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Click here or scroll down to respond to this candidateCandidate's Name
Bristol, TN PHONE NUMBER AVAILABLE EMAIL AVAILABLEProfessional SummarySkilled Patient Service Representative, Claims Specialist, and Admissions Coordinator with over 6 years of experience providing healthcare administrative support in a variety of hospital settings and over 20 years of customer service leadership. Extensive experience in provider services and claims processing including managing calls from Provider offices while conducting research on benefits for inpatient/outpatient procedures, providing cost share information, and checking therapy or medical equipment for contract limitations. Continually exceeds expectations by building valuable relationships and works well with people at all levels of an organization including hospital administration, management, medical staff, and patients. Skills Call Center Operations & Provider Services Inpatient & Outpatient Procedures Insurance Plan Coverage & Benefits Coordination Claims Processing, Adjustments, & Denials Payment Processing & Contract Administration Medical Coding & Claims Submissions Insurance Authorization & Precertification In-Network & Out-of-Network Providers Conducting Research & Analyzing Data Reviewing Medical Equipment & Therapy Information Assessing Appeals for Denied Claims Electronic Medical Records Processing Proactive & Responsive Customer Service Excellent Verbal & Written CommunicationWork HistoryProvider Service Representative & Claims Specialist (Remote) 09/2021 to Current FirstSource Efficiently answering calls from provider offices and conducting research on benefits for inpatient/outpatient procedures. Providing cost share information to providers, including deductibles, coinsurance, maximum out of pocket, and copayments. Being promoted to the Claims Department in August 2022 due to exceptional performance and high-level service. Handling calls from provider offices regarding status of claims and reasons for denied facility and professional claims. Providing information for paid claims, such as date paid, check number, payment method, and any bulk payments. Researching denied claims, such as insurance coverage, benefits, Medicare crossover claim denials, and system limitations. Processing claims adjustments for providers, such as for diagnosis codes that are covered under the plan but initially denied. Checking physical, occupational, or speech therapy visit accumulations and medical equipment for contract limitations. Working remotely and gaining extensive knowledge of claims/benefits for all discussed areas, including medical equipment. Patient Service Representative 01/2018 to 09/2021BHMA Neurology, Ballad Health Neurology-Abingdon Checked patients in for scheduled appointments as well as verified demographic, contact, and insurance information. Scheduled outpatient procedures for patients as well as handled all new patient and follow-up appointments. Performed data retrieval of patient information from computer database for daily appointments and telephone calls. Completed and filed charts or medical records, copied chart forms, and pulled charts for physician sign-offs. Destroyed archived charts and ensured confidential information was purged as well as pulled charts required for audits. Updated data for established patients including copying insurance cards and noting any changes to insurance provider. Received payments and coded encounter forms with proper payment distribution, CPT, and ICD-9 codes. Greeted patients, ascertained nature of business, and directed patient or visitor to the appropriate person or department. Obtained insurance authorizations for scheduled/unscheduled hospital services and secured visit notification to payors. Assisted with scheduling and coordinated post-discharge care for patients and communicated with providers as needed. Patient Access Representative 11/2016 to 01/2018Johnston Memorial Hospital Worked in Central Registration to check in patients for outpatient procedures such as MRIs, CTs, X-rays, and lab work. Performed scheduling, registration, patient pre-admission and admission, reception, and discharge functions. Obtained complete and accurate patient demographic information following compliant collection techniques. Greeted clients following hospital Standards of Care and provided world-class customer service. Completed full patient registration at date of service as well as thoroughly explained and secured all legal forms. Processed completed Advance Directives, Conditions of Services, Consent for Treatment, and EMTALA documents. Adhered to financial and cash control policies as well as filed patient information packets for future hospital services. Educated patients about patient financial liabilities and performed cash reconciliation and secured payment entry. Secured medical necessity checks and verifications in accordance with Centers for Medicare and Medicaid services. Verified insurance, benefits, coverage, and eligibility and completed registration financial clearance work lists activities. Unit Clerk 05/2016 to 11/2016Johnston Memorial Hospital Worked as a nursing assistant in the emergency department taking patient vitals, drawing blood, and performing EKGs. Scheduled initial and follow-up appointments for patients with providers and performed various patient care services. Assisted planning, organization, and implementation for unit activities including clerical and receptionist duties. Answered telephones in a timely, professional manner and notified referring office of patient appointment day and time. Assembled patient charts for new admissions and entered admission orders and demographic data as needed. FOS Representative/Customer Service Representative 11/2001 to 09/2015 OfficeMax/Boise Cascade Worked in the government department to service a national contract with USPS to order office products on eBuy. Reviewed invoices against orders for incorrect contract information such as pricing, units of measure, or quantities. Corrected issues with invoices and resent back through the accounting billing system to ensure proper, timely payment. Processed inbound calls for businesses that had national contracts with Boise/Office Max and placed/tracked orders. Recommended office products to customers based on their interests/needs and made changes to existing orders. Managed and reported account statistics to management and leadership on a weekly, monthly, and quarterly basis. Handled customer contacts by answering product questions, placing orders, and providing account help. Assisted customers with navigating web sites including product filters, policy pages, and other self-service features. Entered orders directly into electronic system and solved all problems with a customer-first mentality. Technical SkillsMicrosoft Office Suite: Word, Excel, Outlook, PowerPoint Training, Licenses & CertificationsPhlebotomy Technician Training CertificationEducationBoston Reed College 10/2013 to 12/2013Virginia Highlands Community College General Studies with Emphasis in health science |
