Summary
Overview
Work History
Education
Skills
Relocation
Experience
Personal Information
Timeline
BusinessAnalyst

Sue Robledo

Insurance Verification/Pre-Authorization
Tx

Summary

Pragmatic Insurance Verification Specialist touting 15+ years of expertise in benefits explanation and coverage tracking. A team player with a vast knowledge of medical terms and working with all types of personalities effectively. Offering dynamic organizational skills and attention to detail.

Overview

16
16
years of professional experience

Work History

Insurance Verification Specialist

IRhythm Technologies Inc.
05.2023 - 12.2023
  • Perform claims integrity by researching and identifying insurance information for the member
  • Verify patient/claimant information, the payer network, in- or out-of-network status, research any/all information to determine coverage levels- to include calling insurance providers or accounts when necessary
  • Provide updates on any/all benefits investigations related to the member's financial responsibility (such as co-pays, co-insurance)
  • Perform order entry - update records with complete patient and insurance information
  • Comfortable and capable of utilizing various communication tools, including IM and video conferencing, to enable virtual work collaboration
  • Deliver on challenging work objectives, including meeting daily, weekly and /or monthly productivity metrics
  • Produce high-quality, high-volume work by leveraging self-motivation and initiative in a remote work environment
  • Assist AR Team by consolidating and finding errors in rejected claims obtained over $32,000.00 in revenue in a 12 week time period
  • Increased patient satisfaction by promptly addressing concerns regarding insurance coverage or billing issues.
  • Collaborated with team members to resolve discrepancies in insurance verification, ensuring proper billing practices.
  • Ensured compliance with HIPAA regulations while managing sensitive patient information during the verification process.
  • Optimized productivity within the department by prioritizing tasks according to urgency and importance levels.
  • Contributed to company''s bottom line by reducing write-offs due to incorrect or outdated insurance information through diligent verification efforts.
  • Demonstrated a high level of professionalism and attention to detail in all aspects of insurance verification specialist role, consistently exceeding performance expectations.
  • Assisted patients with understanding personalized insurance coverage and benefits.
  • Made contact with insurance carriers to discuss policies and individual patient benefits.
  • Updated patient records with accurate, current insurance policy information.
  • Enhanced claim processing efficiency by verifying insurance coverage and obtaining pre-authorizations for procedures.
  • Reduced errors in billing by accurately maintaining patient records with updated insurance information.

Insurance Verification Representative

Aspire Allergy & Sinus
03.2019 - 02.2023
  • Improved efficiency by streamlining insurance verification processes for patient intake.
  • Enhanced customer satisfaction with prompt and accurate insurance verifications for medical services.
  • Reduced claim denials by thoroughly reviewing patient eligibility and coverage details.
  • Facilitated timely patient care by verifying insurance benefits prior to appointments.
  • Maintained up-to-date knowledge of insurance policies, regulations, and industry trends to provide accurate information to clients.
  • Resolved discrepancies in insurance claims by efficiently communicating with patients and carriers.
  • Contributed to office productivity by managing high volumes of inbound calls for insurance verifications.
  • Prevented revenue loss by identifying potential coverage issues and informing appropriate parties in a timely manner.
  • Expedited service delivery by promptly addressing questions from patients, providers, and insurers regarding coverage details or policy changes.
  • Assisted in training new hires on best practices for conducting thorough insurance verifications within established company guidelines.
  • Increased overall accuracy of billing department''s work through close collaboration with colleagues on complex cases requiring additional research or clarification on coverage specifics.
  • Boosted team morale by fostering a supportive work environment that encouraged open communication among colleagues about challenges faced during the verification process.
  • Contributed to company growth by consistently meeting performance metrics for speed, accuracy, and client satisfaction in the insurance verification process.
  • Updated patient records with accurate, current insurance policy information.
  • Made contact with insurance carriers to discuss policies and individual patient benefits.
  • Assured timely verification of insurance benefits prior to patient procedures or appointments.
  • Complied with HIPAA guidelines and regulations for confidential patient data.
  • Trained new staff on current, correct insurance verification procedures.
  • Assisted patients with understanding personalized insurance coverage and benefits.
  • Asked to be a voice over representing our practice and introducing our name change throughout Texas.

Insurance Verification Specialist

Citizens Medical Center
10.2016 - 03.2019
  • Responsible for Verification of insurance benefits for NICU babies, all inpatient surgeries, all inpatients, all observation patients, and maternity mom's being admitted for delivery or pregnancy related complications
  • Responsible for contacting insurance companies to begin the authorization process and get fax numbers for case managers to send medical records.
  • Enhanced claim processing efficiency by verifying insurance coverage and obtaining pre-authorizations for procedures.
  • Reduced errors in billing by accurately maintaining patient records with updated insurance information.
  • Improved communication between medical staff and patients by explaining insurance benefits and financial responsibilities.
  • Streamlined workflow for medical providers by obtaining necessary referrals and authorizations for services.
  • Increased patient satisfaction by promptly addressing concerns regarding insurance coverage or billing issues.
  • Collaborated with team members to resolve discrepancies in insurance verification, ensuring proper billing practices.
  • Maintained up-to-date knowledge of industry trends, changes in regulations, and benefit updates to provide accurate guidance to clients.
  • Ensured compliance with HIPAA regulations while managing sensitive patient information during the verification process.
  • Assisted in training new employees on best practices for efficient insurance verification processes and procedures.
  • Optimized productivity within the department by prioritizing tasks according to urgency and importance levels.
  • Minimized delays in treatment scheduling by promptly identifying potential coverage issues and working proactively towards their resolution.
  • Developed strong relationships with insurance representatives, facilitating smooth communication channels for resolving inquiries or disputes.
  • Contributed to company''s bottom line by reducing write-offs due to incorrect or outdated insurance information through diligent verification efforts.
  • Negotiated payment plans on behalf of clients facing financial hardship, helping them access necessary healthcare services without undue burden.
  • Implemented improvements to existing verification processes, increasing accuracy rates while reducing time spent on manual tasks.
  • Coordinated with care teams across various departments to ensure seamless integration of verified coverage information into overall treatment planning.
  • Demonstrated a high level of professionalism and attention to detail in all aspects of insurance verification specialist role, consistently exceeding performance expectations.
  • Complied with HIPAA guidelines and regulations for confidential patient data.
  • Assisted patients with understanding personalized insurance coverage and benefits.
  • Assured timely verification of insurance benefits prior to patient procedures or appointments.
  • Made contact with insurance carriers to discuss policies and individual patient benefits.
  • Managed high-volume insurance verifications within pressured timeframes for productive medical operations.
  • Achieved insurance pre-authorizations to enable timely patient procedures.
  • Updated patient records with accurate, current insurance policy information.
  • Trained new staff on current, correct insurance verification procedures.
  • Answered telephone calls to offer office information, answer questions, and direct calls to staff.
  • Established and maintained relationships with insurance providers for productive communications.
  • Posted payments to accounts and maintained records.
  • Obtained payments from patients and scanned identification and insurance cards.
  • Greeted and interacted with patients to provide information, answer questions and assist with appointment scheduling.
  • Greeted visitors and initiated triage processes for clients to streamline patient flow.

Insurance Verification Representative

DeTar Hospital Victoria
09.2014 - 10.2016
  • Responsible for verifying insurance and eligibility of all inpatient and observation patients for a 250 bed hospital
  • Improved efficiency by streamlining insurance verification processes for patient intake.
  • Enhanced customer satisfaction with prompt and accurate insurance verifications for medical services.
  • Reduced claim denials by thoroughly reviewing patient eligibility and coverage details.
  • Maintained up-to-date knowledge of insurance policies, regulations, and industry trends to provide accurate information to clients.
  • Resolved discrepancies in insurance claims by efficiently communicating with patients and carriers.
  • Contributed to office productivity by managing high volumes of inbound calls for insurance verifications.
  • Ensured regulatory compliance by maintaining confidentiality of sensitive patient information during the verification process.
  • Prevented revenue loss by identifying potential coverage issues and informing appropriate parties in a timely manner.
  • Supported efficient workflow within the office by organizing verification documents and maintaining electronic records systems.
  • Promoted positive client relationships through empathetic communication and meticulous attention to detail during the verification process.
  • Expedited service delivery by promptly addressing questions from patients, providers, and insurers regarding coverage details or policy changes.
  • Assisted in training new hires on best practices for conducting thorough insurance verifications within established company guidelines.
  • Demonstrated commitment to professional development by attending industry conferences, workshops, and webinars focused on current trends in health insurance management strategies.
  • Boosted team morale by fostering a supportive work environment that encouraged open communication among colleagues about challenges faced during the verification process.
  • Streamlined internal communications between departments through effective use of email, phone calls, and in-person meetings to discuss insurance verification updates or concerns.
  • Contributed to company growth by consistently meeting performance metrics for speed, accuracy, and client satisfaction in the insurance verification process.
  • Updated patient records with accurate, current insurance policy information.
  • Made contact with insurance carriers to discuss policies and individual patient benefits.
  • Complied with HIPAA guidelines and regulations for confidential patient data.
  • Trained new staff on current, correct insurance verification procedures.
  • Assisted patients with understanding personalized insurance coverage and benefits.

Government Billing Specialist/Customer Service Representative

The Boon Group Austin
02.2008 - 03.2012
  • Strengthened relationship with customers and employers by handing escalated/irate callers
  • Responsible for ensuring proper calculation of monthly health insurance premiums due
  • Assisted with billing inquiries and provided timely responses to enhance customer satisfaction.
  • Optimized AR for all government accounts
  • Ensured compliance with industry regulations by staying up-to-date on changes in billing rules and guidelines.
  • Provided excellent customer service, developing and maintaining client relationships.
  • Enhanced customer satisfaction with timely and accurate invoice generation.
  • Used data entry skills to accurately document and input statements.
  • Responsible for handling of incoming calls and proper calculation of monthly premiums.
  • Responded to customer concerns and questions on daily basis.
  • Within 6 months promoted to team lead
  • Collaborated with customers to resolve disputes.
  • After 2 years promoted to Government billing specialist
  • Maintained accurate records of customer payments.
  • Produced and mailed monthly statements to customers and assisted with related requests for information and clarification.

Education

No Degree - Nursing

Austin Community College
Austin, TX

No Degree - Religious Studies

Austin Graduate School of Theology
Austin, TX

Skills

  • Insurance Verification (15 years)
  • Microsoft Office (15 years)
  • Microsoft Excel (15 years)
  • Hipaa (15 years)
  • Customer Service Skills (30 years)
  • Phone Etiquette (30 years)
  • Excellent Communication Skills (30 years)
  • Team Player (30 years)
  • Health Insurance (15 years)
  • Social Work (4 years)
  • Hospital Experience (7 years)
  • Team Leadership (5 years)
  • Medical Terminology (10 years)
  • Case Management (5 years)
  • EMR Systems (15 years)
  • Salesforce (1 year)
  • ICD-10 (15 years)
  • Medical Scheduling (4 years)
  • Business Requirements (15 years)
  • Patient Contact
  • Data Security and Confidentiality
  • Prior Authorization Processing
  • Attention to Detail
  • Eligibility Determination
  • Communication and Interpersonal Skills
  • Coverage and Authorizations
  • Medical Terminology
  • Patient Rapport
  • Customer Relationship Management
  • Understanding of Medical Terms
  • Data Entry and Review
  • Coordination and Scheduling
  • Proficient in Salesforce, NextGen, Meditech
  • Medicaid Knowledge
  • Patient Communication
  • Financial Counseling
  • Accuracy and Precision
  • Active Listening
  • Policy Interpretation
  • Time Management
  • Organizational Skills
  • Telephone Etiquette
  • Conflict Resolution
  • Critical Thinking
  • Follow-up Procedures
  • Multitasking Abilities
  • Insurance Knowledge
  • Decision Making
  • Microsoft Office Suite
  • Healthcare Industry Knowledge
  • Patient Eligibility Requirements
  • Appointment Setting
  • Payment Scheduling and Collection
  • Organization and Time Management
  • Payment Plan Options

Relocation

  • San Antonio, TX


Experience

Insurance Verification Specialist 15+ years experience

Personal Information

Work Permit: Authorized to work in the US for any employer

Timeline

Insurance Verification Specialist

IRhythm Technologies Inc.
05.2023 - 12.2023

Insurance Verification Representative

Aspire Allergy & Sinus
03.2019 - 02.2023

Insurance Verification Specialist

Citizens Medical Center
10.2016 - 03.2019

Insurance Verification Representative

DeTar Hospital Victoria
09.2014 - 10.2016

Government Billing Specialist/Customer Service Representative

The Boon Group Austin
02.2008 - 03.2012

No Degree - Nursing

Austin Community College

No Degree - Religious Studies

Austin Graduate School of Theology

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Sue RobledoInsurance Verification/Pre-Authorization