Tiffany Sipler
Crossville,TN
Summary
Pragmatic Insurance Verification Specialist touting 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
10
10
years of professional experience
Work History
Insurance Verification Specialist
Mary Washington Healthcare
09.2020 - Current
- Utilizes multiple resources to verify eligibility, coverage, and obtain necessary documentation to ensure authorization/pre-authorization requirements have been met and work to ensure that patients' health care benefits cover necessary procedures
- Educate patients on their insurance benefits and coverage
- Monitor reports/and or queues to ensure timely notification and insurance verification processing
- Processes insurance verifications through various systems and websites
- Facilitates insurance requests for peer-to-peer clinical requirements with physicians/practice
- Confirms authorization is appropriate for scheduled service, data span, facility, etc.
- Provides insurance company and third-party payors with required clinical documentation to secure authorization and analyzes data to ensure accuracy of authorized procedure (Common Procedure Terminology/CPT) and scheduled visit
- Oversees clinical documentation and physician orders within patient medical record, to meet clinical coding initiatives and support necessity of performed procedures
- Maintains proficiency and knowledge of insurance payers, compliance, and requirements
- Understands the workflow of the entire patient access process and works with the team to ensure efficient workflow management
- Initiates admission notifications to payers
- Communicates patient/guarantor financial responsibilities, co-pay, deductible, and/or self-pay balance
- Audits center for Medicare and Medicaid (CMS) in-patient only procedure listing for scheduled surgeries
- Ensures patient status is correct based on government reimbursement regulations
- Coordinates patient status changes with physicians, care managements and other clinical areas to meet federal guidelines and to ensure appropriate reimbursement for Mary Washington Healthcare processing, guidelines, laws, and EOBs
- Data entry skills with high accuracy
- Knowledge of managed care, Medicare, and Medicaid guidelines
- Good problem-solving skills with the ability to think outside of the box.
Patient Coordinator/Receptionist
Fredericksburg Orthodontics
04.2018 - 07.2020
- Explained plans for treatment and payment options
- Took copayments and compiled daily financial records
- Took payments including to but not limited to Orthotic, credit/debit cards and checks
- Generated monthly statements to check outstanding balances
- Compiled and reviewed medical charts
- Assisted patients in filling out check-in and payment paperwork
- Used Dolphin Management to schedule appointments
- Handled over 100 calls per day to address customer inquiries and concerns regarding patient treatment, finances, and consultations
- Maintained excellent attendance record, consistently arriving at work on time
- Developed team communications and information for team meetings
- Assisted in social media posts and in-office contests
- Processed monthly patient recall lists to ensure patients not scheduled were contacted to schedule their next appointment to continue orthodontic and general dentistry care
- Stayed up to date on HIPAA regulations
- Discussed dental histories with patients in effort to provide most effective dental advice
- Triaged patient emergency calls to schedule appointments accurately
- Drafted and revised patient referral letters regarding patients starting treatment, ending treatment and extraction/evaluation referrals to other dental care professionals
- Communicated effectively with other healthcare professionals
- Resolved problems with areas such as communication and billing that could negatively impact services
- Updating and processing insurance benefit breakdowns
- Reviewed aftercare instructions with patients and parents.
Office Coordinator
Genesis Rehab Services
11.2016 - 04.2018
- Trained therapy staff on office policies and changes within company, providing direct supervision, ongoing staff development and continuing education to employees
- Created therapy schedule appointments for patients with therapy professionals for occupational and physical therapy
- Insurance billing for therapy sessions
- Responsible for managing daily, weekly and monthly operations as outlined in company policies and procedures
- Assisted therapists in daily routines including but not limited to cleaning and sanitizing therapy rooms, washing and drying laundry as needed, monitoring therapy sessions, and submitting reports as needed for licensed therapist and communicating with patients' family members, other healthcare providers such as physicians and medical doctors
- Direct day-to-day administrative and operational functions for 90-bed facility, providing guidance and leadership to 6 employees across 2 therapy departments (occupational and physical therapy)
- Discussed therapy histories with patients and family members in effort to provide most effective therapy advice and plans.
Patient Access Representative
Bon Secours
10.2016 - 09.2017
- Performed patient scheduling and registration functions to serve as initial contact point for medical office visits
- Attended weekly facility meetings to discuss logistical issues and obtain updated procedural and insurance-related instructions
- Utilized knowledge of electronic medical record systems and medical terminology to perform diverse data entry tasks
- Identified insurance payment sources and listed payers in proper sequence to establish chain of payment
- Secured patient information and confidential medical records in compliance with HIPAA privacy rule standards to protect patient's privacy
- Collected and entered patient demographic and insurance data into computer database to establish patient's medical record
- Obtained patient's insurance information and determined eligibility for benefits for specific services rendered
- Took copayments and compiled daily financial records
- Intercepted phone calls in a call center setting to prevent medical office personnel from patient care
- Provided patient information such as office hours and address, doctor names, insurance accepted, scheduling guidelines for appointments and verifying security questions to ensure HIPAA regulations were being followed
- Handled approximately 100 calls per shift to address customer inquiries and concerns
- Arranged transfers from outside facilities by communicating effectively with facility representatives, physicians, and nursing staff
- Interpreted physician's orders accurately to input correct testing information and verify admissions criteria.
Office Coordinator/Manager
Hooie Family Dentistry
05.2014 - 09.2016
- Delivered top-notch administrative support to office staff, promoting excellence in office operations
- Created and updated physical records and digital files to maintain current, accurate and compliant documentation
- Prepared and distributed team-based communications to create collaboration and enhance team morale
- Calculated daily, weekly, monthly, and yearly financial goals and presented numbers to doctor and staff to follow up on goals
- Filed and followed up on insurance claims
- Produced highly accurate internal and external letters regarding patient treatment
- Sorted, opened, and routed incoming correspondence and deliveries such as other healthcare provider letters and emails
- Developed and implemented office management procedures, increasing training efficiency, team productivity and accuracy
- Screened and transferred incoming calls, took down messages and transmitted information and documents to patient charts and records
- Entered and maintained patient records
- Collect patient and client documents and information upon referral
- Collected and patient and insurance payments
- Processed credit applications for patients to finance treatment
- Managed, scheduled, and organized travel plans for office staff and doctors
- Handled and managed approximately 30-40 phone calls per day, approximately 20 email inquiries and about 5-10 faxes per day
- Monitored office supplies by checking inventory on a weekly basis and placed orders whenever stock appeared low
- Conducted thorough research using diverse resources to assist professional staff with routine and special project tasks.
Education
High school diploma -
Courtland High School
Spotsylvania, VA06.2009
Medical and Dental Office Assisting/Administration -
Ashworth College
Expected in 10/2024 - Medical Coding and Billing
Ultimate Medical Academy
10.2034
Skills
- HIPAA regulations
- Medical Records Verification
- Insurance Verification
- Medical Records
- Document Management
- Medical Billing & Medical Terminology
- Epic software
- Availity & other insurance portals
- ICD-10 & ICD-9
- Electronic Medical Records
- Prior authorization processing
- Eligibility Determination
- Communication and Interpersonal Skills
- Medical receptionist
- CMS guidelines
- Excellent communication etiquette
- Documentation review
- Data Entry
- Patient Care
- Deductible and Co-Pay Calculation
- Advising Patents
- Workflow Development
- Data Integrity
- Patient Health Information Access
- Insurance Terminology
- Referral Coordination
- Patient Contact
- Outpatient, Inpatient, & Urgent Care Procedures
- Prior Authorization Processing
- Patient Eligibility Requirements
- Data Verification
- Organization and Time Management
- Radiology Knowledge
- Electronic Authorization Processing
- Managed Care
- Advanced knowledge of insurance
Timeline
Insurance Verification Specialist
Mary Washington Healthcare
09.2020 - Current
Patient Coordinator/Receptionist
Fredericksburg Orthodontics
04.2018 - 07.2020
Office Coordinator
Genesis Rehab Services
11.2016 - 04.2018
Patient Access Representative
Bon Secours
10.2016 - 09.2017
Office Coordinator/Manager
Hooie Family Dentistry
05.2014 - 09.2016
High school diploma -
Courtland High School
Medical and Dental Office Assisting/Administration -
Ashworth College
Expected in 10/2024 - Medical Coding and Billing
Ultimate Medical Academy
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