+Years of professional experience
Toni Walker
Customer Service Specialist
New Britain,CT
Summary
Dynamic Medical Insurance Verification Specialist with a proven track record at Jefferson Radiology, enhancing claim approval rates through meticulous policy review and effective communication. Adept at problem-solving and data entry, I streamlined verification processes, significantly reducing processing times while ensuring compliance with privacy regulations. Committed to improving patient outcomes and service quality.
Insurance professional with strong background in verifying insurance coverage and benefits. Skilled in navigating complex systems, resolving discrepancies, and ensuring accurate information. Known for excellent team collaboration and adaptability to changing needs. Efficient in communication, problem-solving, and maintaining high standards for quality and results.
Overview
20
20
Work History
Medical Insurance Verification Specialist
Jefferson Radiology
02.2017 - 10.2024
- Verified insurance coverage to ensure patient services were covered.
- Improved claim approval rates by accurately inputting policy information.
- Processed verification requests for timely service provision.
- Increased efficiency with streamlined communication between insurance providers and healthcare facilities.
- Handled confidential patient information, maintaining compliance with privacy regulations.
- Collaborated with healthcare providers to facilitate insurance claims.
- Resolved discrepancies in insurance data to prevent delays in service.
- Assisted in training new team members for enhanced team performance.
- Reduced processing times by implementing effective verification procedures.
- Communicated with insurance companies to verify patient coverage.
FMLA Claims Specialist
Metlife
05.2015 - 02.2017
- Conducted regular audits of claim files, ensuring proper documentation and adherence to established protocols.
- Managed caseloads efficiently, consistently meeting or exceeding performance metrics for claim resolution times and accuracy rates.
- Participated in cross-functional projects aimed at improving overall leave management processes, collaborating with teams from HR, Payroll, Benefits, and Legal departments.
- Performed thorough investigations into potential cases of FMLA abuse or fraud, protecting both employer interests and employee rights under the law.
- Handled escalated claim issues, working closely with employees and managers to achieve timely resolutions.
- Coordinate administrative workload while problem solving
- Inbound/outbound call center environment
- Answered high and heavy call volume of phone calls for the premier account - Bank of America
- Enhanced accuracy of FMLA eligibility determinations through thorough research and analysis of employee records.
- Optimized workflows by identifying areas for improvement in the claims process, leading to increased productivity within the department.
Outreach Healthcare Specialist
Aetna
02.2015 - 05.2015
- Improved patient care by collaborating with multidisciplinary teams.
- Provided specialized healthcare services for enhancing patient outcomes.
- Enhanced patient recovery with tailored treatment plans and interventions.
- Addressed complex medical conditions, ensuring comprehensive care.
- Assessed patient needs to optimize healthcare delivery and satisfaction.
- Enhanced healthcare service quality, implementing best practices.
- Developed treatment protocols with a focus on patient wellness.
- Coordinate appointments
- Make in/outbound calls to doctor offices for information for the yearly HEDIS project
- Collecting/faxing/entering patient medical records via Aetna computer program
Education
Bachelor of Science - Health Sciences
Grand Canyon University
Phoenix, AZ-Remote09-2019
Medical Billing And Coding
Capital Community College
Hartford, CT06-2019
Skills
- Insurance verification
- Claims processing
- Policy review
- Data entry
- Customer service
- Documentation management
- Problem solving
- Attention to detail
- Communication skills
- Time management
- EPIC
- EMR
- ICD
Timeline
Medical Insurance Verification Specialist
Jefferson Radiology
02.2017 - 10.2024
FMLA Claims Specialist
Metlife
05.2015 - 02.2017
Outreach Healthcare Specialist
Aetna
02.2015 - 05.2015
Bachelor of Science - Health Sciences
Grand Canyon University
Medical Billing And Coding
Capital Community College
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