Rickey Jones
Humble,TX
Summary
Equipped with strong problem-solving abilities, willingness to learn, and excellent communication skills. Poised to contribute to team success and achieve positive results. Ready to tackle new challenges and advance organizational objectives with dedication and enthusiasm.
Overview
5
5
years of professional experience
Work History
Patient Access Service Representative
HCA
03.2024 - Current
- Confirmed insurance eligibility, benefits, and authorizations through payer portals, phone verification, and internal systems to facilitate patient access.
- Handled high-volume inbound and outbound calls from patients, providers, and insurance carriers to efficiently schedule appointments, verify insurance coverage, and convey benefit information.
- Coordinated with clinical departments, scheduling teams, and referral coordinators to ensure smooth patient access and service delivery.
- Addressed patient inquiries regarding billing statements, payment plans, and prior authorizations with empathy and professionalism to enhance patient experience.
Prior Authorization Representative
BroadPath Healthcare
02.2022 - 03.2024
- Managed high-volume inbound and outbound calls to verify insurance coverage and secure prior authorizations for medical services, diagnostic tests, and prescriptions, ensuring timely patient care.
- Collaborated with physicians, clinical staff, and schedulers to collect essential documentation, including medical necessity and referral information, facilitating efficient authorization processes.
- Entered and updated insurance information, authorization numbers, and patient demographics accurately in EMR/EHR and billing systems.
- Interpreted EOBS, payer guidelines, and policy requirements to address coverage issues, denials, or authorization rejections, improving overall approval rates.
Benefits Specialist/Medicare Enrollment Specialist
Randstad
05.2021 - 02.2022
- Managed high-volume inbound and outbound calls from Medicare beneficiaries, caregivers, and providers to clarify plan options, benefits, and enrollment processes.
- Educated members on Medicare Advantage, Medicare Part D, and supplemental plan features, ensuring understanding of eligibility requirements and coverage details in compliance with CMS guidelines.
- Provide guidance on prescription drug coverage, co-pays, premiums, deductibles, and out-of-pocket expenses.
- Guided members on prescription drug coverage, co-pays, premiums, deductibles, and out-of-pocket expenses to enhance their understanding of plan benefits.
Education
High School Diploma -
Klein Collins High School
Spring, TXSkills
- Patient eligibility verification
- Authorization
- Claims processing
- CPT and ICD coding
- Revenue cycle management
- Epic
- Athenahealth
- Patient Call Management
- Customer satisfaction
- Referral coordination
- Eligibility determinations
- Insurance verification
- Coverage and authorizations
- Claims Review
- Medical billing
- Appointment coordination
- Inbound/Outbound Calling
- Customer service
- Medicare expertise
- Patient confidentiality
Timeline
Patient Access Service Representative
HCA
03.2024 - Current
Prior Authorization Representative
BroadPath Healthcare
02.2022 - 03.2024
Benefits Specialist/Medicare Enrollment Specialist
Randstad
05.2021 - 02.2022
High School Diploma -
Klein Collins High School