Mona Gibson
Lexington,MA
Summary
Detail-oriented Financial Clearance Specialist with expertise medical insurance verification and prior authorization processes. Proven ability to streamline and enhance team collaboration contributing to improved workflow and positive patient & hospital outcomes
Overview
17
17
years of professional experience
Work History
Financial Clearance Specialist
Mount Auburn Hospital
Cambridge, MA
12.2018 - Current
- Coordinated insurance verification to ensure coverage compliance for services.
- Ensured prior authorization was finalized before surgery scheduled
- Submitted prior authorization requests to appropriate payor or vendor for Urgent Admissions, Maternity Admissions, Elective Admissions, and Elective Cardiology imaging services
- Analyzed patient clinical documentation to identify discrepancies and resolve issues promptly with appropriate payors and vendors
- Collaborated with medical staff to gather necessary documentation for financial clearances.
- Maintained accurate records in EPIC to support prior authorization requests
- Assisted in developing protocols to streamline the clearance process efficiently when obtaining cardiology prior authorization.
- Trained new and current staff on clearance policies and best practices for obtaining appropriate prior authorization for my payors and the cardiology work queue
- Provided guidance and assistance to other departments regarding proper procedures for obtaining and maintaining authorization clearance
- Worked closely with supervisors, managers, and fellow staff members in order to provide updates on pending authorization requests or changes in status.
- Researched and responded to inquiries from internal staff members concerning the status of an individual's prior authorization request
- Followed up with old prior authorization requests ensuring authorization was processed and claim was paid
- Maintained positive working relationship with fellow staff and management.
OR Scheduler
Mount Auburn Hospital
Cambridge, MA
03.2017 - 12.2018
- Coordinated daily, weekly, monthly schedules for OR and Day surgery
- Utilized scheduling software to help find appropriate OR time for individual surgeries for providers' offices
- Resolved scheduling conflicts by collaborating with medical providers and financial clearance.
- Managed communication between departments to ensure smooth operations.
- Handled incoming calls effectively by scheduling and confirming surgeries.
- Communicated schedule changes effectively throughout the organization when necessary.
- Resolved scheduling disputes between OR rooms
- Supported operational workflows by prioritizing urgent requests effectively.
Provider Services Representative
Celtic Care
Waltham, ME
03.2016 - 03.2017
- Provided high volume telephone customer service to providers inquiring about Celtic Care claims, prior authorizations or members
- Resolved complex, escalated claims and eligibility issues and billing questions by collaborating with internal departments, or supervisors
- Insured providers adhered to Celtic Care guidelines and educated them on administrative requirements such as CPT and Diagnosis codes, authorization processes, and fee schedules.
- Documenting all calls to ensure quality assurance
Case Managers Assistant
Tufts Health Plan
Watertown, Massachusetts
01.2009 - 05.2012
- Supported case managers in managing client files and records.
- Attended team meetings to discuss client needs and progress updates.
- Managed and triaged members to case managers.
- Delegated member based on the case complexity and each nurses work capacity.
- Documented in Tufts internal platform about steps taken for each member
Education
High School Diploma -
Cambridge Rindge And Latin
Cambridge, MA05-2005
Skills
- Insurance verification expertise
- Prior authorization initiation
- EPIC documentation expertise
- Clinical document retrieval
- Effective communication
- Teamwork and collaboration
- Reliability
Timeline
Financial Clearance Specialist
Mount Auburn Hospital
12.2018 - Current
OR Scheduler
Mount Auburn Hospital
03.2017 - 12.2018
Provider Services Representative
Celtic Care
03.2016 - 03.2017
Case Managers Assistant
Tufts Health Plan
01.2009 - 05.2012
High School Diploma -
Cambridge Rindge And Latin