Tammy Brown
Cleveland,TN
Summary
Hardworking, Reliable Insurance Coordinator with 6 years background in a ASC setting. Expertise in securing authorizations and pre-certifications. Proficient in medical terminology and CPT, ICD-9 and ICD-10, and HCPCS coding. Well-versed in Medicare, Medicaid, HMO and PPO insurance requirements.
Overview
20
20
years of professional experience
Work History
Insurance Coordinator
Surgery Center Of Cleveland
09.2017 - 10.2023
- 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.
- Prepared insurance claims for submission to clearinghouses or insurance companies.
- Maintained compliance with local, state and federal regulations governing insurance, Medicare and Medicaid requirements.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- 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.
- Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Verified client information by analyzing existing evidence on file.
- Calculated adjustments, premiums and refunds.
- Communicated verification and authorization status updates with administration department to facilitate decision-making for patient admissions and insurance coverage.
- Checked documentation for accuracy and validity on updated systems.
- Determined appropriateness of payers to protect organization and minimize risk.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
- Verified patient insurance coverage and benefits for medical claims.
- Identified and resolved discrepancies between patient information and claims data.
- Utilized electronic medical record systems to store, retrieve and process patient data.
- Input data into computer programs and filing systems.
- Communicated effectively with staff, patients, and insurance companies by email and telephone.
- Maintained accuracy, completeness, and security for medical records and health information.
- Verified accuracy of patient information in medical records.
- Followed exact procedures for handling transfers and other releases of medical records.
Medical Billing and Coding
Cleveland Family Physicians
06.2006 - 05.2017
- Skilled at working independently and collaboratively in a team environment.
- Self-motivated, with a strong sense of personal responsibility.
- Proven ability to learn quickly and adapt to new situations.
- Worked well in a team setting, providing support and guidance.
- Worked effectively in fast-paced environments.
- Demonstrated respect, friendliness and willingness to help wherever needed.
- Excellent communication skills, both verbal and written.
- Passionate about learning and committed to continual improvement.
- Proved successful working within tight deadlines and a fast-paced environment.
- Strengthened communication skills through regular interactions with others.
- Used critical thinking to break down problems, evaluate solutions and make decisions.
- Developed and maintained courteous and effective working relationships.
- Identified issues, analyzed information and provided solutions to problems.
- Participated in team projects, demonstrating an ability to work collaboratively and effectively.
- Cultivated interpersonal skills by building positive relationships with others.
- Communicated with insurance companies to research and resolved coding discrepancies.
- Utilized active listening, interpersonal, and telephone etiquette skills when communicating with others.
- Monitored changes in coding regulations to provide recommendations for compliance.
- Reviewed patient charts to better understand health histories, diagnoses, and treatments.
- Resourcefully used various coding books, procedure manuals, and on-line encoders.
- Reviewed, analyzed, and managed coding of diagnostic and treatment procedures contained in outpatient medical records.
- Interacted with physicians and other healthcare staff to ask questions regarding patient services.
- Reviewed outpatient records and interpreted documentation to identify diagnoses and procedures.
Medical Assistant
Cleveland Family Physicians
06.2006 - 05.2017
- Sanitized, restocked, and organized exam rooms and medical equipment.
- Directed patients to exam rooms, fielded questions, and prepared for physician examinations.
- Obtained client medical history, medication information, symptoms, and allergies.
- Performed medical records management, including filing, organizing and scanning documents.
- Collected and documented patient medical information such as blood pressure and weight.
- Called and faxed pharmacies to submit prescriptions and refills.
- Documented vital signs and health history for patients in clinic and hospital environments.
- Scheduled appointments, registered patients, and distributed sample pharmaceuticals as prescribed.
- Assisted with routine checks and diagnostic testing by collecting and processing specimens.
- Completed clinical procedures and gathered patient data for interpretation by physician.
- Assisted physicians with minor surgeries, including preparing operating room and sterilizing instruments.
- Taught patients about medications, procedures, and care plan instructions.
- Verified patient insurance coverage and collected required co-payments.
- Obtained and documented patient medical history, vital signs and current complaints at intake.
- Answered telephone calls to offer office information, answer questions, and direct calls to staff.
- Completed EKGs and other tests based on patient presentation in office.
- Prepared lab specimens for diagnostic evaluation.
- Explained procedures to patients to reduce anxieties and increase patient cooperation.
- Oriented and trained new staff on proper procedures and policies.
- Measured patient pulse oximetry.
- Helped improve patient outcomes by educating and advising on relevant treatments and care.
- Liaised with patients and addressed inquiries, appointment requests and billing questions.
- Measured patient spirometry.
- Implemented care and efficiency improvements to support and enhance office operations.
Certified Nursing Assistant
Life Care Center
03.2004 - 06.2006
- Answered call lights and supported patient comfort and safety by adjusting bed rails and equipment.
- Promoted good oral and personal hygiene by aiding patients with shaving, bathing, and teeth brushing.
- Checked patient vitals such as temperature, blood pressure, and blood sugar levels.
- Assisted with feeding and monitored intake to help patients achieve nutritional objectives.
- Utilized therapeutic communication, empathy and active listening skills to encourage and develop positive relationships with patients.
- Delivered individualized patient care by recording vital signs, documenting observations, administering treatments, and evaluating patient needs.
- Cared for residents in assisted living facility and delivered high-quality support to meet needs.
- Cared for clients with diagnoses such as respiratory failure, diabetes, Parkinson's disease and muscular dystrophy.
- Participated in fun group activities with patients to boost mood, improve overall memory, and provide light entertainment.
- Offered immediate assistance in emergency and routine paging situations to evaluate needs and deliver care.
- Supported ambulation and physical therapy needs by conducting planned exercise routines.
- Evaluated patients to identify and address wounds, behavioral concerns, and medically relevant symptoms.
- Completed activities of daily living for patients unable to self-care, and assisted those with limited mobility in completing tasks.
- Changed linens in rooms, keeping spaces fresh and clean for patient health and satisfaction.
- Helped patients with self-feeding and assisted feeding, based on individual needs.
- Assisted nursing staff with completing daily rounds, documenting vital signs and answering calls.
- Maintained patient stability by checking vital signs and weight and recording intake and outtake information.
- Helped patients complete range of motion exercises to prevent loss of function during care.
- Upheld infection control and prevention policies across different patient-facing areas.
- Reduced risks of patient infection and cross-contamination by cleaning and sterilizing equipment.
Education
No Degree - CDA
Cleveland State Community College
Cleveland, TNHigh School Diploma -
Bradley Central High School
Cleveland, TN06.1991
Skills
- Insurance Verification
- Medicare and Medicaid Knowledge
- File and Records Management
- Customer Service and Assistance
- Insurance Processes
- Payment Planning
- Claims
- Insurance Claims Processing
- Medical Billing and Coding
- Strategic Thinking Skills
- ICD-10 Coding
- Accounts Receivable
- CPT Coding
- Teamwork and Collaboration
- Eligibility Determination
- Data Entry
- Customer Service
- Medicaid Knowledge
- Proficient in Microsoft Office, Word, Excel Outlook
- Verbal and Written Communication
- Critical Thinking
- Data Entry Software
- Attention to Detail
- Understanding of Medical Terms
- Prior Authorization Processing
- Decision-Making
- Billing Software
- Coverage Determination
- Reporting Skills
- Medical Terminology
- Claims Processing
- Patient Contact
- Insurance Coverage Verification
- Documentation Abilities
- Denied Claims Identification
- Information Verification
- Documentation Processing
- Telephone Etiquette
Timeline
Insurance Coordinator
Surgery Center Of Cleveland
09.2017 - 10.2023
Medical Billing and Coding
Cleveland Family Physicians
06.2006 - 05.2017
Medical Assistant
Cleveland Family Physicians
06.2006 - 05.2017
Certified Nursing Assistant
Life Care Center
03.2004 - 06.2006
No Degree - CDA
Cleveland State Community College
High School Diploma -
Bradley Central High School
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