet insurance company requirements.
- Analyzed electronic medical records workflows, identifying areas for efficiency improvements.
- Maintained comprehensive knowledge of coding guidelines and insurance policies.
- Assessed medical codes on patient records for accuracy.
- Educated staff on coding practices and billing procedures during training sessions.
- Worked closely with physicians to obtain additional clinical information when needed for accurate coding assignments.
- Streamlined claim submission processes in coordination with billing department.
Education
Bachelor of Science - Psychology
St. Leo University
Dade City, FL05-2009
Skills
- Attention to detail
- Organizational skills
- HIPAA compliance
- Medical coding
- HEDIS reporting
- Denial management
- Coverage verification
- Effective communication
- HEDIS knowledge
- Clinical quality measures
- Healthcare management
- HEDIS compliance
- Claims processing
- Compliance auditing
- EMR analysis
- Problem solving
- Time management
- Clinical documentation
- Professionalism
- Multitasking Abilities
Timeline
Healthcare Insurance Specialist
Premier Physician Services
05.2002 - Current
Bachelor of Science - Psychology
St. Leo University