Customer Service Insurance

RD

OBJECTIVE

To secure a full time position

within in a medical research

department, customer centric

healthcare organization

dedicated to its mission, and to

achieving its vision.

The organization will utilize my

varied experience and training

in Data Collection, Case

Report Forms, Data Queries,

and Customer Service.

SKILLS

ICD 9, CPT Codes, Human

Anatomy and Physiology,

Medical Terminology, HCPC,

S, Knowledge of Medical

Billing, Microsoft Package,

Report Writing, Human Rights

ROSALINE C. NIM-DIXON

HOME 770-***-**** CELL 301-***-****

**********@***.***

EXPERIENCE

Visiting Nurse Healthcare of Atlanta 09/15-Present Insurance Research and Patient Data Specialist

● Communicates with VNHS Registration team and clinical staff to obtain all necessary information in order to verify insurance coverage and completes patient registration.

● Interacts with personnel at various insurance providers, both government and commercial, to research and confirm coverage, obtain authorization for treatment and resolve any issues which arise related to a patient’s insurance coverage.

● Provides timely and accurate completion of clinical research Case Report Forms (CRF), data queries, and feedback to branch office on viability of coverage for respective referrals. All insurance verified within 24 hours of receipt.

● Receives referrals set up in Horizon, verifies and confirms insurance eligibility and coverage.

● Obtains authorization for treatment from Insurer and runs accurate data management over documents in Horizon.

● Assist TL’s or Branch office with ad hoc insurance verification related requests as required

● Assist other Insurance Verification resources as need based on workload or coverage requirements and other duties as assigned.

Digestive Healthcare of Atlanta 02/15/-09/15

Insurance Verification Rep

● Collected and reviews all the patient insurance information to the degree authorized by the verification process. Training, Incident Report

Writing, Switchboard, Right

Fax, GroupWise, EMR,

UB92/1500 Claim Forms, Next

Gen, Navicure, Third Mill, IDX,

Epic, Emedon, TherCall,

Mckesson and Image Now,

CPT EDC Metadata Wave.

EDUCATION

In-House Certifications:

Navicure, Third Mill, IDX, Epic,

Emedon, TherCall, Mckesson

Certificates: CPT EDC

Metadata Wave

VOLUNTEER EXPERIENCE OR

LEADERSHIP

Homeless Shelter:

Volunteer work for Hagar

House, Atlanta, Ga

● Completed and submitted all necessary insurance forms and electronics claims to process the claim in a timely manner as required by all third party payers.

● Provided exceptional customer service to internal and external customers, resolves any customer requests in a timely and accurate manner, escalates complaints

accordingly.

● Responsible to report any reimbursement trends/delays to supervisor.

● Responsible to research and to resolve any claim denials or underpayment of claims.

● Performed related duties as assigned.

Amerisource Bergen Consulting Services, 08/14-01/15 Reimbursement Counselor Rockville, MD

● Collected and reviews all the patient insurance benefit information to the degree authorized by the SOP.

● Provided assistance to physician office staff and patients to complete and submit all necessary insurance forms and program applications

● Completed and submitted all necessary insurance forms and electronics claims to process the claim in a timely manner as required by all third party payers.

● Provided exceptional customer service to internal and external customers, resolves any customer requests in a timely and accurate manner, escalates complaints

accordingly.

● Responsible to report any reimbursement trends/delays to supervisor.

● Responsible to research and to resolve any claim denials or underpayment of claims.

● Performs relates duties as assigned.

Piedmont Healthcare, Atlanta, GA 05/13-05/14

Front Office Assistant II/Billing Rep

● Checks in patients by verifying and updating demographic, insurance and registration information.

● Schedule and cancel appointment communicate effectively with front and back office staff on changes.

● Edit patient's bills generated by providers through the electronic medical records.

● Enter charges and payments from fee tickets, coordinates referrals and hospital.

ROSALINE C. NIM-DIXON

HOME 770-***-**** CELL 301-***-****

**********@***.***

4991 WEWATTA STREET, ATLANTA, GA 30331

● Admission arrangements as directed, seek to acquire knowledge of managed care plans.

● CPT and ICD-9 coding.

● Analyzed patients accounts according to the explanations of benefits (eob). Process adjustments of debits and credits according to eob.

● Posted and adjustments of payment from third party insurance carriers in Payment Posting Department.

● Processing Appeal and Denials for Reimbursement. ROSALINE C. NIM-DIXON

HOME 770-***-**** CELL 301-***-****

**********@***.***

4991 WEWATTA STREET, ATLANTA, GA 30331

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