Insurance Customer Service

Ronnica M. James

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

College Park, GA 30349

Phone: 678-***-****

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

Professional Summary: Experienced Medical Secretary/Scheduler/Pre Certification

Specialist with intermediate knowledge of insurance billing and follow up in hospital and

clinic environment. Highly adept in providing general and medical clerical service while

delivering outstanding customer service. Possess secretarial skills and ability to remain

organized while working under pressure in combination with meeting deadlines and

possessing a natural ability to put people at ease, while working as part of a team.

Qualifications Summary:

Medical Front Office/Secretary Medical Records EMR/Scanning

Scheduler/ Intake Coordinator General Clerical

Insurance Verification/Billing (Medicare, Medicaid, Commercial, PPO, OON)

Environment (hospital, Private Practice, Home Health) Insurance Authorization

Medical terminology E-Clinical Gateway, Nava Net, Ativity

Computer Skills: Microsoft Office, Excel, PowerPoint, ICD 9 coding 45/55 WPM, 10,

000- 12,000 ksph

Familiarity of Software: Medical Manager, MISYS Tiger, Citrix Web, OMEGA,EMR

Medicare verification system HIPPA compliant, HDX insurance verification software,electronic medical records.

Education: Alabama State University Business Administration, Criminal Justice

PROFESSIONAL EXPERIENCE:

12/2006- Present Medical Scheduler/ Intake Specialist/ Pre Certification

Specialist/Insurance Billing

Amedisys Central Home Health Care/ Atlanta

Schedule to field clinicians for home patient visits ranging from disciplines for such care

as Physical Therapy, Skilled Nursing, Medical Social Worker, and Occupational

Therapy to Home Health Aids on daily, weekly and monthly basis for census of 250-

300 patients while adhering to insurance and physician orders.

Receive and enter data for new and current patient and employee records.

Create, maintain and update the clinicians schedule according to authorizations and

patient needs .Maintain clinician’s availability lists.

Serve as the point of contact for all interactions with clinical team members,

administrative associates, referral sources and patients. Ensure adherence to company

policies associated with record establishment, retention, maintenance and

confidentiality. Prepare clinical records for new patients upon receipt of referral.

Complete quantitative administrative review of clinical records at start of care and

upon patient discharge. File incoming documents daily. Maintain a control procedure

for active patient files. Maintain a tracking system to ensure clinical records are

current according to company policy and regulatory requirements. Partner with

clinical resources to oversee patient intake and inquiries and assess patient needs.

Assist in the daily processing of numerous reports in conjunction with Accounts Payable

and Accounts Receivable for billing per Medicare/Medicaid and Private insurance

guidelines in accordance with patient visits

Initiate outbound calls to health insurance companies, utilizing online and electronic

documents to verify medical benefits

Responsible for the distribution of patient supplies via mail or to clinicians per field visits

for continuity of care per MD order. Verify and monitor Medicare/Medicaid/Private

insurance authorization, approvals and visit referrals prior to scheduling admissions

for services.

Responsible for the following up of A/R to all payers and/or including self-pay and

resolution of denials, while contacting insurance carriers, patients and other facilities

as needed.

Assist in the verification, research and completion of paperwork and forms to bill all

types of claims for reimbursement. Perform other related duties as required

Obtain insurance verification for new referrals while communicating with patients

regarding OON obligations while also obtaining Letter of Agreements from managed

care insurances for future patient visits.

Responsible for analyzing previous account documentation in eFIR, HIS and other

available sources, in order to determine the appropriate action(s)necessary to resolve

each assigned account

Initiate the admissions process for patient referrals by collecting demographic and

insurance information on patients over the phone and act as the primary contact for new

and existing patient. Investigate type and level of insurance coverage to assess

Gwinnett Hospital Systems Lawrenceville, GA

04/2006-12/2006 (Contract)

Work in fast paced hospital departments such as Labor and Delivery, Emergency Room

and Imaging Center and Patient Admissions.

Conduct patient/guarantor interviews, while explaining hospital policies, financial

responsibilities as well as obtain demographic and insurance information for pre-

registration of all patients.

Communicate financial counseling interviews and identify patients who require early

financial counseling intervention.

Identify Medicaid and managed care patients for pre-certification requirements.

Responsibilities include but not limited to overseeing aspects of Financial

Counseling, Pre-Registration and Insurance Verification.

Ensure that pre-certification and/or authorization are obtained, patient liabilities and

unmet deductibles are collected and appropriate bed assignments are made while

using Medicare Verification system OMEGA, HDX, and Sovera software.

Obtain all necessary patient consents/ attestations. Verify and post transactions.

10/04-4/2006 Front Office Receptionist/ Check In/Out Scheduler

North Fulton Urology Roswell/Cummings

Work in Private Practice under the direction of 3 Medical Doctors, 3 Medical Assistants 1

Nurse Practitioner while traveling between two satellite offices.

Responsible for check in/out scheduling, answering phones, taking messages, inputting

patient data and researching insurance eligibility per patient visit.

Follow up with hospitals or physician offices for any lab results, operative notes or other

documentation as needed for upcoming patient appointment while assisting with

transitioning medical records via scanners using EMR system. Retrieve patient copay

per visit per insurance agreement.

Notify patient of pertinent visit information; i.e. Copay reminders, and appropriate check

in times

05/04-10/04 Front Office Check In/ Out, Receptionist St. Joseph Mercy Care Clinic

Atlanta, GA (CONTRACT)

Facilitate the coordination of patient information including insurance carriers or other

payer. Enter demographic patient information into computer system.

Collect all applicable payments from patients at time of services.

Track all fee tickets to identify any missing in a timely manner. Schedule patient

appointments when appropriate. Instruct patients in regards to financial policies.

Complete pre and post chart reviews. Print and maintain updated “Doctor Daily

Schedule. Balance daily receipts with monies collected; complete and fax daily cash

reconciliation form to Reimbursement at the end of each day

Assist with the processing and generation of EOB's to start insurance and patient billing

at time of visit.

11/03-5/04 Medical Secretary for Director of Anesthesiology Crawford Long Hospital

(CONTRACT)

Provide general administrative support duties. Responsibilities include scheduling

meetings; appointments and calendar respond to routine telephone inquiries and refers

calls to appropriate staff.

Perform basic word processing of documents, reports and meeting minutes, chart and

schedule for departments using standard software.

Liaison to deal effectively and professionally with faculty, staff, vendors and the general

public.

Additional Work Experience

10/00-07/03 Client Service Representative AP/ Specialist Risk Management

Alternative Duluth, GA

05/98-10/00 Emory Clinic Switchboard Operator Emory Clinic Atlanta, GA

Front Office Secretary I 20 Chiropractic Clinic Atlanta, GA

Reference given upon request

Contact this candidate