Overview
Work History
Education
Skills
Languages
Timeline
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Miriam Breitenbach

Westwego,Louisiana

Overview

16
16
years of professional experience

Work History

Insurance Verification Specialist

Crane Rehab Center
New Orleans, LA
04.2021 - Current
  • Maintained accurate documentation on all pre-authorization requests, denials and appeals.
  • Analyzed complex health plan contracts to determine benefit coverage levels for services rendered.
  • Performed daily audits of submitted claims to ensure compliance with industry standards and regulations.
  • Identified discrepancies in patient's insurance coverage or benefits, ensuring accuracy of data entered into system.
  • Provided timely follow up with payers regarding payment status of claims.
  • Assisted in resolving claim issues related to billing and reimbursement inquiries.
  • Interpreted Explanation of Benefits statements from various insurers and communicated relevant information with other departments as needed.
  • Processed manual claims when necessary due to incorrect or incomplete information from providers or patients.
  • Researched third party payer guidelines related to prior authorizations, coding and billing processes.
  • Monitored changes in government regulations affecting healthcare reimbursement systems.
  • Evaluated policies and procedures related to Insurance Verification activities.
  • Responded promptly to customer inquiries regarding their benefits and eligibility status.
  • Generated reports detailing trends in denied claims for use by management team.
  • Ensured that the most current version of provider contracts were stored in the database.
  • Verified patient eligibility for insurance coverage by contacting insurance carriers and obtaining the necessary authorization numbers.

Sales Associate

Cost Plus World Market, Inc
New Orleans, Louisiana
05.2009 - 12.2024
  • Greeted customers and provided exceptional customer service.
  • Assisted customers with product selection, sizing and styling.
  • Provided accurate information about products, prices and services.
  • Processed transactions using a point-of-sale system.
  • Greeted customers and answered any questions they had about the store's products and services.
  • Verified that customers were of legal age to purchase alcohol or tobacco products.
  • Operated cash register efficiently and accurately, processed payments by cash, check, credit card, gift card or automatic debit.
  • Counted money in cash drawer at the beginning of shift to ensure that amounts were correct and have sufficient change.

Patient Access Representative

Ocshner Medical Center
Metairie, Louisiana
11.2016 - 04.2021
  • Greeted patients and visitors in a courteous and professional manner.
  • Verified insurance coverage for services provided by the facility.
  • Collected co-pays and other payments from patients at time of service.
  • Assisted with scheduling outpatient appointments.
  • Scanned documents into electronic medical records system.
  • Created new patient accounts in EMR system as needed.
  • Performed pre-registration functions such as verifying demographic information, obtaining authorizations, and collecting deposits and co-payments.
  • Answered phones promptly in a professional manner.
  • Facilitated communication between patients, staff members, and third party payers.
  • Managed incoming faxes related to patient registration processes.
  • Applied HIPAA privacy and security regulations while handling patient information.
  • Ensured accuracy of all data entered into computer system.

Supervisor

Cost Plus World Market, Inc
New Orleans, Louisiana
06.2014 - 12.2015
  • Directed and supervised team of 15 employees in daily operations.
  • Developed and implemented operational policies and procedures to ensure efficiency and accuracy of workflows.
  • Maintained accurate records of employee performance, attendance, leave requests, and disciplinary actions.

Education

Associates Degree - Early Childhood Education

Delgado Community College
New Orleans, LA
05-2014

Skills

  • Database Management
  • Insurance plan verification
  • Data Entry and Review
  • Understanding of medical terms
  • Medical Billing
  • Insurance terminology
  • Customer Service
  • Electronic Medical Records
  • Prior authorization processing
  • Electronic authorization processing
  • Insurance benefits verification
  • Eligibility Determination
  • Attention to Detail
  • Coordination and Scheduling
  • Medical Terminology
  • Documentation and Correspondence
  • Analytical Thinking
  • Secure data practices
  • Medicaid knowledge
  • Insurance Coverage Verification
  • Coverage and Authorizations
  • Statement preparation
  • Deductible & co-pay calculation
  • Insurance claim validation
  • Data Verification
  • Radiology Knowledge
  • Customer Database Systems
  • Accuracy and Precision

Languages

Spanish
Native/ Bilingual

Timeline

Insurance Verification Specialist

Crane Rehab Center
04.2021 - Current

Patient Access Representative

Ocshner Medical Center
11.2016 - 04.2021

Supervisor

Cost Plus World Market, Inc
06.2014 - 12.2015

Sales Associate

Cost Plus World Market, Inc
05.2009 - 12.2024

Associates Degree - Early Childhood Education

Delgado Community College

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Miriam Breitenbach