Robin Renee Burns
205 Chelsey Ave Bear Branch,KY
Summary
Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals. To seek and maintain full-time position that offers professional challenges utilizing interpersonal skills, excellent time management and problem-solving skills.
Overview
22
22
years of professional experience
Work History
Authorization Specialist
Marshfield Health Systems
06.2021 - Current
- Improved patient satisfaction by streamlining authorization processes and ensuring timely responses to inquiries.
- Enhanced departmental efficiency with thorough knowledge of insurance guidelines and medical terminology.
- Collaborated with healthcare providers to obtain necessary documentation for prior authorization requests.
- Reduced processing times by effectively managing a high volume of authorizations, referrals, and appeals.
- Maintained compliance with HIPAA regulations, safeguarding sensitive patient information during the authorization process.
- Increased accuracy by diligently reviewing and verifying patient eligibility, coverage, and benefits information.
- Developed strong relationships with insurance representatives to expedite approvals and resolve issues promptly.
- Contributed to revenue growth by identifying opportunities for additional services requiring authorization within the organization.
- Promoted positive customer experiences by addressing concerns or questions related to authorizations in a professional manner.
- Optimized workflow processes through effective communication between departments regarding authorization needs and statuses.
- Prevented delays in care delivery by proactively identifying potential issues during the pre-authorization process and seeking clarification from providers when needed.
- Contributed to team goals by consistently meeting or exceeding individual productivity targets for processing authorization requests.
Insurance Coordinator
Manchester Memorial Hospital
05.2003 - 09.2020
- Enhanced customer satisfaction by efficiently handling insurance claims and processing policy updates.
- Streamlined office workflows for increased productivity, organizing and maintaining client files.
- Coordinated communication between clients, adjusters, and repair facilities during the claims process.
- Conducted thorough policy reviews, identifying gaps in coverage and offering appropriate solutions.
- Assisted clients with understanding complex insurance policies, effectively addressing concerns or questions.
- Managed a high volume of inbound calls, promptly resolving issues while providing accurate information on policies and procedures.
- Monitored industry trends to ensure knowledge of market changes and compliance with regulations.
- Developed strong relationships with carriers, leveraging partnerships for better negotiation outcomes in coverage options.
- Mentored new hires within the department, sharing best practices and fostering team cohesion.
- Stayed updated on current industry news through regular attendance at conferences and seminars.
- Verified insurance and communicated coverage to staff and patients.
- Obtained data such as patient, insurance ID, insurance provider and medical codes to properly file insurance claims.
- Obtained prior authorization and precertification for outpatient procedures.
- Maintained compliance with local, state and federal regulations governing insurance, Medicare and Medicaid requirements.
- Trained numerous staff on current Medicare regulations and guidelines.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- Prepared insurance claim forms or related documents and reviewed for completeness.
- Assured timely verification of insurance benefits prior to patient procedures or appointments.
- Communicated effectively with staff members of operations, finance and clinical departments.
- Maintained confidentiality of patient finances, records, and health statuses.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Verified client information by analyzing existing evidence on file.
- Communicated verification and authorization status updates with several departments to facilitate decision-making for patient admissions and insurance coverage.
- Checked documentation for accuracy and validity on updated systems.
- Coordinated with contracting department to resolve payer issues.
Pre Registration/Registration Clerk
Manchester Memorial Hospital
05.2002 - 05.2004
- Accurately collected and verified patient demographic information for seamless recordkeeping.
- Maintained strict confidentiality of sensitive patient information in compliance with HIPAA regulations.
- Reduced errors in insurance verification, ensuring accurate billing and timely payments from insurance companies.
- Collaborated with hospital staff to ensure smooth transitions between departments and services for patients.
- Served as a liaison between patients, clinical staff, and administrative personnel to facilitate optimal communication and coordination of care.
- Assisted patients with questions or concerns about their appointments, addressing any issues promptly and professionally.
- Managed high call volumes while accurately scheduling appointments and directing calls to appropriate departments as needed.
- Provided training to new registration clerks on policies, procedures, and best practices for maintaining an efficient workflow within the department.
- Completed registration paperwork, verifying accurate patient information.
- Updated patient contact information to support accurate electronic medical records.
- Answered patient questions and inquiries regarding registration process and documentation.
- Scheduled patient appointments, collected copays and verified insurance coverage to complete check-ins.
- Verified insurance benefits and obtained pre-authorizations before any medical procedures were performed.
- Assisted other clerks with front desk duties, answering questions and accurately using reservation system.
- Entered patient information into payment system accurately for billing purposes.
- Explained form wording to patients to help each understand information required.
- Upheld HIPAA regulations and standards for protecting patient information.
- Retrieved medical data for physicians and patients.
- Secured confidential patient information from unauthorized access.
Education
High School Diploma -
Leslie County High School
Hyden, KY05.1993
Skills
- Critical Thinking
- HIPAA Compliance
- Resourcefulness
- Attention to Detail
- Computer Literacy
- Continuous Learning
- Medical Terminology Expertise
- Multitasking Capabilities
- Organizational Skills
- Data Entry Proficiency
- Interpersonal Skills
- Problem Solving Abilities
- Active Listening
- Professionalism
- Prior Authorization Processing
- Insurance Verification
- Effective Communication
- Effective Communication Skills
Timeline
Authorization Specialist
Marshfield Health Systems
06.2021 - Current
Insurance Coordinator
Manchester Memorial Hospital
05.2003 - 09.2020
Pre Registration/Registration Clerk
Manchester Memorial Hospital
05.2002 - 05.2004
High School Diploma -
Leslie County High School
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