Tammy Himes
Dundalk,MD
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. Hands-on individual boasting a career spent managing administrative tasks in fast-paced offices with relative ease. A well-trained Insurance Verification Specialist offering a background in contacting insurance companies for critical information and crafting patient documents for billing purposes. Demonstrated knowledge of admissions, insurance verification and authorization processes in hospital and medical office settings. Outgoing patient access specialist with several years of experience working in the patient services arena. Exceptional knowledge of all procedures at medical facilities to multitask and prioritize work. A fast learner types several wpm and work with various field related software. Dedicated employee known for punctuality, pursuing employment options where good customer service and positive attitude will make a difference.
Overview
25
25
years of professional experience
Work History
Patient Access Specialist II
Johns Hopkins University
Baltimore, MD
07.2024 - Current
- Contributed to team meetings, sharing insights and strategies for improving patient access services.
- Verified demographics and insurance information to register patients in computer system.
- Demonstrated knowledge of coding systems used in healthcare setting for reimbursement purposes.
- Verified patients' insurance and payment methods during admissions or check-in processes.
- Responded to patient concerns and inquiries professionally and efficiently.
- Kept patient appointments on schedule by notifying providers of patients' arrival and reviewing service delivery compared to schedule.
- Educated patients about financial policies and procedures at facility; explained benefits of various payment options available.
- Verified patient insurance coverage, collected copays and other payments, processed credit card transactions.
- Utilized hospital systems to update patient records, ensuring accuracy and completeness.
- Provided directions and information to patients and families, enhancing their hospital experience.
- Applied HIPAA privacy and security regulations while handling patient information.
- Received patient inquiries or complaints and directed to appropriate medical staff members.
- Participated in training sessions to stay updated on healthcare policies and registration software.
- Explained policies, procedures and services to patients.
- Organized and maintained records by updating and obtaining both personal and financial information from patients.
Insurance Verification Specialist
Kennedy Krieger Institute
Baltimore, MD
07.2022 - Current
- Verified that patients had proper insurance coverage prior to procedures or appointment scheduling.
- Updated patient and insurance data and input changes into company computer system.
- Verified patient eligibility for insurance coverage by contacting insurance carriers and obtaining the necessary authorization numbers.
- Called insurance companies to ascertain pertinent information regarding policies and payment benefits for patients.
- Communicated with insurance carrier, patient and third party or employer to verify patient insurance benefits.
- Entered data in EMR database to record payer, authorization requirements and coverage limitations.
- Navigated through multiple online systems to obtain documentation.
- Accessed third-party insurance databases to identify coverage of benefits.
- Maintained accurate documentation on all pre-authorization requests, denials and appeals.
- Developed a working knowledge of insurance plans, including Medicare and Medicaid regulations and requirements.
- Contacted patients to confirm demographic information and communicate financial responsibilities.
- Checked documentation for appropriate coding, catching errors and making revisions.
- Identified discrepancies in patient's insurance coverage or benefits, ensuring accuracy of data entered into system.
- Reviewed medical records to ensure accuracy of required information needed for pre-authorization requests.
- Retained strong medical terminology understanding in effort to better comprehend procedures.
- Evaluated policies and procedures related to Insurance Verification activities.
- Interpreted Explanation of Benefits statements from various insurers and communicated relevant information with other departments as needed.
- Collaborated with internal staff members such as Billing Specialists, Medical Coders to resolve any discrepancies in patients' insurance information.
- Responded promptly to customer inquiries regarding their benefits and eligibility status.
- Participated in training sessions on new software programs used for verification purposes.
- Examined claims, records and procedures to grant approval of coverage.
- Researched third party payer guidelines related to prior authorizations, coding and billing processes.
Patient Service Representative
Patient First
Odenton, MD
06.2016 - 08.2020
- Facilitated patient registration, verifying all required documentation is collected and filed properly.
- Coordinated with patients and healthcare professionals to meet patient needs.
- Assisted with the completion of medical forms and records.
- Verified insurance information, collected payments, and scheduled appointments.
- Assembled registration paperwork and placed identification bands on patient.
- Sorted and distributed incoming mail daily.
- Processed insurance verifications and authorizations to ensure coverage of services.
- Accessed patient information through various software applications, maintaining strict confidentiality to remain compliant with HIPAA regulations.
- Conducted financial counseling for patients, explaining payment options and assistance programs.
- Verified patients' insurance and payment methods during admissions or check-in processes.
- Processed patient co-pays, deductibles, and other payments, ensuring accurate financial records.
- Provided customer service by answering patient questions and addressing concerns.
- Reviewed patient accounts for accuracy on a regular basis.
- Explained policies, procedures and services to patients.
- Registered patients by completing face-to-face interviews to obtain demographic, insurance, and medical information.
- Adhered to HIPAA regulations when handling confidential patient information.
- Ran credit card batches and balanced deposits on daily basis.
- Obtained informed consent and payment documentation from patients and filed in system.
- Ensured that all necessary documentation is completed prior to discharge of patient.
Medical Assistant
Frederick Primary Care Associates
Frederick, MD
03.2006 - 04.2015
- Changed dressings on wounds to prevent infection and check for healing.
- Assisted with pre-operative preparation of patients including providing instruction about post-operative care plans.
- Inspected equipment to ensure proper working order prior to use on patients.
- Conducted patient interviews to gather health history, vital signs and information about current medical issues.
- Conducted routine laboratory tests and sample analyses to monitor diseases.
- Secured patient information and maintained patient confidence by completing and safeguarding medical records.
- Assisted physicians with patient care by taking vital signs, patient histories and preparing patients for examinations.
- Prepared treatment rooms for patients by cleaning surfaces and restocking supplies.
- Collected samples from patients for laboratory testing purposes.
- Conducted EKGs, spirometry testing, audiograms and other diagnostic tests as requested by the physician.
- Prepared treatment rooms for patient examinations.
- Communicated with pharmacies for prescription refills on behalf of supervising physician.
- Performed basic laboratory tests such as urinalysis and blood glucose levels under direct supervision of a physician or registered nurse.
- Contacted pharmacies to submit and refill patients' prescriptions.
Nursing Assistant
Citizens Nursing Home
Frederick, MD
05.2000 - 01.2006
- Measured and recorded food and liquid intake and output, reporting changes to medical or nursing staff.
- Provided physical support to assist patients with bathing, dressing and toileting.
- Administered medications and educated patients and families on correct at-home administration.
- Promoted patient satisfaction by assisting with bathing, dressing and exercising.
- Assisted patients with daily activities under nurse's supervision to provide essential care and emotional support.
- Answered signal lights, bells and requests-for-service to assist patient services fulfillment.
- Assessed vitals and noted medical information to report changes to nursing staff and physicians.
- Ensured that all equipment was functioning properly prior to use.
- Collected specimens from patients for laboratory testing purposes.
- Planned and served meals and snacks to patients according to prescribed diets.
- Reminded patients to take prescribed medications or nutritional supplements.
- Observed patients' conditions regularly for any physical or mental changes and reported findings to the appropriate personnel promptly.
- Demonstrated respect and regard for dignity of patients, families and fellow employees to promote professional, responsible and courteous environment.
- Conducted regular rounds to check on patients' safety and proactively address issues.
- Provided companionship to patients, monitored their emotional well-being, and offered reassurance when needed.
- Assisted patients with daily activities such as bathing, dressing, and grooming.
- Maintained confidentiality of all patient information according to HIPAA guidelines.
- Protected patient, self and others from injury during transfers, lifts and transports by using proper equipment and body mechanics.
- Safeguarded patient privacy with strict adherence to HIPAA protocols.
- Maintained patient records accurately by documenting daily activities and changes in conditions or treatments.
- Implemented fall prevention techniques as specified in plan of care.
Education
High School Diploma -
Linganore High School
Frederick, MD06-1989
Skills
- Insurance Terminology
- Medical Billing
- Customer Relationship Management
- Communication and Interpersonal Skills
- Documentation and Correspondence
- Medical Terminology
- Coverage and Authorizations
- Data Security and Confidentiality
- Database Management
- Insurance Coverage Verification
- Medicaid Knowledge
- Electronic Authorization Processing
- Secure Data Practices
- Electronic Medical Records
- Customer Service
- Coordination and Scheduling
- Data Entry and Review
- Proficient in [Software]
- Eligibility Determination
- Analytical Thinking
- Attention to Detail
- Insurance Plan Verification
- Understanding of Medical Terms
- Accuracy and Precision
- Data Verification
- HIPAA Compliance
- Insurance Billing
- Patient Communication
- Document Management
Timeline
Patient Access Specialist II
Johns Hopkins University
07.2024 - Current
Insurance Verification Specialist
Kennedy Krieger Institute
07.2022 - Current
Patient Service Representative
Patient First
06.2016 - 08.2020
Medical Assistant
Frederick Primary Care Associates
03.2006 - 04.2015
Nursing Assistant
Citizens Nursing Home
05.2000 - 01.2006
High School Diploma -
Linganore High School
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