MORGAN STONE
Broadview,IL
Summary
Results-driven individual with a proven track record of successfully resolving a wide range of claims cases. Proven ability to manage multiple cases simultaneously, build strong relationships with clients and handle sensitive information discreetly. Adept in data analysis and process optimization.
Overview
11
11
years of professional experience
1
1
Certification
Work History
Customer Service and Claims Representative
Group Administrators
10.2024 - 03.2025
- Processed and analyzed customer claims with accuracy and attention to detail.
- Maintained accurate records of all communications with customers.
- Utilized effective problem-solving techniques to resolve complex customer issues.
- Successfully resolved escalated claims to ensure customer satisfaction.
- Utilized knowledge of insurance policies and procedures to determine coverage eligibility.
- Communicated effectively both verbally and in writing when dealing with customers or colleagues.
- Stayed up-to-date on local, state, and federal law changes in insurance field to maintain knowledge.
- Managed a high volume of incoming calls from customers, providing excellent customer service.
Customer Service Administrator
Urology Comprehensive Care
07.2024 - 10.2024
- Created and maintained reports for tracking scheduling data.
- Developed scheduling protocols to improve efficiency and accuracy of scheduling process.
- Ensured compliance with all policies and procedures related to scheduling.
- Confirmed and scheduled appointment dates and times with physicians' offices.
- Created and updated records of patient visits, including medical history and insurance information.
- Resolved conflicts between physician schedules, hospital policies, and patient needs efficiently.
- Processed incoming and outgoing calls promptly and professionally.
- Collaborated with colleagues to coordinate multiple appointments within a timely manner.
- Ensured that all appointment times were accurately recorded in the system.
- Developed and maintained patient scheduling protocols, ensuring accuracy and efficiency.
- Demonstrated proficiency in operating various computer software programs for scheduling purposes.
- Utilized excellent communication skills to interact with patients over the phone or in person regarding their appointments.
- Performed clerical duties such as filing documents, faxing forms, printing reports.
- Assisted with check-in and check-out procedures for scheduled patients.
- Maintained up-to-date knowledge of office policies related to scheduling operations.
Medical Biller and Coder
Superior Ambulance
01.2024 - 06.2024
- Verified insurance eligibility and benefits using online resources and contacting payers directly as needed.
- Coded patient information accurately into the practice management system according to ICD-10 standards.
- Assessed third party denials, underpayments due to incorrect coding or other errors, omissions.
- Helped review insurance denials related to diagnosis issue.
- Posted medical insurance billings.
- Performed minimum number of coding quality reviews consistent with established departmental goals.
- Scanned patients' health records into electronic formats.
- Resolved medical coding edits or billing item rejects in relation to code assignment.
Benefits Verification Representative
CVS Health
07.2020 - 12.2023
- Provided outstanding customer service and support to clients, resolving inquiries efficiently and effectively.
- Successfully managed multiple projects simultaneously while maintaining high standards of performance.
- Assessed insurance policy terms to determine patient coverage and limitations.
- Reviewed patient deductibles and copays and entered into billing system.
- Verified insurance coverage and eligibility prior to appointments and procedures.
- Followed established verification processes to confirm insurance benefits, medical necessity, and authorization.
- Addressed and resolved issues identified by billing staff related to eligibility and coverage.
- Processed pre-authorizations for medical services according to established guidelines.
- Calculated estimated patient financial responsibility via estimation tool.
- Transmitted correspondence and medical records by mail, e-mail and fax.
- Analyzed patient records and accurately coded diagnoses and procedures according to ICD-10 guidelines.
- Handled third-party billing, collection, and reimbursements.
- Assisted with answering telephone to provide requested billing information.
- Verified that medical procedures were medically necessary and within insurance coverage guidelines.
Intake Representative
CVS Health
03.2016 - 07.2020
- Answered telephones and directed calls to appropriate staff.
- Collaborated closely with doctors, nurses and other staff members to ensure smooth operations within the practice.
- Scheduled and confirmed patient diagnostic appointments, surgeries, and medical consultations.
- Scheduled tests and procedures for patients, such as lab work and x-rays, based on physician orders.
- Completed documents, case histories, and forms, such as intake and insurance forms.
- Scheduled and coordinated patient intake appointments, verifying insurance coverage and obtaining necessary authorizations.
- Determined patient eligibility by reviewing patient documentation for completeness and accuracy.
- Demonstrated excellent organizational skills when coordinating multiple tasks simultaneously within tight timelines.
- Completed detailed intake paperwork including assessment forms, clinical notes and other required documents in a timely manner.
- Confirmed and scheduled appointment dates and times with physicians' offices.
- Maintained database of employee contact information, shift preferences, and availability records.
- Scheduled lab work or diagnostic tests for patients based on physician orders.
Certified Nursing Assistant
The Grove Of La Grange Park
01.2014 - 01.2016
- Assisted patients with personal hygiene tasks, such as bathing and dressing, while maintaining respect for patient privacy and dignity.
- Delivered direct care to patients, assisting with bathing, feeding, and grooming tasks.
- Completed daily documentation and charts regarding patient care and input reports into practice databases.
- Followed HIPAA regulations to maintain confidentiality of sensitive medical and personal information.
- Prepared residents for meals and assisted with feeding.
- Provided quality care to elderly patients in a long-term care facility setting.
- Measured patient vital signs, recording body temperature, blood pressure, and heart rate.
- Demonstrated strong communication skills when interacting with patients, families, and healthcare professionals.
- Utilized PPE appropriately and followed patient safety and infection control guidelines.
- Helped maintain a positive environment by providing encouragement and support to residents.
- Utilized safe lifting techniques to transfer patients from bed to wheelchair or other mobility devices.
- Lifted and repositioned nonambulatory patients to prevent accidents and falls.
- Provided emotional support and companionship to residents during times of distress.
- Answered call lights to provide emergency treatment and assistance to patients.
- Observed changes in patient status and response and immediately communicated concerns to nursing staff.
Education
Certification - Nursing
Triton College
05.2014
HS Diploma -
Proviso West High School
05-2011
Skills
- Microsoft office
- Customer service
- Critical thinking
- Data entry
- Customer relations
- Computer proficiency
- Microsoft Excel
- Professional telephone demeanor
- Microsoft outlook
- Scheduling
- Follow-up skills
- Call management
- Administrative support
- Microsoft PowerPoint
- Patient confidentiality
- Call center experience
- Insurance verification
- Medical terminology
- Data entry proficiency
- Healthcare industry
- Teamwork and collaboration
- Attention to detail
- Multitasking Abilities
- Adaptable and flexible
- Reliability
- Excellent communication
- Organizational skills
- HIPAA compliance
- Verbal and written communication
- Patient education
- Electronic health records
- Clinical documentation
- Office administration
- Insurance authorizations
- Medical charting
- Patient health information Access
- Epic systems
- Patient eligibility requirements
- Medical records verification
- Patient referral
- Insurance benefits verification
- Insurance coverage verification
- Availity
- Emdeon
- Aetna
- Caremark
- Medicaid/Medicare
- Federal Insurance
- Insurance claims review
- Claims investigation
- Denied claims identification
- Prior authorization processing
- Authorizations
- ICD and CPT coding
- HCPCS coding
Certification
- CNA - Certified Nursing Assistant
Timeline
Customer Service and Claims Representative
Group Administrators
10.2024 - 03.2025
Customer Service Administrator
Urology Comprehensive Care
07.2024 - 10.2024
Medical Biller and Coder
Superior Ambulance
01.2024 - 06.2024
Benefits Verification Representative
CVS Health
07.2020 - 12.2023
Intake Representative
CVS Health
03.2016 - 07.2020
Certified Nursing Assistant
The Grove Of La Grange Park
01.2014 - 01.2016
HS Diploma -
Proviso West High School
Certification - Nursing
Triton College
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