Remote Financial Clearance 1 - Trinity Health - Mason City, Iowa
(2024-03)
The Insurance Verification Specialist will be responsible for ensuring all pre-service accounts are financially cleared prior to the date of service for the Trinity Mid-Atlantic Region which includes, Mercy Fitzgerald, Nazareth Hospital, St. Francis Wilmington and St. Mary Medical Center Langhorne.
- Has the ability to work proficiently in the multiple areas of verification: Outpatient verification, Elective Short Procedure/Inpatient verification, Urgent Admission verification or Scheduling
- Is responsible for obtaining and verifying accurate insurance information, benefit validation, authorization and preservice collections.
- Financially clears patients for each visit type, admit type and area of service via current HIS (Health Information System). Collects and documents all required demographic and financial information. Appropriately activates registration and discharges in a timely fashion.
- Analyzes patient insurance(s), identifies the correct insurance plan, selects appropriately from HIS insurance and plan selections and documents correct insurance order. Applies recurring visit processing according to protocol.
- Verifies patient information with third party payers. Collects insurance referrals and documents within HIS.
- Communicates with patients and physician/offices regarding authorization/referral requirements. Identifies potential need for financial responsibility forms or completed electronic forms with patients as necessary. Escalates accounts appropriately in accordance with department Defer/Delay policy to manager.
Insurance Verification Specialist - Baylor Scott White Healthcare
(2019-03 - 2024-03)
- Assured timely verification of insurance benefits prior to patient procedures or appointments.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Trained New team members to help assist our service line
- Observed strict procedures to protect sensitive patient information, medical records.
- Reviewed Number patient cases per week and verified insurance coverage information.
- Help assist management and providers with any issues, questions, task they may have with no questions asked in a timely manner
Care Coordinator Assistant - Triwest
(2017-06 - 2019-03)
- Conducts thorough research to identify issues related to escalated requests ensures accurate documentation of the Veteran's information into the medical management system and works to resolve the issues utilizing hub or corporate resources as needed
- Review and respond to complex or escalated referral requests from VA and civilian providers with appropriate coding and provider selection
- Responds to inquiries from VAMC staff and providers regarding specific aspects of the PC3 or Choice VA programs
- Consistently displays professional and courteous service skills to internal and external customers Takes appropriate measures to comply with HIPAA regulations to protect privacy of Veteran's health information
- Documents the transmission of medical requests to the facility or community providers
- Documents all communications involving Veteran, VAMC and provider contacts
- Develops knowledge of various software applications in use at TriWest, including procedures and processes of the VA
- Works with standard coding systems including: standard are followed for the various types of VA eligible beneficiaries
- Coordinates with the clinical supervisor, VAMC staff, hub or corporate staff and the Regional Director to resolve escalated issues medical taxonomy, International Classification for Diseases, Current Procedural Terminology, and Health Care Common Procedure Coding System
- Verifies and ensures that appropriate referral procedures
- Worked with supervisor to assess needs and determine best courses of action.
- Received and responded to customer requests via letters, emails, telephone calls and in-person interactions.
- Aided colleagues, managers and customers through regular communication and assistance.
- Oversaw technical, operational, clerical and customer service support activities.
Complex Authorization Specialist - Triwest
(2016-09 - 2017-06)
- Reviews and enters complex authorizations and referrals from VA providers
- Ability to effectively communicate medical information, test results, diagnosis and or proposed treatment in a manner easily understood by the patient
- Must be able to effectively communicate with clinical staff
- Ensures accurate data entry and completion of authorization data from customer's information, medical records, referral/authorization forms
- Assist Patient Service Representative (PSR) in obtaining consults reports within required turnaround times
- Provides initial data entry related to potential quality issues
- Under direction of a supervisor, request appropriate records and process initial review of those records
- Works in a fast-paced production environment
Patient Access Representative - West Jefferson Medical Center
(2004-02 - 2016-09)
- Insurance Verification and Authorizations
- Entered data into multiple systems
- Assigned Beds, Scheduled, Registered, and Assisted patients to their appointed schedule test
- Collecting and Posted payments to patients accounts
- Certified for Medicaid
- Maintained office organized and sanitized
- Trained new employees
Medicaid Specialist - Crescent City WIC
(2008-02 - 2015-05)
- Assisting with Medicaid, WIC, and Food Stamp applications
- Handing out vouchers to qualified individuals
- Answered multi-line telephone, routed calls, and took accurate messages
- Scheduled Appointments
Patient Access Representative - East Jefferson General Hospital
(2012-12 - 2013-03)
- Entered data into multiple systems
- Assigned Beds, Scheduled, Registered, and Assisted patients to their appointed schedule test
- Collecting and Posted payments to patients accounts
- Insurance Verification and Authorizations
Mental Health Specialist - Catholic Charities
(2003-06 - 2004-03)
- Assisting patients with needed future aid
- Helping with treatment plans for patients
- Assisting the residents
Waitress - Frazier's Connection
(2003-01 - 2003-06)
- Maintained a clean work environment
- Serving patrons
- Prepared food
- Keeping control of the floor
Student Worker - Nicholls State University
(2001-09 - 2001-12)
- Answering multi-lined telephone, routed calls, and took accurate messages
- Greeted family and guest upon arrival
- Monitored guest log-ins
