Tobi Michael
New Braunfels
Summary
Insurance verification specialist with proven expertise in claims processing and customer service. Achieved operational efficiency through accurate policy interpretation and effective training. Proficient in medical coding and database management, ensuring high accuracy in billing and patient financial assessments. Enhanced patient satisfaction by streamlining appointment processes and reducing waiting times.
Overview
11
11
years of professional experience
Work History
Insurance Verification Specialist / Patient AR Rep
Dr. Alexander S Roka MD
San Antonio
09.2024 - Current
- Evaluated insurance policy terms to identify patient coverage and limitations.
- Communicated effectively with insurance companies, providers, and patients regarding benefit information.
- Reviewed patient deductibles and copays, entering data into billing system.
- Resolved eligibility and coverage issues raised by billing staff.
- Transmitted correspondence and medical records via mail, email, and fax.
Senior Financial Counselor
Cross Creek Hospital
Austin
10.2021 - Current
- Conducted engaging training sessions for new financial counselors on financial analysis and regulatory compliance.
- Facilitated peer collaboration sessions to promote knowledge sharing among financial counselors.
- Participated in weekly conference calls to resolve escalated issues efficiently.
- Performed regular evaluations to identify improvement areas and implemented targeted training interventions.
- Utilized advanced billing software for accurate financial transactions and claims processing.
- Audited admission packets, verified benefits, and maintained accurate patient demographic records.
- Managed adjustments and approved charity/administrative requests while overseeing appeals.
- Prepared comprehensive financial disclosure documents, including income verification for patient assistance.
Senior Medical Biller
Rapid Radiology
Austin
12.2019 - 07.2021
- Utilized billing and invoicing software for accurate, timely processing of transactions.
- Managed accounts receivables through proactive follow-up with clients and insurance companies.
- Collaborated with facilities to determine patient Part A/B status and ensure proper billing claims.
- Conducted research and review of claims issues to identify discrepancies.
- Provided training and served as point of contact for process-related inquiries.
- Handled payment processing and advised customers on unpaid accounts to enhance collections.
- Prepared and maintained reports related to credentialing activities and compliance.
- Repriced claims while meeting established turnaround times.
Negotiations Claims Processor
Altrua Healthshare
05.2017 - 12.2019
- Provide timely claim status updates to providers.
- Submit accurate paper and electronic commercial insurance claims.
- Demonstrate comprehensive knowledge of ICD9/10 and HCPC/CPT Coding.
- Train new hires on claims processes and contribute to workload organization.
- Compile and prepare detailed reports.
Payment Specialist II
Hanger Prosthetic and Orthotic
06.2014 - 02.2017
- Submit accurate paper and electronic commercial insurance claims.
- Maintain comprehensive knowledge of coding and billing systems.
- Reconcile electronic billing error reports and ensure high accuracy levels.
- Process cash, deposit ERA and Lockbox details, and post payments.
- Consistently meet SLA and accuracy targets.
Education
Diploma -
EL Broady
San Antonio, TX04-2025
Some College (No Degree) - Medical Billing
Austin Community College
Austin, TXSkills
- Medical coding
- Claims processing
- Insurance verification
- Medical billing
- IMS, Availity, Zelis, Meditrac, Meditech, ECW, Viatrack, Optum, OPS
- Financial counseling
- Time management
- Training facilitation
- Accuracy and precision
- Database management
- Policy interpretation
- Referral coordination
- HIPAA compliance
- Allscripts
- Skilled in Word, Excel, Sharepoint
- Workflow development
- Electronic medical records
- Radiology
References
- Jonathan Brown, Risk Management Director, Cross Creek Hospital, Co Worker, 408-601-8293, jonathan.brown@crosscreekhospital.com
- Tamika Clewis, Sr Recruiter Specialist, Ascensia Diabetes Care, Friend, 210-516-5160, tamikaalex7@gmail.com
Timeline
Insurance Verification Specialist / Patient AR Rep
Dr. Alexander S Roka MD
09.2024 - Current
Senior Financial Counselor
Cross Creek Hospital
10.2021 - Current
Senior Medical Biller
Rapid Radiology
12.2019 - 07.2021
Negotiations Claims Processor
Altrua Healthshare
05.2017 - 12.2019
Payment Specialist II
Hanger Prosthetic and Orthotic
06.2014 - 02.2017
Diploma -
EL Broady
Some College (No Degree) - Medical Billing
Austin Community College
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