Insurance Medical
Resume:
GioVonnie K. Smith ***********@*****.***
*** ********* ***** **********, ** 30022 843-***-**** Cell (770)
Objective:
To obtain a position with a progressive organization where my skills and
abilities will be utilized to maximum potential.
Experience:
Processed 90-120 claims (including UB92 and CMS 1500) per day to bill to
third party payer including Medicare, Medicaid, BCBS, Workman's
Compensation, and other various insurance companies.
Reviewed contracts for third party payer and calculated amount that
insurance owes and type letter of appeal if necessary.
Accurately reviewed claims sent from hospital that need adjustment,
deductible and co-pay
Managed significant workload, navigate through different hospitals
database with minimal supervision.
Did follow up on claims status and verified coverage and benefit for
patient and send insurance information to hospital/ clinic.
WORK EXPERIENCE
Children's Healthcare of Atlanta Utilization Review Administrative
Assistant / Insurance
Verification
2/1/2010 - Current
. Initiates and performs revenue cycle activities by interviewing
patients and/or family members as needed, to secure information
concerning insurance coverage, eligibility, and qualification for
various financial programs.
. Coordinates and performs verification of insurance benefits by
contacting insurance provider and determining eligibility of coverage,
and communicates the status of verification/authorization process with
appropriate team members in a timely and efficient manner.
. Provides clinical information as needed, emphasizing the medical
justification for procedure/service to insurance companies for
completion of pre-certification process.
. Ensures referring physician obtains prior authorization as needed,
from insurance company for all scheduled healthcare procedures within
assigned department/area.
. Contacts referring physicians and or/patients to discuss rescheduling
of procedures due to incomplete/partial authorizations.
. Acts as liaison between clinical staff, patients, referring
physician's office and insurance payers by informing patients and
families of procedures authorization delays/denials, answering
questions, offering assistance, relaying messages, pertaining to the
authorization of procedure/service.
. May perform revenue cycle activities required for pre-registration and
registration, facilitating insurance pre-certification and
authorization.
. Maintains tracking of patients on schedule, ensuring that eligibility
and authorization information has been entered into data entry
systems.
. Contacts parents/guardians regarding co-payment amounts prior to
service date.
. Pre-screens doctor's orders (scripts) received for new patient to
ensure completeness/appropriateness of scheduled appointment.
. Responds to all inquiries from throughout the system and outside
related to authorization/pre- certification issues.
. Collaborates with Appeals department to provide all related
information to overturn claims denied.
. Monitors insurance authorization issues to identify trends and
participates in process improvement initiatives.
. Provides on-going communication and training to physician offices,
patients/families and others as necessary to resolve insurance
authorization-related departmental issues.
Hill-Rom (Durable Medical Equipment) Medical Billing
Specialist
01/2008 - 11/30/2009
. Responsible for ensuring timely and accurate processing, follow-up and
reporting of all product orders received along with timely re-
certifications and reauthorizations of orders while adhering to
governmental compliance regulations and Community Health Accreditation
Program requirements.
. Receive and review referral from the sales organization and set up in
database.
. Complete payer source benefit verification and documentation.
. Verify order information and register patient account in correct
systems.
. Follow up on scheduled re-certifications for third party payers by
calling to validate continued medical necessity.
. Update re-certification / follow up record in appropriate systems and
patient chart.
. Forward medical necessity documentation to appropriate payer or
billing department.
. Review the weekly unbilled report for new patients, re-certifications,
credit/re-bills, aging items, etc.
. Determine and implement appropriate action to reduce unbilled.
. Participate in weekly conference calls with Sales Representative as
needed.
Medical University of South Carolina Central Verification
Specialist
08/2005- 12/2007
Under the supervision of the IDX Visit Management Analyst or Central
Verification Coordinator, I facilitate accurate and timely completion and
resolution of appropriate VM (Visit Management), hold bills and Tes Edits.
. Ensure patient insurance information is verified and entered
appropriately into the IDX system.
. I have advanced knowledge of medical insurance and system logic which
promotes an accurate and more timely reimbursement for services.
. IDX, Keane, Medical Terminology, Terahealth systems.
Hill-Rom Company (Durable Medical Equipment) Customer Contact
Representative
11/2004 - 8/2005
. Responsible for creating and maintaining exceptional customer value,
employee value and shareholder value in an environment that is
demanding and changing due to customer expectations and product
technology.
. Answer technical and operational questions, provide information on
product features and uses and be the subject matter expert on OME and
Therapy Products.
. Responsible for the customers in the regions assigned which includes
ensuring familiarity with their customer's business needs and that
customer orders are managed with a high level of accuracy, customer
service and follow through.
. Answer customer questions regarding accessory items, pricing and
inventory availability and contracts.
. Work closely with the Customer Care Center (CCC) Specialists, sales
and field service regarding specific issues with customers through
resolution of those issues.
. Backup the CCC Specialist on managing OME purchase orders for assigned
accounts.
. Maintain technical product knowledge to keep abreast of updates
product training.
EDUCATION
6/2004
Dorchester County Adult and Community Education North Charleston, SC
. Introduction to Computers/Internet, Microsoft Excel, Microsoft Power
Point & Keyboarding
3/2003
Trident Tech College North Charleston, SC
. Computers & Business Admin
1989 -1993
Burke High School Charleston, SC
. General English, General Math, Biology, US History,& Spanish
SKILLS
. Microsoft Excel, Microsoft PowerPoint, IDX, Keane, J.D Edwards, & Epic
REFERENCES
Jennifer Gowder
Medical University of South Carolina
Office Manager/STNICU
Administrative Specialist
*******@****.***
Tracy Wilson
Children's Healthcare of Atlanta
Patient Access Supervisor
*****.******@****.***
Tamika Noel
Southern Crescent Personnel
Recruiter
*****@***-****.***
Contact this candidate