Medical Specialty Scheduler

Leslie D. Wright

**** ********* **

Snellville, GA 30078

Cell# 678-***-****

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

Professional Profile: To pursue a long term Customer Service position as a

Team Player in a people oriented organization where I can utilize my

interpersonal communication, problem solving and problem analysis, ability

to work under pressure, and organizational skills in a challenging

environment, to achieve corporate goals

Professional Experience:

Hire Dynamics Staffing Agency Atlanta, GA

02/2012-Present

Children's Healthcare of Atlanta Atlanta, GA

05/13-11/2013

Specialty Scheduler//Patient Access Representative

. Schedules all admissions, surgeries, specialty, testing or procedures

in the hospital or outpatient facilities following current insurance

criteria and coordinating physician and patient schedules

. Confirms insurance Medicaid & Medicare criteria and coordinates

physician/patient scheduling

. Request charts from Physician Practices for Medical review

. Responsible for providing admission orders to hospital or outpatient

facility

. Instructs patient regarding insurance requirements, and distributes

printed pre-op instructions. Provides written material to support pre-

op and post-op patient education

. Maintains current knowledge regarding insurance policies, workman's

compensation, special billing obtain pre-certification and second

opinion information when required

. Files/reviews all appropriate medical documents which include lab, x-

ray, hospital reports dictation and other correspondence. Confirm

completion of all documentation required to support surgery

WellPoint-Utilization Management

Claims Specialist Atlanta, GA

12/2010-01/2012

. Accountable for Discharge Planning, Concurrent Planning, Pre-

Certification and Clinical Case Appeals

. Process Claims, including receiving documentation, reviewing the

information and deciding if the claim is eligible for payment in

accordance with the company policies and procedures

. Create case reviews for clinical team to review

. Maintain accurate records of all communications and interventions

. Review precertification requests for medical necessity, referring to

the Medical Director those that require additional expertise

Disability Adjudication Services Stone Mountain, GA

02/2010-12/2010

Program Assistant

. Processed initial, Reconsideration, DC, and CDR cases

. Request authorized Medical documentation according to HIPPA

Regulations

. Requested the results of consultative examinations and medical records

from other organizations

. Reviewed and analyzed a wide variety of medical and legal

documentation

. Researched and report on the status of pending claims for insurance or

CE providers

Patient Services LLC. Atlanta, GA

02/2005-02/2010

Health Insurance Specialist

. Maintained AR denial report to remain under 2% of total AR

. Monitored payment and denial activity for correct reimbursement from

insurance payers

. Posted insurance and patients payments daily with 100% accuracy

. Flowed up on 60-75 accounts per day with insurance companies for

status on claim payments

. Called insurance companies on status of outstanding claim payments

Skills:

. EPIC Software, Cisco Agent, In-basket Messaging, Cisco Agent

. SalesForce, Navigator, Nav Net, Citrix, WMDS, SharePoint

. Medical Terminology, ICD -9, CPT & HCPCS codes, Medical Billing &

Coding

. Knowledge of general principles, methods, techniques and practices of

automated billing

. Skilled in maintaining a high level of customer service under

stressful conditions.

. Skilled in communicating effectively verbally and in writing.

. Microsoft Windows Applications, Keyboarding Proficiency 50 wpm

. Member of the AAPC (American Academy of Professional Coders)

Contact this candidate