Valerie de Wijk

• Ensured compliance with HIPAA regulations during all aspects of the benefit verification process, protecting patient privacy.
• Improved patient satisfaction by accurately verifying benefits and providing timely responses to inquiries.
• Leveraged advanced problem-solving skills in navigating complex cases involving multiple policies or payers, ultimately securing coverage approvals where possible.
• Assisted with staff training on new software systems and procedures, promoting a cohesive team environment focused on quality assurance.
• Served as a subject matter expert for peers and supervisory staff, providing guidance on best practices in benefit verification processes.
• Maintained up-to-date knowledge of insurance regulations, enabling accurate benefit verifications for various plans.
• Facilitated smooth transitions for patients between care providers by coordinating authorizations for outpatient services.
• Increased accuracy in data entry through meticulous attention to detail when inputting patient demographics and insurance information into the system.
• Observed strict procedures to maintain data and plan participant confidentiality.
• Called on Insurance companies to verify benefits and pulled insurance reports.
• Input supply orders submitted from providers and called the providers whenever there was a discrepancy or insurance problem
• Worked the fax que in processing and funneling incoming fax to the proper location.

Process, analyze, and respond to Medicare claim audits as they go through Medicare’s formal appeal process while ensuring proper regulation guidelines and time limits have been met throughout the duration of each audit.

Responsible for reviewing medical documentation of beneficiaries represented by Lincare and making determinations for payment in accordance with Medicare’s regulations.

Assess whether services/items billed were reasonable and necessary, supported by national and local policies, and are properly billed and coded with various insurance providers.

Identify areas of insufficient documentation within each claim, if applicable, and take the proper steps needed to obtain the missing documentation in order to ensure payment for each claim is properly met.