Pamela
South Jordan,UT
Summary
Professionally known for working closely with insurance companies to alleviate denied claims and obtain necessary prior approvals for services. Passionate about providing exceptional level of patient care and with sharp clinical skills. Experienced in both clinical and administrative settings. Experienced medical Insurance Specialist successful at managing high caseloads in fast-paced environments. Organized, driven and adaptable with excellent planning and problem-solving abilities. Offering 7 years of experience and willingness to take on any challenge.
Overview
6
6
years of professional experience
Work History
Insurance/Billing/Claims Specialist
Rocky Mtn MS Clinic
12.2021 - Current
- Managed changes in integrated health care delivery systems and technological innovations while keeping focus on quality of care.
- Contacted insurance carriers to obtain authorizations, notifications and pre-certifications for patients.
- Applied knowledge of Medicare, Medicaid and third-party payer requirements utilizing on-line eligibility systems to verify patient coverage and policy limitations.
- Coordinates and manages a high volume and wide range of patient referrals.
- Performed detailed medical reviews of prior authorization requests, following established criteria and protocols.
- Clearly document all communication and contacts with providers and personnel in standardized documentation requirements, including proper format.
- Made contact with insurance carriers to discuss policies and individual patient benefits. Assured timely verification of insurance benefits prior to patient procedures or appointments.
- Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
- Reviewed outstanding requests and redirected workloads to complete projects on time.
- Generated, posted and attached information to claim files. Worked with claims adjusters and examiners to expedite processing in alignment with procedures.
- Communicated effectively with staff members of operations, finance and clinical departments.
- Carried out administrative tasks by communicating with clients, distributing mail, and scanning documents.
Medical Assistant
Rocky Mtn MS Clinic
06.2017 - 12.2021
- Prepared treatment rooms for patients by cleaning surfaces and restocking supplies
- Interviewed and engaged patients to obtain medical history, chief complaints and vital signs
- Organized charts, documents and supplies to maintain team productivity
- Participated in team meetings to improve workflows and contribute to improving patient population outcomes
- Prioritizes (triage) patient needs identified through phone, electronic, and walk-in communication in accordance with established guidelines, standing orders, and protocols
- BLS Certified until 09/2023
Education
Medical Assistant Diploma -
Eagle Gate College
2016
Skills
- Financial Transactions
- EMR, CPT, ICD-10
- Attention to Detail
- Policy and Procedure Explanations
- Operational Efficiency and Active Listening
- Team Goals and Positive Attitude
- Confidential Records Management
- Organization and Time Management
Timeline
Insurance/Billing/Claims Specialist
Rocky Mtn MS Clinic
12.2021 - Current
Medical Assistant
Rocky Mtn MS Clinic
06.2017 - 12.2021
Medical Assistant Diploma -
Eagle Gate College
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