Shane Alonzo
Titusville,FL
Summary
Friendly Insurance Verification Specialist promoting a background in keeping sensitive patient data confidential while maintaining knowledge of Medicaid and private policy benefits. Possessing great relationship building and communication skills. Looking to tackle new challenges with a company that values dynamic skills and a strong work ethic.
Overview
6
6
years of professional experience
Work History
Claims Operational Auditor
Centene Corporation
Lakeland, FL
04.2023 - Current
- Analyzed statutory requirements for accuracy, completeness, and compliance with company policies and procedures.
- Monitored changes in state regulations pertaining to operational processing guidelines for variance's.
- Created audit memos to document audit findings resulting in audit recommendations, reports and claims audit criteria enhancements.
- Trained new employees on departmental rules, standards and job duties.
Lead Insurance Verification Specialist
Advance Recovery Systems
Orlando, FL
08.2019 - 04.2023
- Verified patient eligibility for insurance coverage by contacting insurance carriers and obtaining the necessary authorization numbers.
- Utilize CRM portals to communicate benefit information
- Identified discrepancies in patient's insurance coverage or benefits, ensuring accuracy of data entered into system.
- Researched third party payer guidelines related to prior authorizations, coding and billing processes.
- Employee payroll, scheduling/forecasting and PTO requests
- Manages hiring process by conducting resume reviews, interviews and hiring suggestions to upper management
- Evaluated policies and procedures related to Insurance Verification activities.
Medical Billing and Insurance Specialist
The Center for Bone and Joint Disease
, FL
07.2018 - 08.2019
- Obtain referrals and pre-authorizations for procedures
- Verify eligibility of insurance while coordinating with insurance companies regarding discrepancies
- Review and audit bills for accuracy
- Processing as per Medicare and Medicaid standards
- Research and appeal activities as per standards
- Responded promptly to customer inquiries about their policies and provided timely updates as needed.
Skills
- Electronic Medical Records
- Insurance plan verification
- Medicare/Medicaid knowledge
- HIPAA Compliance
Areas Of Practice
- Medical Insurance
- Management
- Medical Billing
- Claims
- Collections
- Customer Service
- Conflict Resolution
- Auditing
- Benefits Pre-authorization
- Budgeting
- CPT-4 codes
- Diagnostic Coding
- Medicaid
Timeline
Claims Operational Auditor
Centene Corporation
04.2023 - Current
Lead Insurance Verification Specialist
Advance Recovery Systems
08.2019 - 04.2023
Medical Billing and Insurance Specialist
The Center for Bone and Joint Disease
07.2018 - 08.2019
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