Wendy Cooley
Orange,TX
Summary
Detail-oriented insurance verification specialist with expertise in eligibility determination and claims management. Proven track record in ensuring HIPAA compliance and maintaining accurate patient information. Skilled in efficiently resolving insurance issues to enhance operational effectiveness.
Overview
3
3
years of professional experience
Work History
Insurance Verification Specialist And collections
Dr. Heartfield
Beaumont, Texas
05.2012 - 08.2014
- Verified patient insurance information for accuracy and completeness.
- Communicated with insurance companies to resolve eligibility issues.
- Processed pre-authorization requests for medical services efficiently.
- Maintained detailed records of insurance verifications and updates.
- Collaborated with healthcare providers to gather necessary documentation.
- Assisted patients in understanding their insurance benefits and coverage options.
- Ensured compliance with HIPAA regulations during the verification process.
- Verified that patients had proper insurance coverage prior to procedures or appointment scheduling.
- Updated patient and insurance data and input changes into company computer system.
- Called insurance companies to ascertain pertinent information regarding policies and payment benefits for patients.
- Communicated with insurance carrier, patient and third party or employer to verify patient insurance benefits.
- Navigated through multiple online systems to obtain documentation.
- Accessed third-party insurance databases to identify coverage of benefits.
- Maintained accurate documentation of pre-authorization requests, denials, and appeals to support timely processing.
- Developed comprehensive knowledge of insurance plans, including Medicare and Medicaid regulations, to enhance verification accuracy.
- Contacted patients to confirm demographic information and clarify financial responsibilities for improved understanding.
- Checked documentation for appropriate coding, catching errors and making revisions.
- Reviewed medical records to ensure accuracy of required information needed for pre-authorization requests.
- Identified discrepancies in patients' insurance coverage or benefits, ensuring accuracy of data entered into system.
- Contacted patients to arrange payment arrangements for deductible and out-of-pocket liability.
- Interpreted Explanation of Benefits statements from various insurers and communicated relevant information with other departments.
- Collaborated with internal staff members such as Billing Specialists, Medical Coders to resolve any discrepancies in patients' insurance information.
- Responded promptly to customer inquiries regarding their benefits and eligibility status.
- Assisted in resolving claim issues related to billing and reimbursement inquiries.
- Provided timely follow up with payers regarding payment status of claims.
- Maintained confidentiality of patient information in accordance with HIPAA regulations.
- Ensured compliance with federal and state regulations regarding insurance verification.
- Managed multiple tasks and priorities in a high-volume, fast-paced environment.
- Developed and maintained professional relationships with insurance representatives.
- Conducted follow-ups with insurance companies to expedite verification processes.
Referral Coordinator
Folsom Medical Group
Beaumont, Texas
03.2011 - 05.2012
- Coordinated patient referrals to specialists within Folsom Medical Group network, enhancing patient access to necessary care.
- Managed scheduling for patient appointments and follow-up consultations efficiently.
- Processed referral documents and ensured compliance with healthcare regulations.
- Communicated with healthcare providers to verify patient information and referral status.
- Maintained accurate records of referrals and patient interactions in electronic systems, ensuring compliance and facilitating timely follow-ups.
- Assisted patients in understanding referral procedures and available services offered.
- Collaborated with team members to improve referral processes and streamline workflows.
- Provided support in resolving patient inquiries related to referrals and appointments.
- Scheduled patients according to availability, urgency and insurance authorization guidelines.
- Prioritized referrals according to urgency and adhered to appropriate referral deadlines.
- Reviewed demographic, clinical and insurance information before sending to referred specialists.
- Coordinated with external agencies to ensure timely processing of referrals.
- Communicated regularly with patients regarding their care plans following a referral.
- Adhered to HIPAA regulations when handling confidential patient information.
- Reviewed data obtained from referring physicians for completeness and accuracy.
- Advised staff on appropriate protocols when making a referral.
- Monitored patient progress throughout the referral process.
- Verified documents and associated records to catch and resolve discrepancies.
- Handled patient referrals daily using a multi-line telephone system to ensure effective communication.
- Cultivated relationships with key stakeholders within healthcare system to streamline referral processes and improve patient outcomes.
- Conducted outreach to community providers for referrals and resources.
- Coordinated with healthcare providers to verify patient insurance coverage and obtain necessary pre-authorizations for treatments.
- Maintained accurate and up-to-date patient records, including referral status and follow-up information.
- Ensured compliance with HIPAA regulations when handling patient information.
Education
Some College (No Degree) - Medical Office Specialist
Kaplan College
Beaumont, TXSkills
- Insurance verification
- Pre-authorization processing
- Claims management
- HIPAA compliance
- Healthcare regulations
Timeline
Insurance Verification Specialist And collections
Dr. Heartfield
05.2012 - 08.2014
Referral Coordinator
Folsom Medical Group
03.2011 - 05.2012
Some College (No Degree) - Medical Office Specialist
Kaplan College