Sandra Jones

Customer service and general office administration professional with extensive experience in delivering expert client and support services within the medical insurance, medical supply, and sales environments. Detailed-oriented with strong organizational, communication, and conflict resolution skills. Technically proficient across a variety of systems, applications, and programs

Referrals Specialist at DUPAGE MEDICAL GROUP & BONCURA (2019-03 – 2019-07)

Full-time/Temp – Medix Staffing Services

• Received and documented telephone and electronic requests for referrals from Primary Care Physicians, Specialists, and Ancillary providers
• Verified member eligibility and basic benefit coverage levels including obtaining information regarding the coordination of benefits and third-party liability
• Performed data entry and processing of referral requests using the EPIC system including editing referral notes
• Contacted review organizations and insurance companies to obtain prior approval requirements and submitted documentation to appropriate personnel

Insurance Benefits Verification Representative at FERTILITY CENTERS OF ILLINOIS (2017-02 – 2019-03)

• Supported and participated in the overall functions of the Revenue Cycle Division of the Central Billing Office
• Performed insurance benefits verification and payer authorization in accordance with departmental policies
• Served as insurance benefits resource to financial coordinator and medical office staff during treatment including primary point of contact when escalated requests occurred during the verification process
• Maintained confidentiality of patient information per HIPPA requirements, and complied with external healthcare industry policies and procedures including government, insurance, and third-party payer regulations

Insurance Verification Specialist at ATI PHYSICAL THERAPY (2011-05 – 2017-02)

• Accountable for verification of physical therapy medical insurance across multiple carriers for the Midwest and South Regions utilizing direct telephone contacts and on-line sites
• Accurately set-up patient's physical therapy account including contact and billing information, in-network and out-of-network benefits, and effective policy end dates utilizing Insync and RTK on-line systems
• Consistently met or exceeded department goal of completing over 30 accounts per day
• Coordinated benefit information and resolution of account issues with specific regional offices

Documentation Specialist at CCS MEDICAL (2007-12 – 2011-02)

• Reviewed and verified that all required medical documentation and patient accounts were consistent and accurately completed to ensure timely processing and billing of services
• Utilized expert customer service and conflict resolution skills in managing a high volume of direct telephone contacts with patients and physicians regarding shipment of supplies, account information, and resolution of issues

Proof of Delivery Representative at OMNICARE MEDICAL SUPPLY COMPANY (2007-04 – 2007-10)

• Coordinated with both the billing and customer service departments to ensure accurate billing for services by conducting billing statement verification, proofreading, correcting errors, and troubleshooting issues
• Established new documentation filing system

Client – NALCO at Kelly Services (2006 – 2007)

Staffing Agency Employment

Clients included Petcare, Neuman Homes, and Nicor Home Energy at Venturi Staffing (2005 – 2007)

Staffing Agency Employment

Client – The Hartford Insurance Company at Professional Staffing (2006 – 2006)

Staffing Agency Employment

Client – Travelers Insurance Company at Manpower (2004 – 2006)

Staffing Agency Employment

Previous experience in retail department stores Lord & Taylor, Nordstrom in the cosmetic department as counter manager. Also worked at Soma part time in Ponte Vedra Florida..

Cross sales, product demonstration, cash handling, inventory.