Insurance Quality Assurance

Debra A. Rose

**** *** ***** *******, ***** Home 832-***-****

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

Career

Objective

To pursue a challenging position in a result oriented company that will

utilize my educational background and relevant experience while offering

professional development and advancement.

Professional Experience

MD Anderson Cancer Center Houston, Texas 11/2010-12/2012 Patient Insurance

Specialist

Obtains insurance pre-certifications and verifications to ensures

reimbursement from patients or other responsible parties. Provides

financial counseling to patient including cost estimate, payment plan, and

supplemental financial assistance. Handle new patient registration in

accurate, efficient manner. I am responsible for third party carriers and

manage care. Use excellent oral communication with patient, doctors, and

peers to represent the department in an appropriate way. Operate within

the guidelines of the policy and procedure of the institution.

The Methodist Hospital Houston, Texas 07/2007-01/2009 Patient Access

Supervisor

Assist management with leadership responsibilities in supervising a team of

12. Maintain employees time on Kronos, and made any necessary correction.

Develop and maintained relationship with staff and facility administrators

with in the hospital. Ensured staff was in compliance with company

policies, and procedures. Monitored patient access staff to ensure patient

were being registered accurate, efficient, and in a timely manner.

Performed a comprehensive analysis to ensure patient registration was being

entered accurately. Streamline a process to reduce patient registration

wait time by 40%. Develop an open door policy to create team development.

Enhanced employee's recognition resulting from 70% to 97% increase.

Contribute strategy that will have meaningful impact on the organization.

HCA-Shared System Houston, Texas 11/2006-08/2007 Agency Representative

Reviewed and researched facility credit balance accounts to determine

accuracy of payment. Audit accounts for claims compliance. Handled

liability cases and ensured all cases were paid at the amount agreed by

collecting 80 % on litigation claims. Analyze and research payer

contracts. Prepared claims report for management, which are utilizing as

affidavits for collection. Authorized and approve to credit patient account

for contractual adjustment. Filed appealed denied claims, and re-filed for

resubmission per contact agreement. Ability to identify discrepancies, and

resolve problems with patient accounts. Corresponds with insurance

companies regarding patient diagnosis and accounts information.

RE/MAX Professional Group Houston, Texas 02/2005-Current Realtor

Represent consumers in making logical financial decision regarding

property. Represent sellers/buyers in how to market property. Followed up

with consumer to ensure proper customer relation was administered. Produce

one million dollars of revenue in sales for the months of March, and April

of 2006. Supervise consumers in the best loan product. Keep current with

the market analyst on property to inform consumers.

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UnitedHealth Group Health Houston, Texas 11/2000-08/2001 Member Service

Representative

Administer healthcare benefit and eligibility for members. Receive calls

answer patient inquires resolve all discrepancies regarding patient

accounts. Handle reimbursement on over paid claims. Assist nursing staff,

intake specialist with pre-certification. Contact physicians to confirm

referral authorization. Contact member to confirm procedure, and

appointment time. Reduced hold time by resolving members and providers

issues real-time. Maintain high level response time which increased volume

productivity by 98%.

Ben Taub General Hospital Houston, Texas 05/1999-02/2005 Patient Access

Representative

Obtain initial and subsequent pre-authorization for services, and handled

day surgery procedure. Updated all patient insurance, and demographic

information was entered. Perform pre-admit, and insurance verification on

patient account. Recoup 85 % of revenue on past due accounts. Assist

patients in obtaining financial assistance, and other community services.

CNA Insurance League City, Texas 10/1997-08/1998 Benefit Specialist

Provided comprehensive insurance benefits to members. Reviewed member

claims to determine ICD-9, CPT codes were accurate. Adjudicated claims for

payment. Handle adjudication on unpaid claims. Renewed providers contract

for services, processes address changes in privileges, on-going maintenance

and handled member enrollment. Documented and prepared reports of

discrepancies and unsatisfactory service.

The Montrose Counseling Center Houston, Texas 08/1991-10/1997 Insurance

Specialist

Scheduled patients for office visit. Ensure all demographic information

was obtained. Obtains insurance pre-certifications and verifications and

ensures reimbursement from patients or other responsible parties, and

billed Medicaid/Medicare claims for consideration of payment. Collected

clients co-pay for service render. Posted account receivable to reflect

payment on clients account. Examined EOB to determine denials, and execute

claims resubmission. Submitted correspond letter to appeal denied claims.

Recoup on 100 % of revenue from insurance carriers.

Education

Houston Community

College, Houston, TX Accounting 1999

University of Houston, Houston, TX

Accounting/Business 1981

Personal

Qualities

A highly motivated and detail oriented person with excellent organizational

skills. My major strengths are in customer relation, quality assurance,

management principles, resource allocation, production methods, and

coordination of people. Knowledge of Manage Care Contracts, Healthcare

Claims, Medical Terminology, ICD-9, CPT, UB92, HCPC, HIPPA, JACHO, ICH and

GCP (FDA) Guidelines. Additional skills: Microsoft Word, WordPerfect,

Lotus 123, Excel, EPIC, Meditech, and IDX. Bringing professionalism,

innovation, integrity, diplomatic, motivation, tactful, dependable,

character, while maintain strict confidence.

Contact this candidate