Melissa Johnson
Cypress,CA
Summary
I'm a highly motivated outgoing individual who is seeking to obtain a challenging position where I can utilize my talents and skills for your organization. My recent focus has been admitting patients in the Emergency Department and Main Admitting. This is a fast paced job with many duties. In addition to financial counseling for patients regarding their insurance coverage I have also had the pleasure to be a patient advocate to help patients get financial assistance for high coinsurance responsibilities through non-profit foundations and co-pay assistance through pharmaceutical companies. My background includes billing, coding, insurance verification, prior authorizations for procedures and oral medications, specialty pharmacy, front office, training employees, problem solving, and my ability to execute a variety of tasks simultaneously. Pragmatic Insurance Verification Specialist touting 20 plus years of expertise in benefits explanation and coverage tracking. A team player with a vast knowledge of medical terms and working with all types of personalities effectively. Offering dynamic organizational skills and attention to detail.
Overview
28
28
years of professional experience
Work History
Main Admitting, Insurance Verifier, Authorizations, Financial Counselor
Los Alamitos Medical Center
10.2019 - 06.2024
- Collecting all copays and out of pocket due at time of service
- Assisted clients with understanding their insurance policies, benefits, and limitations to promote informed decision-making regarding healthcare services.
- Increased accuracy in claim submissions with thorough review of documentation prior to submission to insurers.
- Contributed to company's growth through consistent achievement of performance metrics related to accuracy, speed, and customer satisfaction ratings.
- Enhanced client satisfaction by accurately verifying insurance coverage and processing claims in a timely manner.
- Strengthened relationships between insurers, clients, and healthcare providers through clear communication and timely resolution of disputes or inquiries.
- Collaborated with healthcare providers to obtain required patient information for accurate insurance verification.
- Ensured timely referrals for specialty care or diagnostic tests by verifying coverage and obtaining necessary authorizations.
- Provided exceptional customer service during interactions with clients, addressing concerns or questions promptly and professionally.
- Acquired billing information by worker's compensation accounts and MVA.
- Supported billing department by verifying coverage details to ensure correct invoicing of clients and prompt payment from insurers.
- Utilized advanced software tools for efficient management of client records, policy information, and claim statuses.
- Established contact with ordering physician's office to resolve any issues or to collect missing vital information.
- Safeguarded client privacy by adhering to stringent HIPAA regulations in all aspects of work responsibilities.
- Managed high-volume caseloads efficiently while maintaining strict deadlines for completing verifications and processing claims.
- Verified all patient demographic information when registering for services.
Customer Service Representative
St Joseph Heritage
02.2015 - 09.2019
- Advocating for patients and physicians, scheduling patients with primary care physicians
- Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
- Resolved customer complaints with empathy, resulting in increased loyalty and repeat business.
- Handled escalated calls efficiently, finding satisfactory resolutions for both customers and the company alike.
- Responded to customer requests for products, services, and company information.
- Enhanced customer satisfaction by promptly addressing concerns and providing accurate information.
- Developed strong product knowledge to provide informed recommendations based on individual customer needs.
- Maintained detailed records of customer interactions, ensuring proper follow-up and resolution of issues.
- Collaborated with team members to develop best practices for consistent customer service delivery.
- Provided coaching and mentoring to new hires, contributing to their successful integration into the team.
Financial Counselor, Patient Advocate
Los Alamitos Hematology Oncology
06.2001 - 06.2014
- Insurance verification, cost analysis, prior authorizations, billing, coding, data entry, managed 'in house' pharmacy, worked directly with pharmaceutical reps and specialty pharmacies
- Cultivated a positive, non-judgmental environment for clients to openly discuss their financial challenges and concerns.
- Conducted interviews with patients and family members and answered questions regarding insurance benefits.
- Streamlined counseling processes by implementing efficient record-keeping systems and communication tools.
- Contacted insurance providers to obtain key information regarding patient benefits and to submit documentation for accounts.
- Worked directly with clients to provide financial counseling and education using individualized counseling model and personal finance course.
Front Office, Financial Counselor
Randall T Kanamaki DDS Incorporated
07.1999 - 03.2001
- Scheduled patients, processed x-rays, prior authorizations, billing
Financial Counselor
Arizona Oncology Services
06.1996 - 06.1999
- Prior authorizations, calculated and post charges, train new employees
Education
General Education and Business -
Boise State University
Boise, IDGeneral Education and Business -
Idaho State University
Moscow, IDSkills
- Financial counseling for all medical insurance
- Cost Analyst for all treatment
- Patient Advocate
- Management of Specialty pharmacy for Oncology
- Prior authorizations for procedures and oral medications
- Insurance verification
- Billing
- Coding
- Data entry
- Training of new employees
- Front office
- Customer service experience
- HIPAA Compliance
- Insurance Verification
- Understanding of database procedures
- Customer Service
- Data Entry and Review
- Patient confidentiality
- Electronic Medical Records
- Medical Terminology
- Data entry proficiency
- Prior authorization processing
- Insurance Coverage Verification
- Understanding of medical terms
- Eligibility Determination
- Financial Counseling
- Patient contact
- Problem-solving abilities
- Multitasking
- Cash Handling
- Adaptability and Flexibility
- Patient Scheduling
- Insurance Authorizations
- Professionalism
References
References available upon request
Timeline
Main Admitting, Insurance Verifier, Authorizations, Financial Counselor
Los Alamitos Medical Center
10.2019 - 06.2024
Customer Service Representative
St Joseph Heritage
02.2015 - 09.2019
Financial Counselor, Patient Advocate
Los Alamitos Hematology Oncology
06.2001 - 06.2014
Front Office, Financial Counselor
Randall T Kanamaki DDS Incorporated
07.1999 - 03.2001
Financial Counselor
Arizona Oncology Services
06.1996 - 06.1999
General Education and Business -
Boise State University
General Education and Business -
Idaho State University
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