Insurance Manager

Kristy I. Hiatt

*** ** *’ Henry Court ~ Poulsbo, WA 98370

Cell Phone 206-***-**** ~ ***********@*******.***

SKILLS:

Experienced in medical billing, and medical insurance, Strong commitment to customer service and professionalism, Ability to interrelate with wide variety of people and cultures, Organized, Ability to learn new skills quickly

PROGRAMS:

Point Click Care, Epic, Primeclaims, Direct Data Entry for Medicare, Curaspan, Availity, RFMS- National Data Care System, Authorize.net, Allscripts, Word, Encoder Pro, Outlook, One Health Port, Provider One, Trans Union, Omnicare

WORK HISTORY:

Bainbridge Island Health and Rehabilitation

Business Office Manager 7/2015 to 5/2018

Screened all uninsured or underinsured in-house patients for possible Medicaid or third party reimbursement

Knowledgeable with Medicare, Medicaid, private insurance, HMOs, Hospice, VA billing and Private pay

Reviewed every admission for financial risk

Obtained preauthorization’s for patients that had private, HMO, or VA insurance prior to admit

Maintained necessary billing and financial information in resident business files

Responsible for operating petty cash reconciliation and Resident Trust Cash on a weekly basis

Experienced in accounts receivable

Reviewed invoices for accuracy and approve for payment, and resolve any questions regarding payment.

Completed Month-end closing and corporate reporting

Weekly billing of Medicaid Claims and Monthly Electronic Medical claim billing for other insurances

Triple Check for Medicare A claims for up to 40 per month and Medicare B claims up to 30 per month

Assisted in applying for and the completion of documentation for Medicaid benefits for beneficiaries as necessary

Conducted collection efforts for outstanding accounts

Knowledge of reimbursement systems, allowable services and documentation required so billings are accurate.

ICD-10 coding, medical terminology knowledge

Maintained accurate records of payer sources, appropriate record keeping, and communication with residents regarding bills.

Balanced daily census to Nurses’ census

Responsible for bank deposits and cash posting to patients accounts

Investigated and responded to complaints from, patients, family members, guardians and providers.

First Choice Health

Intake Coordinator 1/2015 to 7/2015

Answer incoming calls from providers and hospitals

Determine if procedure needs preauthorization based on CPT codes

Ensure that all documents are received for Medical Management team determine

if a procedure is medically necessary and call providers office if more chart notes are needed

Called hospitals daily to verify if patient is still inpatient

Maintain daily reports for documenting patient load

Instructed providers and facilities on how to submit a preauthorization request correctly

Resource Corporation of America

Patient Support Representative, Financial Counselor, Seattle, WA 4/2011 to 6/2014

Screened all uninsured or underinsured in-house patients and outpatients for possible Medicaid or third party reimbursement

Verified patients insurance using OneHealth port

Updated patients insurance information in the computer

Reviewed medical records as needed to determine eligibility for Medicaid

Gathered and analyzed financial data of patients to determine eligibility for Charity or Medicaid

Evaluated and processed Financial Assistance applications

Assisted patients in completing Washington State Medicaid Application if qualified

Completed all applications, scheduled appointments

Assisted with the completion of daily, weekly and monthly reports

Sound Naturopathic Clinic

Office Coordinator, Poulsbo, WA 3/2010 to 2/2011

Ensured that all the patients complete the required registration forms

Applied payments to patients accounts from insurance remittance advice

Investigated and responded to complaints from patients

Reviewed insurance remits for charge entry

Ensured claims had CPT and ICD-9 codes before submitting to insurance companies

Researched rejected claims for errors

Rebilled claims to insurance companies and prepared claim appeals

Audited accounts on a daily and monthly basis for payments, problems or errors

Verified insurance coverage’s and checked claim status on One Health Port

Provided clinic charges for visit types and procedures

Followed up on insurance claims that have not paid within the 30 day time frame

Managed the inventory of the clinic and ordered medical supplies accordingly.

KPS Health Plans

Customer Service Representative 10/2005 to 1/2009

Thoroughly familiar with the all of the companies lines of insurance plans offered

Informed members and providers of insurance benefits for up to 40 different insurance plans that were offered.

Explained what a deductible, co-pay and coinsurance and how they related to the different types of care given by the providers

Understood the specific items needed to start a preauthorization from the providers and was able to explain this to the provider or member

Assisted with claim processing and investigated claim denials for providers and members

Documented all customer interactions and transactions, recording accurate details of inquiries, complaints and comments along with the action taken,

Eton Technical Institute 1995

Medical Assistant

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