Veronica Brooks
Summary
Claim Specialist who is responsible for examining and evaluating claims and providing exceptional customer service. Responsible for managing claims from start to finish and ensuring that customer receive accurate and timely payments. I am able to work independently and adapt to changing circumstances in a timely manner. A problem solver who is motivated to help customers.
Developed skills in fast-paced insurance environment, demonstrating expertise in data analysis and problem-solving. Proven ability to manage complex claims processes with focus on customer satisfaction and efficient resolution. Seeking to leverage transferrable skills in new field, bringing high level of adaptability and proficiency in managing intricate tasks.
Overview
11
11
years of professional experience
Work History
Claim Specialist
State Farm
01.2022 - Current
- Company Overview: Claim Specialists are committed to helping our customers through the claims process while providing Remarkable service
- Investigating, evaluating, negotiating, and settling claims
- Applying knowledge of policies and insurance regulations when determining coverage, liability, and damages
- Contacting customers by telephone, written correspondence and/or various electronic media
- Effectively managing work through task driven queues while multi-tasking in a fast-paced call center environment
- Supporting our customers through personalized, caring, and simple interactions
- Claim Specialists are committed to helping our customers through the claims process while providing Remarkable service
Admission Representative
Encompass Health (HealthSouth)
01.2021 - 01.2022
- Company Overview: The admission representative interviews patients and/or their representatives to obtain complete and accurate demographic, financial and insurance information, required for billing and collecting patient accounts
- Conducts intensive screening of all worker's compensation, Medicare, Medical and managed care patients for pre-certification requirements and provider service eligibility
- Obtains all necessary customer consents/attestations
- Maintains a working knowledge of insurance benefits and coverage verification
- Coordinates the collection of estimated patient liabilities, including co-payments when applicable
- The admission representative interviews patients and/or their representatives to obtain complete and accurate demographic, financial and insurance information, required for billing and collecting patient accounts
Optum Healthcare Advisor
United Healthcare
01.2020 - 01.2021
- Company Overview: Single point of contact for consumers for all things related to health and wellness benefits
- A healthcare advisor helps members navigate the health care system; including helping with claim and benefit questions
- Help members find quality doctors and schedule appointments
- Connecting consumers with health and wellness resources
- Coaching members to make better health choices by providing education
- Handle inbound and outbound calls with an emphasis on excellent customer service in a call center environment
- Single point of contact for consumers for all things related to health and wellness benefits
- A healthcare advisor helps members navigate the health care system; including helping with claim and benefit questions
Front Office Assistant
Georgia Retina
01.2019 - 01.2020
- Company Overview: Under general supervision of the practice manager, perform a variety of non-clinical duties in support of a physicians practice following established methods and procedures involving some independent judgement
- Check in patients by verifying and/or updating demographic, insurance, and registration information in accordance with established policies and procedures
- Facilitates the scheduling, canceling, and rescheduling of patient appointments and communicates changes to staff as needed
- Coordinates with back office staff to ensure for the timely and efficient flow of patients to the providers
- Demonstrate basic knowledge of managed care plans, CPT, and ICD-10 coding
- Under general supervision of the practice manager, perform a variety of non-clinical duties in support of a physicians practice following established methods and procedures involving some independent judgement
Patient Access Rep II
Emory Healthcare
01.2014 - 01.2019
- Company Overview: A Patient Access Rep II will assist in the coordination, prioritization and completion of front-end patient registration activities ranging from pre-registration through discharge in the Patient Access Services Department
- Ensures all insurance requirements are met prior to or on the date of service and informs patients of their financial liability and collects liability due
- Maintain thorough understanding of insurance, registration, scheduling, referrals, authorizations, and account follow-up
- Maintains knowledge of multiple department system applications utilized by Patient Access
- Familiar with and adheres to all state and federal regulations such as EMTALA, CMS, HIPAA, and JCAHO guidelines
- Obtains appropriate signatures and scans all appropriate documents (Admission/Registration Agreement, Notice of Privacy Practice, and Important Message from Medicare, etc)
- A Patient Access Rep II will assist in the coordination, prioritization and completion of front-end patient registration activities ranging from pre-registration through discharge in the Patient Access Services Department
Education
B.S. - Healthcare Management
Clayton State University
Morrow, GA01.2013
Skills
- Interpersonal skills
- Analytical skills
- Negotiation skills
- Clear communication
- Relationship building
- Knowledge of insurance coverage
- Knowledge of medical terminology
- Investigation skills
- Evaluation skills
- Settlement of insurance claims
- Claims analysis
- Claims investigation
- Legal compliance
- Policy interpretation
- Critical thinking
- Decision-making
Phone
cellular, 678-274-8227
Timeline
Claim Specialist
State Farm
01.2022 - Current
Admission Representative
Encompass Health (HealthSouth)
01.2021 - 01.2022
Optum Healthcare Advisor
United Healthcare
01.2020 - 01.2021
Front Office Assistant
Georgia Retina
01.2019 - 01.2020
Patient Access Rep II
Emory Healthcare
01.2014 - 01.2019
B.S. - Healthcare Management
Clayton State University
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