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Insurance Representative

Atlanta, Georgia, United States
October 27, 2016

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Atlanta, GA 678-***-****


Knowledgeable Senior Medical Clerk representative specializing in insurance verification and third-party billing seeks position as an insurance verification representative

99% reimbursement on claims and prior authorizations filed on behalf of Grady billing

Certified Patient Account Representative (CPAR) through Healthcare Financial Management Association

Advanced Certified Patient Account Representative through HFMA,

Skilled in utilizing Medicaid verification and customer databases such as Georgia Health Partnership and Passport

Proficient in use of ICD-9 and CPT coding

Knowledgeable of Medical Terminology

Nominated and Selected by the Directors of Grady Health System as a Grady Great 100 out of 5,000 employees


Grady Health Systems Atlanta, GA 1978-2014

Senior Insurance Verification Representative 2006 -2014

Verify Commercial insurance, Medicare and Medicaid

Utilized Passport and Georgia Health Partnership (GHP) databases

Appropriately coordinate all benefits (COB) according to payer requirements

Enter appropriate comments, updated information for patients scheduled for Outpatient Patient Diagnostic Radiology procedures, OB and Cancer Center.

Obtain pre authorizations/pre-certification for Outpatient Diagnostic Radiology

Notified patients of Grady Card eligibility status via telephone

Informed patients of co-pays, deductibles

Provided quotes for the cost of Diagnostic Radiology tests from Charge Master and Federal Poverty Guideline Policies.

Senior Credit and Collections 1999-2006

Grady EMS/Ambulance Specialist

Precise collection of Medicaid and Medicare, all Third Party and Patient Liability Accounts.

Productive interaction with insurance companies, third party agencies, and patients always obtaining maximum reimbursement.

Effectively assist and resolve third party and patient collection problems and issues, while coordinating work flow in collection area and answering questions as needed.

Posting payments for self-pay, third party insurance (commercial, Health Maintenance Organizations and Preferred Provider Organizations, as well as Exclusive Provider Organizations

Third Party Insurance Verification Specialist 1998-1999

Verified all third party payer dates. i.e. Medicaid, Medicare,

Commercial insurance, HMO, PPO, possible liability, and BCBS.

Responsible for updating patient records in accordance with Grady Health System policies and entering data into the hospital wide data base.

Pre-certify all third parties for Utilization Management EDUCATION

Georgia Perimeter (formerly DeKalb Community) College, Nursing Atlanta Area Technical College, Certified, Medical Office Assistant


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