Accomplishments

Professional Summary

P J

*** **** ****** * *, Lancaster, CA 93534 • Home: 661-***-**** • Cell: 661-***-**** • ac4rk6@r.postjobfree.com Completed, Processed and reconciled open cases with a 24 hour, 48 hour and 72 hour turn around. Detailed when getting authorization status and when I am calling on a case to get answers on the old open cases as well as the new cases.

Verify insurance eligibility and verification for patient information to receive additional equipment, and services like leg braces, diabetic supplies, lenses, hearing aids, tubing and equipment for sleep apnea, home health care, infertility treatment etc. Verify that the patient's insurance would cover additional items as well as how many cycles, and how often the patient would receive certain items per year, per day, per hour if applicable. Billed all insurances Medicare, Medicaid, Medi-cal, Worker's Compensation and all commercial and private insurances.

Assisted the coding team with getting valid ICD-10 from the Physicians and also requested missing information from clients pertaining to the patient to proceed with third party billing and prior authorizations.

Assisted in correcting claims that were on hold due to missing or invalid information in Emdeon, which was the clearinghouse used to file claims to the payors. Data Entry Operator entered patient demographics and test results also verifying correct ICD-10 and CPT codes were given or calling providers for the correct codes to use per guidelines. Assisted the medical lab with specimens when there were people absent. Special clients used a separate program called IDAA that I was assigned too to enter the results and send it back electronically back to the doctor.

Prior Authorization Coordinator and Data Entry Operator with over 7 years experience providing administrative and patient support in hospital and medical office settings as well as third party billing. Advanced knowledge of private, commercial and worker's compensation insurance processes and codes. Efficient in tackling administrative and patient-oriented tasks in a fast-paced environment. Adept Skills

Work History

at verifying insurance coverage, reviewing records, scheduling appointments and updating patient information.

Insta-Med

NextGen

Excel

60 WPM

Medical terminology expert

Billing and collection procedures expert

Office support (phones

filing)

HCPCS Coding Guidelines

Insurance and collections procedures

Excellent problem solver

Close attention to detail

organizational skills

Fast data entry

SAP

Word

10 Key by touch

ICD-10 (International Classification of Disease

Systems)

Records maintenance professional

faxing

Patient referrals expert

Familiar with commercial and private insurance

carriers

Understands insurance benefits

Resourceful and reliable worker

Adept multi-tasker

typing

verbal communication

Prior-Authorization Specialist, 11/2013 to Current Boston Scientific – Valencia, CA

Work closely with all payers to perform initial benefit verification and pre-surgical authorization for new pre- surgical cases.

Document case status, actions, and outcome in the Reimbursement Services contact management database.

Communicate with HCP offices and sales representatives on missing case information Work closely with the designated Reimbursement Specialists on benefit verification information received, questions about pre-authorization, payer issues, and case volume. Notify appropriate internal departments based on information received department needs to be aware of including complaint handling and adverse event notifications. Utilize high touch customer service skills with customers, communications with Sales representatives, and working in Call Center team environment to expedite processing of cases. Handled Medicare, Medicare Supplement, Medicaid, Medi-Cal and Commercial cases for benefit verifications.

Accomplishments I was able to help the Medicare team with case turnaround time of 2 days, cases included Medicare, Medicare Supplement, and commercial plans. I was able to process and complete between 12- 18 cases per day depending on the complexity of the insurance plans.

Referral Specialist, 02/2012 to 09/2013

City of Hope – Irwindale, CA

Responsibilities I am involved with the contact payor position where I contact all insurances and check authorization status pertaining to Chemo Therapy, Radiology, Urology, Oncology, and Clinical Trials, resubmit authorization request if needed i.e. missing information, clinical notes, and ICD-10 codes. Follow up with patient if procedure has not been authorized and their appointment needs to be reschedule. Notify MD, Financial Coordinator and patient of the change. Reconcile all open cases. Accomplishments in the short amount of time being their with the cases I have touched I am able to complete and reconcile open cases dated back to July and August. Skills used I am very detailed when getting authorization status and when I am calling on a case I try to get answers on the old open cases as well as the new cases.

Maintained accurate records of patient care, condition, progress and concerns. Obtained information about clients' medical history, drug history, complaints and allergies. Scheduled and accompanied clients to medical appointments. Performed clerical duties, such as word processing, data entry, answering phones and filing. Prior Authorization Coordinator, 10/2011 to 02/2012 Regal Medical Group – Northridge, CA

This assignment was contracted to verify insurance eligibility and verification for patient to receive additional equipment, and services like leg braces, diabetic supplies, lenses, hearing aids, tubing and equipment for sleep apnea, home health care, infertility treatment etc. I would call and verify that the patient insurance would cover additional items as well as how many cycles, and how often the patient would receive certain items per yr., per day, per hour . Also called providers office and requested medical records, progress notes that was needed to send to for review to the nurse or medical director. Attached notes to pending cases, followed up with the providers office regarding missing documents requested to process authorization.

Analyzed departmental documents for appropriate distribution and filing. Worked directly with Nurses, Medical Directors and Providers to achieve timely processing and not falling out of compliance with the insurance companies. Reached out to approximately 100 provider offices daily. Maintained compliance with fair debt practices and regulatory guidelines. Medical Billing Operator, 04/2007 to 01/2010

Specialty Labs – Valencia, CA

Billed all insurances Medicare, Medicaid, Medical and all other insurances including entering all patient demographics and diagnosis. I also assisted the Coding team with getting valid ICD-9 from the Physicians and also requested missing information from clients pertaining to the patient that was not given to proceed with third party billing. I also assisted in correcting claims that were on hold due to missing or invalid information in Emdeon which is the clearinghouse used to file claims to the payors. Outlined the appropriate process and procedures necessary to fulfill and complete inquiries. Added new material to file records and created new records. Entered numerical data into databases in a timely and accurate manner. Scanned documentation and entered into the database. Obtained scanned records and uploaded them into the database. Organized forms, made photocopies, filed records and prepared correspondence and reports. Reviewed and updated client correspondence files and scheduling database. Negotiated with accountholders to devise repayment plans and minimize collections receivables. Managed delinquency cycle, including past due collection calls, skip tracing, outside collections agency coordination and litigation activities.

Identified and analyzed rejection patterns, partial denials, and denials from third parties to improve existing processes.

Investigated accounts with balance errors using accounting software. Maintained compliance with fair debt practices and regulatory guidelines. Data Entry Operator I and Lab Specimen Entry, 05/2005 to 02/2007 Quest Diagnostics – North Hills, CA

Entered patient information and test results also making sure correct codes were entered by doctor. Assisted the medical lab with specimens when low staffed. Special clients used a separate program called IDAA that I was assigned too to enter the results and send it back electronically back to the doctor.

Entered numerical data into databases in a timely and accurate manner. Added new material to file records and created new records. Outlined the appropriate process and procedures necessary to fulfill and complete inquiries. Education

Produced monthly reports using advanced Excel spreadsheet functions. Assisted with receptionist duties, file organization and research and development. Scanned documentation and entered into the database. Obtained scanned records and uploaded them into the database. Reviewed medical records for completeness and filed records in alphabetic and numeric order. Organized forms, made photocopies, filed records and prepared correspondence and reports. Medical Billing & Terminology, CPT & ICD-9 Coding, 2002 Chester Adult School - Los Angeles

High School Diploma: 1988

Jordan High School - Long Beach, CA

Criminal Law,

El Camino College - Torrance, CA

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