Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic

Scott Venus

Disability Claims Consultant
Atlanta,GA

Summary

Friendly disability claims consultant experienced in eligibility and enrollment. Hardworking and communicative individual excels at eligibility and enrollment with federal and state agencies as well as post application follow-up and credentialing. Recognized for patient advocacy, providing optimum service to claimants and quickly identifying resolution for final disposition on claims.

Overview

13
13
years of professional experience
1
1

HFMA Certified Patient Accounts Rep

1
1

HFMA Patient Financial Counseling

1
1

Lean Six Sigma Yellow Belt

Work History

Claims Consultant

Allsup Inc.
12.2022 - Current
  • Maintain knowledge of policies and procedures and qualifiers for social insurance programs for the purpose of enrolling eligible consumers for cash and healthcare benefits
  • Communicate with other departments to establish action plans for filed applications resolution
  • Resolve claims by evidence gathering, documentation, progress tracking and determining medical viability of the claim
  • Document specific claims by completing medical updates, medical questionnaires, and administrative forms needed to satisfy non-medical requirements for Social Security Disability
  • Pre-screen, research, and review information to determine insurability, medical viability of claims to garner a favorable decision for the claimant and third-party insurers
  • Plan and conduct intake interviews of claimants to confirm medical eligibility and compensability
  • Conduct follow-up with federal/state agencies to track progress of Social Security Disability Insurance applications
  • Review and close all applications that have been determined ineligible for social insurance benefits
  • Retrieve medical updates from claimants and provide information to the disability determination section to include with medical evidence for claimants.

Resolutions Specialist

Change Healthcare
01.2017 - 10.2019
  • Fostered relationships with Department of Family and Children Services and Social Security Administration to quickly resolve issues effecting application registration, standard of promptness and delays in disposition
  • Assisted patients (clients) in resolving medical account issues by identifying and taking appropriate actions including contacting the agency, completing required forms to support application process, and filing appeals for application that were denied incorrectly
  • Effectively educated and answered inquiries from patients (clients) and family representatives regarding the application process
  • Completed case management follow up by identifying, collecting, and submitting required financial, medical, and personal information to support the eligibility and enrollment process at state and federal agencies
  • Identified appropriate escalation points and worked with leadership as necessary to resolve issues
  • Processed and mailed medical records to the state and federal agencies to make disability determination for patients assigned to caseload.

Resolve Application Specialist

Change Healthcare
01.2015 - 12.2016
  • Responsible for interviewing, training, and leading Client Support Specialist
  • Consulted with Senior Leaders about trouble areas to drive revenue and reduced aged inventory
  • Monitored weekly reports to ensure timely follow-up on pending applications
  • Drive performance to increase revenue and make sure team members were aware of objectives, key results, and expected growth targets
  • Developed and monitored departmental budget.

Quality Assurance Analyst

Change Healthcare
01.2011 - 12.2014
  • On a monthly basis performed audits on healthcare representatives at the hospital site identified, screened, and enrolled eligible patients in the appropriate Medicaid insurance program at the state and federal agencies
  • Acted as an advisor to suggest improving opportunities to help accelerate revenue for the hospital
  • Collaborated with District Managers to create performance management processes and improvement plans based on Medicaid/Medicare application quality
  • Performed weekly audits and reported findings to stakeholders detailing approval/denial trends in the application taking and how revenue goals were impacted
  • Conducted monthly meetings with contracted providers to discuss how to better advocate for patients, improve revenue recovery and use technology to shorten processing times for the Medicaid/Medicare applications.

Education

Bachelor of Arts - Social Work

Northwestern State University of Louisiana
Natchitoches, LA
12.1992

Skills

  • Information Confidentiality
  • Active Listening
  • Client Interviewing
  • Team Collaboration
  • Decision Making
  • Report and Records Review
  • Sourcing and Compiling Information

Critical Thinking

  • Advocacy and Negotiation
  • Time Management and Organization
  • Empathy and Compassion
  • Culture Competence
  • Documentation and Record Keeping
  • Disability Law and Policies

Certification

Certified Patient Accounts Representative

Certified Patient Financial Counselor

Lean Six Sigma Yellow Belt

Timeline

Claims Consultant

Allsup Inc.
12.2022 - Current

Resolutions Specialist

Change Healthcare
01.2017 - 10.2019

Resolve Application Specialist

Change Healthcare
01.2015 - 12.2016

Quality Assurance Analyst

Change Healthcare
01.2011 - 12.2014

Bachelor of Arts - Social Work

Northwestern State University of Louisiana

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Scott VenusDisability Claims Consultant