Medical Insurance Verification/Authorization Coordinator

JESSICA GAINEY ***** Memorial Hwy Apt #*** Miami, Fl 33161 Tel: 407-***-****, E-mail: ***************@*****.***

QUALIFICATIONS SUMMARY

Driven and experienced health care service professional with over ten years in both the medical and insurance industries.

● Customer service oriented and highly efficient at identifying client's needs ● Excellent at establishing and maintaining client relationships leading to increased referrals ● Adept at resolving escalated customer service issues ● Working knowledge of ICD 9 and CPT codes maintained by the American Medical Association ● Proficient in Microsoft applications such as Word, Excel, PowerPoint, Access, and Outlook ● Working Knowledge in Medicare and Medicaid

PROFESSIONAL EXPERIENCE Center for Arthritis & Rheumatic Diseases, Miami, Fl 08/09/2017 to Present Infusion Authorization Coordinator ● Obtain authorizations for Biologic infusion drugs and SQ drugs ● Obtain Authorizations and Referrals from insurance companies ● Obtain clinical evidence for appeal services and denials ● Coordinate shipments with Speciality and retail pharmacies ● Verified Co-pays, Deductibles, OOp Max, and Co-insurance ● Offered patients Co-pay assist when needed for infusions

Compass Health System of Florida, N. Miami, Fl 01/28/2016 to 08/7/2017 Insurance Verification Specialist ● Responsible for verifying multiple insurance plans including Workers Comp cases ● Verify for 2 offices for Outpatient mental health/behavioral health patients and Inpatient for Florida and Charleston, SC ● Obtain Authorizations and referrals from insurance companies ● Verified Co-pays, Deductibles, OOP Max, and Co-insurance

Funeral Funding Center, Hollywood, FL 01/21/14 to 09/2015 Verification Specialist/Assignment Coordinator ● Responsible for verifying new claims in a timely manner ● Verified to make sure policy will cover the assignment amount ● Verified beneficiary information ● Verified loans, reinstatements, premiums, on the policies ● Called funeral homes for missing information Assignment Coordinator ● Responsible for new claims in the faxes and over the phone ● Checked new assignments to make sure required fields are filled in ● Assigned new claims to verification specialists ● Gather all scans/faxes and place them into the respective assignment folder ● Assist clients with status updates on their new claims

Employment Professionals/The Imaging Center, Hollywood, FL 08/11/14 to 12/7/14 Front Desk Scheduler ● Responsible for calling the referral bin ● Scheduled appointments for MRI's throughout 4 facilities ● Checked patients In/Out ● Collected Copays and coinsurance ● Managed and operated 5 phone lines ● Responsible for doing radiologist reports in a timely manner ● Maintained, updated and scanned patients charts/medical records

Acclivity Healthcare/Advance Medical Specialties Oncology and Radiation Associates, Miami, FL 12/2013 to 7/2014 Insurance Verification Specialist ● Responsible for verifying multiple insurance plans for 9 oncology offices ● Verify chemo treatments CT's and PET SCANS ● Verify Co-pays, Deductibles, OOP Max, and Co-insurance ● Follow up with e-mails pertaining to insurance changes ● Updated patient demographics Office Team/Accretive Health, Ft. Lauderdale, Fl 8/2013 to 11/2013 Prior-Authorization Coordinator ● Follow up with doctor offices with RX's, Lab Results, and Authorizations ● Verify insurance plans to see if CT's, PET SCANS, MRI'S, and Ultra Sounds require authorizations with appropriate CPT CODES ● Pre-Certed patients to the appropriate imaging centers CuraScript Pharmacy, Orlando, Florida 2011 to 2013 Escalation Team ● Receive internal Assist Calls from patient care advocates ● Receive internal Supervisor calls from patients and physicians ● Expedite Orders and Referrals ● Price Quote Requests ● Escalated Inbound Calls

CuraScript Pharmacy, Orlando, Florida 2007 to 2011 Insurance Verification Specialist, Managed Care/Certified Clinical Prior Authorization Technician ● Responsible for coordination of all aspects of the insurance verification process ● Educate patients on services offered by CuraScript ranging from the storage of medication to insurance benefits ● Communicate and coordinate patient care with the physician's office according to standard policies and procedures, while protecting the privacy of the patient's medical information ● Verified insurance benefits for Medicaid, Medicare Part-D, and Health First patients ● Screen patients for potential co-pay assistance eligibility ● Serve as point of contact for various insurance plans and conduct clinical reviews for Prior Authorization verification Health South Med/Rehab, Orlando, Florida 2004-2007 Intake Coordinator ● Checked patients In/Out of facility, scheduled patient visits and verified insurance eligibility ● Maintained, updated and scanned patient medical records ● Performed accounting and book-keeping functions

● Managed and operated as many six phone lines Orlando Heart Center, Orlando, Florida 2/2004-4/2004 Patient Service Coordinator ● Scheduled patients for in/out visits and verified insurance eligibility ● Scheduled appointments for medical exams ● Updated patient demographics and medical records

EDUCATION AND TRAINING

Career Prep Institute Certificate in Phlebotomy- Completed

Ashworth College Associates in Science Degree, HealthCare Administration - In Progress

Central Florida College Associates in Science Degree, Medical Assistance - Completed