Victoria Cooke
Philadelphia,PA
Summary
Dynamic professional with extensive experience in implementing innovative practices and policies, complemented by a strong foundation in customer service. Eager to embrace a challenging position that fosters career advancement and skill enhancement. Committed to contributing to an organization that values professional development and personal growth. Proven ability to adapt and thrive in fast-paced environments while delivering exceptional results.
Insurance professional with in-depth experience in verifying insurance coverage and handling patient information to ensure smooth operations. Known for reliability and adaptability in dynamic environments, contributing effectively to team goals. Proficient in utilizing verification systems and maintaining comprehensive records while displaying strong attention to detail and collaborative mindset.
Overview
19
19
years of professional experience
Work History
Admissions & Insurance Verification Specialist
Avenues Recovery Center
01.2024 - Current
- Verify insurance eligibility and behavioral health benefits for 15-20 patients daily to ensure accurate coverage determination prior to admission.
- Conduct direct outreach to insurance payers to confirm plan benefits, deductible status, authorization requirements, and coverage limitations.
- Utilizing Salesforce systems to input all patient information insuring all submitted VOB's are accurate.
- Document detailed benefit breakdowns in Kipu health to support billing accuracy and minimize claim discrepancies.
- Collaborated with healthcare teams to facilitate timely admissions based on insurance verification outcomes.
Health Assistant
Accolade
09.2022 - 12.2024
- Answer inbound calls in a call center environment.
- Helped people understand their health Insurance and benefit options.
- Uncover information on who our clients are & tailor our approach to fit their needs.
- Perform the legwork and answers questions regarding billing, benefits and insurance coverage.
- Being a translator of their benefit packages & care plans.
- Identify member needs to connect them with the right clinical resources (ex. Clinician, Health Plan Disease Management, Health Plan Case Management).
Patient Service Representative
Salus University The Eye Institute
03.2022 - 08.2022
- Scheduled patient vision appointments including follow-up and rescheduling of missed appointments.
- Greeted patients, obtained, verified, and updated all registration, demographic and insurance information required.
- Received inbound calls and provided information regarding fees, marketing and services.
- Prepared patient medical records for new patients and updated information for existing patients. Reviewed patient records for completion and returns to the record room. Make photocopies of medical records, as required.
- Enters patient charges into the billing system including total bill, recording the information, collecting payments, completing insurance forms and recording charges, payments and adjustments.
Amazon Sortation Associate
Amazon
09.2021 - 01.2022
- Receiving incoming inventory and moving inventory as required.
- Pulling and picking product as directed
- Preparing orders for shipment and processing orders for returns.
- Sorting, scanning, and stacking packages on pallets.
- Preparing customer orders for delivery.
- Using technology such as scanners, computers, and handheld printers.
Amazon Delivery Driver
Seventy-six Logistics
07.2021 - 09.2021
- Completed package deliveries in a timely manner and insured customers received a positive, memorable experience.
- Leveraged GPS system and navigation app to determine and follow the most efficient routes.
- Performed preventative vehicle maintenance checks prior to departure to identify concerns or potential issues.
Audit Support Assistant
Cotiviti
03.2018 - 06.2021
- Placing outbound calls into an automated system at CMS (Center for Medicare/Medicaid Services) performing searches by member's date of birth and social security number to determine if they are eligible for Medicare.
- Provide payment integrity services (claim auditing) to government and commercial health plans.
- Perform a variety of support and general administrative assignments in support of the audit OR auditors, including filing, data entry, and tracking/correspondence while following established standards and work processes.
- Obtains data files and/or generates reports for audits by identifying appropriate file parameters extracting data from downloaded and/or imported data files as requested by the auditor.
- Serves as a point of contact and facilitates responses to general inquiries and data requests from both internal and external customers. As requested or required, communicates directly with the client or providers following established processes and procedures.
- Provides proofing support on claims submittals to double check totals, verbiage, calculations or general accuracy prior to client submission.
- Maintains productivity goals and standards set by the department.
Customer Service Rep
Open Sky CC
01.2017 - 02.2017
- Provide customers with updates on credit card applications
- Update customers information: address, phone numbers etc.
- Researches problems with appropriate departments, formulates resolutions, provides feedback on resolution, and document issues.
Client Service Advocate
Medrisk
04.2016 - 12.2016
- Responsible for supporting the Client Advocacy team by processing new referrals via fax, email and phone
- Communicated effectively with multiple departments to plan and provide exceptional services to clients.
- Processed new worker compensation cases in a timely fashion, adhering to company policies and procedures.
- Made outbound calls and electronic contact with adjusters and physical therapy centers to verify new case information or to obtain missing information.
- Handled inbound calls while consistently exceeding Medrisk's customer service and quality standards.
Member/Provider Service Representative
Amerihealth Caritas
05.2012 - 09.2015
- Handled inbound calls from members and providers, assisting with plan benefits and policies.
- Offered resolutions on escalated calls to ensure satisfactory service.
- Provided detailed information on the status of provider claims via Facets.
- Provided updates on authorizations and capitation remittance payments for network providers.
- Researched member and provider enrollment issues utilizing department procedures.
- Communicated members request to management. Identifies and responds to inquiries, dissatisfaction, complaints and grievances.
- Maintained a 99% or above accuracy and quality matrix. Provided excellent customer service to guarantee exceeding monthly department goals.
Collector
Yellowbook
03.2008 - 02.2010
- Performed collection activity for past due accounts, moved accounts to appropriate queues by the month's end.
- Maintained telephone contact via noble Dialer software with customers according to establish guidelines and standards to ensure prompt payment.
- Processed customer transactions on a daily basis.
- Provided the field sales team with regular updates on customer account status with a focus on accounts that are past due and/or high risk for default.
- Post daily customer payments
Bank Teller
Citibank
06.2007 - 03.2008
- Performed efficient and accurate banking transactions with clients.
- Executed financial transactions in accordance with bank policies and procedures while maintaining an excellent record in daily drawer balancing.
- Developed positive relationships with Citi's clients by identifying referral opportunities for new products and services based on the client's financial goals.
- Adhered to operational controls, including legal, corporate, and regulatory procedures to ensure the safety and security of the customers and the bank’s assets.
Education
Associate of Science - Medical Assisting/ Office Administration
Lincoln Technical Institute
Philadelphia, PASkills
- Attention to detail
- Patient confidentiality
- HIPAA compliance
- Insurance coverage verification
- Eligibility determination
- Data entry proficiency
- Coverage and authorizations
- EHR software
- Insurance benefits verification
- Patient communication
- Customer service
- Analytical thinking
Timeline
Admissions & Insurance Verification Specialist
Avenues Recovery Center
01.2024 - Current
Health Assistant
Accolade
09.2022 - 12.2024
Patient Service Representative
Salus University The Eye Institute
03.2022 - 08.2022
Amazon Sortation Associate
Amazon
09.2021 - 01.2022
Amazon Delivery Driver
Seventy-six Logistics
07.2021 - 09.2021
Audit Support Assistant
Cotiviti
03.2018 - 06.2021
Customer Service Rep
Open Sky CC
01.2017 - 02.2017
Client Service Advocate
Medrisk
04.2016 - 12.2016
Member/Provider Service Representative
Amerihealth Caritas
05.2012 - 09.2015
Collector
Yellowbook
03.2008 - 02.2010
Bank Teller
Citibank
06.2007 - 03.2008
Associate of Science - Medical Assisting/ Office Administration
Lincoln Technical Institute