Michele Stewart
San Diego,CA
Summary
Highly-motivated employee with desire to take on new challenges. Strong worth ethic, adaptability and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.
Overview
30
30
years of professional experience
Work History
Dictionary Reporting Analyst
Scripps Healthcare
San Diego, CA
- Maintained high level of professionalism when speaking to doctors and insurance companies.
- Followed-up with insurance companies and individuals to resolve discrepancies.
- Verified insurance eligibility for patients seeking medical treatment.
- Communicated with providers regarding authorization status and other related issues.
- Assisted management with special projects as needed.
- Acted as a liaison between providers, billing staff, and insurance companies.
- Compiled and maintained all HMO health plan benefits into IDX system.
Managed Care Representative
Scripps Healthcare
- Assured timely verification of insurance benefits prior to patient procedures or appointments.
- Coordinated with contracting department to resolve payer issues.
- Checked documentation for accuracy and validity on updated systems.
Member Relations Specialist
Scripps Healthcare
- Promoted superior experience by addressing customer concerns, demonstrating empathy, and resolving problems swiftly.
- Followed up with customers about resolved issues to maintain high standards of customer service.
- Provided primary customer support to internal and external customers.
ED Resource Specialist - Training
Scripps Healthcare
- Delivered group and individual training covering front desk, appointment scheduling in multiple medical departments.
- Trained staff in IDX system.
Insurance Processor
Scripps Healthcare
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Posted payments to accounts and maintained records.
- Calculated adjustments and refunds.
- Verified all case related services, such as work comp, special studies & employee health services.
Medical Claims Processor
Scripps Healthcare
San Diego, CA
09.2019 - 01.2024
- Reviewed medical claims for accuracy and completeness, verifying patient eligibility and coding.
- Ensured compliance with insurance company policies and procedures related to the processing of claims.
- Reviewed eligibility for medical insurance coverage and other benefit plans.
- Assisted customers with questions regarding their eligibility status or benefit coverage.
- Performed follow-up calls to verify that insurance companies received requests for authorization of services.
- Responded promptly and accurately to inquiries from patients, healthcare providers, and insurance companies via phone or email.
- Worked closely with internal teams such as billing department, utilization management team., to resolve any issues related to benefit verifications.
- Developed strategies for improving workflow processes related to benefit verifications.
- Adhered to HIPAA regulations when handling confidential patient information.
- Assisted with audits by preparing accounts and providing information.
Education
High School Diploma -
West High School
Bremerton, WA06-1978
Skills
- Excellent Customer Service
- Insurance Claims Processing
- Proficiency Microsoft Office applications
- Knowledgeable in EPIC
- Medical terminology
- Data Entry
- Teamwork and Collaboration
- Insurance Plan Verification
- Attention to Detail
- Insurance Terminology
- IDX system
- Verify auth status
- Review and resolve benefit issues in EPIC
- Proven Training Skills (IDX trainer)
- Payment collection
- Patient Scheduling
- Medical office administration
Timeline
Medical Claims Processor
Scripps Healthcare
09.2019 - 01.2024
High School Diploma -
West High School
Dictionary Reporting Analyst
Scripps Healthcare
Managed Care Representative
Scripps Healthcare
Member Relations Specialist
Scripps Healthcare
ED Resource Specialist - Training
Scripps Healthcare
Insurance Processor
Scripps Healthcare
References
References available upon request.
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