Theresa Pletcher
Oregon City,OR
Summary
Highly-motivated employee with desire to take on new challenges. Strong work ethic, adaptability, and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.
Overview
10
10
years of professional experience
Work History
Clinic Service Specialist 2
Legacy Medical Group Canby
Canby ` , OR
04.2022 - 08.2023
- Straightened up waiting room to maintain neat and organized space.
- Completed relevant insurance and other claim forms.
- Checked patients in and out for appointments and collected co-payments.
- Greeted patients and visitors to answer questions or refer inquiries to appropriate personnel.
- Entered insurance, demographics and health history into patient database.
- Scheduled and confirmed patient appointments and consultations.
- Performed data entry tasks related to billing and collections procedures.
- Answered multi-line phone system and directed callers to requested personnel and departments.
- Transmitted medical records and other correspondence by mail, e-mail, or fax.
- Assisted with filing of medical records and documents, maintaining accurate electronic files.
- Gathered, transcribed and typed medical information into charts.
- Interviewed patients to complete case histories and intake forms.
- Processed patient payments and scanned identification and insurance cards.
- Prepared charts for new patients, ensuring all necessary forms were completed correctly.
- Delivered high-quality administrative and customer service to sustain patient and work flows.
- Compiled physical and digital documents, charts and reports.
- Conducted patient intake interviews to collect medical information and insurance details.
- Ordered and maintained supply inventory for medical office.
- Scheduled patient appointments, verifying accuracy of appointment times with providers.
- Maintained supply inventory for office area, ordering items as needed and stocking shelves.
- Communicated with patients with compassion while keeping medical information private.
- Called patients to confirm scheduled appointments and obtain additional details.
- Greeted patients, determined purpose of visit and directed to appropriate staff.
- Photocopied insurance cards, documented details and verified patient coverage for upcoming procedures or appointments.
- Answered incoming calls, responding to inquiries from patients and other medical offices.
- Informed patients of financial responsibilities prior to rendering services.
- Protected patients by observing strict HIPAA guidelines.
- Scheduled appointments, optimizing patient satisfaction, provider time and treatment room utilization.
- Routed laboratory or diagnostic results to appropriate staff.
- Greeted each patient pleasantly and offered desk sheet for easy sign-in.
- Scheduled and followed up on patient appointments, collected and processed patient payments and maintained patient files.
- Adhered to HIPAA requirements to safeguard patient confidentiality.
- Greeted and checked in patients, updating patient information in computer system.
- Maintained patient accounts by obtaining, recording and updating personal and financial information.
- Carried out daily tasks by professionally communicating with physicians, nursing staff, technicians and medical assistants.
- Answered telephones and directed calls to appropriate medical or adminstrative staff.
- Managed office phone lines by checking voicemail, returning calls and directing messages to team members.
- Provided excellent service and attention to customers when face-to-face or through phone conversations.
- Exceeded customer satisfaction by finding creative solutions to problems.
- Completed day-to-day duties accurately and efficiently.
- Maintained updated knowledge through continuing education and advanced training.
- Approached customers and engaged in conversation through use of effective interpersonal and people skills.
Insurance Verification Specialist
Legacy Health Emanuel Hospital
Portland , OR
10.2013 - 02.2022
- Collaborated with internal staff members such as Billing Specialists, Medical Coders to resolve any discrepancies in patients' insurance information.
- Monitored changes in government regulations affecting healthcare reimbursement systems.
- Interpreted Explanation of Benefits statements from various insurers and communicated relevant information with other departments as needed.
- Arranged hospital admissions for patients as required.
- Entered data in EMR database to record payer, authorization requirements and coverage limitations.
- Updated patient and insurance data and input changes into company computer system.
- Communicated with insurance carrier, patient and third party or employer to verify patient insurance benefits.
- Adhered to HIPAA requirements to safeguard patient confidentiality.
- Verified that patients had proper insurance coverage prior to procedures or appointment scheduling.
- Examined claims, records and procedures to grant approval of coverage.
- Verified patient eligibility for insurance coverage by contacting insurance carriers and obtaining the necessary authorization numbers.
- Analyzed complex health plan contracts to determine benefit coverage levels for services rendered.
- Accessed third-party insurance databases to identify coverage of benefits.
- Called insurance companies to ascertain pertinent information regarding policies and payment benefits for patients.
- Conducted regular audits of patient accounts for accuracy of demographic data.
- Compiled and coded patient information or data in appropriate computer system.
- Participated in training sessions on new software programs used for verification purposes.
- Maintained accurate documentation on all pre-authorization requests, denials and appeals.
- Determined estimated self-pay portion by calculating charges, co-insurance and deductibles.
- Evaluated policies and procedures related to Insurance Verification activities.
- Developed a working knowledge of insurance plans, including Medicare and Medicaid regulations and requirements.
- Liaised between physician, site of service and billing department to obtain appropriate documentation.
- Reviewed medical records to ensure accuracy of required information needed for pre-authorization requests.
- Identified discrepancies in patient's insurance coverage or benefits, ensuring accuracy of data entered into system.
- Retained strong medical terminology understanding in effort to better comprehend procedures.
- Navigated through multiple online systems to obtain documentation.
- Checked documentation for appropriate coding, catching errors and making revisions.
- Communicated with cross-functional teams to report insurance company trends.
- Researched third party payer guidelines related to prior authorizations, coding and billing processes.
- Displayed strong telephone etiquette, effectively handling difficult calls.
- Planned and completed group projects, working smoothly with others.
- Maintained updated knowledge through continuing education and advanced training.
- Understood and followed oral and written directions.
- Prioritized and organized tasks to efficiently accomplish service goals.
- Worked with cross-functional teams to achieve goals.
- Exceeded customer satisfaction by finding creative solutions to problems.
- Identified needs of customers promptly and efficiently.
- Achieved cost-savings by developing functional solutions to problems.
- Completed day-to-day duties accurately and efficiently.
- Maintained open communication with team members and stakeholders, resulting in successful project outcomes.
- Collaborated with others to discuss new opportunities.
- Maintained schedule of class assignments to meet deadlines.
Education
High School Diploma -
Molalla High School
Molalla, OR06-1979
Skills
- Account Management
- Call Documentation
- Customer Service
- Quality Control
- Order Processing
- Multi-Line Phone Systems
- Customer Data Confidentiality
- Medical Terminology Knowledge
- Schedule Mastery
- Understanding Customer Needs
- MS Office
- Document and Records Management
- Work Prioritization
- Call Center Operations
- Teamwork and Collaboration
- Needs Assessment
References
References available upon request.
Timeline
Clinic Service Specialist 2
Legacy Medical Group Canby
04.2022 - 08.2023
Insurance Verification Specialist
Legacy Health Emanuel Hospital
10.2013 - 02.2022
High School Diploma -
Molalla High School
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