Medical Insurance
Resume:
Lourdes B. Potts
Ft. Myers, FL 33967
239-***-**** E-mail ******@***.***
SUMMARY OF PROFESSIONAL QUALIFICATIONS:
● Fluent in reading, writing and speaking both English and Spanish
● Excellent communication and organizational skills both verbal and written
● Perform daily clerical functions such as answering phones, data entry, filing and outstanding customer service
● Able to maintain staffs scheduling and appointment calendars for multi-office practice.
● Skilled in computerized scheduling, billing and insurance claims processing
● Proficient in computer office programs: QuickBooks, MS Word, MS Excel, Windows, Med soft, Epic, Medical Manger, NexTech, Availity, Navigate, Codonix Notes, Gateway and Outlook Express
● Strong working knowledge of medical terminology and ICD-9-CPT coding
● Ability to resolve accounting issues to include patient invoicing and insurance claims and appeals
● Ability to process accounts payable and payroll time sheets
● Ability to write patient prescriptions, calling in prescriptions, obtaining prior authorization from insurance companies
● Organize procurement of services, supplies and equipment
● Arrange payment plans for patients. Finding sources to help with financial assistance
● Hardworking, motivated, dedicated, trustworthy, and professional; able to serve clients with outstanding customer service
● Ability to be a support staff for other departments
PROFESSIONAL EXPERIENCE
Orthopedic Associates of S.W.FL
13691 Metro Pkwy
#400, Ft. Myers, FL 33918
Ft. Myers, FL 33911
Emily Bouchard
Worker’s Compensation Coordinator/Intake Coordinator
August 2016 to May 2017
Investigated and processed claims reports and supporting documentation.
Identified and removed obstacles to ensure highest quality claims outcomes.
Timely filing of the D.W.C. to the Adjuster
Performed thorough reviews of all documentary evidence including investigative reports.
Conducted and evaluated legal strategy conference calls at regular intervals.
Coordinated claims case management with physicians and other health care professionals.
Identified cases in need of medical management.
Evaluated injured employees' compliance with prescribed physical therapy regimens.
Obtaining authorization from Adjuster for any outside referrals and coordinate all physician orders for testing, physical therapy, etc.
Urgent Care of S.W. Fl
10201 Arcos Ave
Suite 105
Estero, FL 33928
Emily Bouchard
Front Desk/Billing/Worker's Compensation Specialist
March 2014 to May 2016
● Verify insurance benefits
● Screen and prioritize a high volume of calls, manage medical records, prep charts, check in and check out, collecting all co-payments/co-insurance, setting appointments and follow up appointments
● Balance each day and deposit
● Answer patient queries, problems and complains and identify solutions.
● Detail database entry of patient details and records
● Work in other areas of the practice when needed.
● Process payments from insurance companies ensuring that reimbursement is correct according to the terms of contractual agreements/fee schedules
● Intake of new patient demographics, requesting referral and consults from outside providers.
● Review medical record documentation to Medicare and third-party payers when necessary, while maintaining and abiding by Federal laws governing such release
● Obtaining all the documentation needed to process all Worker's Compensation claims
● Preparing appeals from attorneys
Riverchase Dermatology
9400 Gladiolus Dr. Suite 205
Ft. Myers, FL 33905
Christina Williams
Billing Specialist
July 2013 to March 2014
● A/R, posting of insurance payments
● Verify insurance benefits and preauthorization requirements
● Screen and prioritize a high volume of calls, manage medical records, prep charts, check in and check out, collecting all co-payments/co-insurance, setting appointments and follow up appointments
● Balance each day and deposit
● Answer patient queries, problems and complains and identify solutions.
● Detail database entry of patient details and records
● Work in other areas of the practice when needed.
● Process payments from insurance companies ensuring that reimbursement is correct according to the terms of contractual agreements/fee schedules
● Intake of new patient demographics, requesting referral and consults from outside providers.
● Review medical record documentation to Medicare and third-party payers when necessary, while maintaining and abiding by Federal laws governing such release
● Analyze claim rejects and denials for correction and resubmission
● Preparing appeals from insurance company denials
Golisano Pediatric Neurologist Lee Memorial
9800 S. Health Park Dr. Suite 140
Ft. Myers, FL 33908
DeAnna Moore 841-***-**** or Dr. Margie Morals 239-***-****
Customer Service Representative
September 2012 to July 2013
● Verify insurance benefits and preauthorization requirements for 5 providers
● Screen and prioritize a high volume of calls, manage medical records, prep charts, check in and check out, collecting all co-payments/co-insurance, setting appointments and follow up appointments
● Balance each day and deposit
● Answer patient queries, problems and complains and identify solutions.
● Detail database entry of patient details and records
● Scanning all documents into the proper patient record
● Work in other areas of the practice when needed.
● A/R, posting charges and billing for Medicaid and third party providers.
● Intake of new patient demographics, requesting referral and consults from outside providers.
Pediatric Neurologist of S.W. FL
15749 New Hampshire Ct. Suite B
Ft. Myers, FL 33908
Dr. Margie Morales
Office Manager
June 2010 to September 2012
● Verify insurance benefits and pre-authorization requirements
● Screen and prioritize a high volume of calls, manage medical records, prep charts, check in and check out, collecting all co-payments/co-insurance, setting appointments and follow up appointments
● Balance each day and deposit
● Answer patient queries, problems and complains and identify solutions.
● Detail database entry of patient details and records
● Implement company policy and procedures
● Taking vitals, taking medical history, explaining treatment procedures to patients and preparing patients for examination for the physician
● Compliance and updating of HIPPA and new state and federal mandates
● Set up all medical conferences for the physician and keeping abreast of all the new regulations
● Arrange payment arrangement with patients
● Managing medical records and requests for medical records from outside sources
● Keeping stock of office materials, supplies and forms.
● Appeal all denials from insurance companies
ACADEMIC BACKGROUND
Bachelor of Arts in Business and Marketing
International College aka Hodge’s University
REFERENCES AVAILABLE UPON REQUEST
Contact this candidate