Tosha Luster ***** Ike Street Roseville, MI ***** 586/764-7642 (cell) ad29lb@r.postjobfree.com

Summary: Highly dedicated and reliable Insurance Verification Specialist/Supervisor with experience of over 20 years of knowledge with insurances, medical terminology, Healthcare/DME, Customer Service and Supervisor skills. Knowledge of HIPAA compliance

Skills/Qualifications: Some knowledge of Microsoft Word and Excel *Customer Service *ICD9 and ICD10 knowledge for Diabetes/DME *Experience with verifying insurance coverage/benefits for local and private health insurances through Medicaid, Medicare, Aetna, Blue Cross Blue Shield, Medicare Plus Blue, HAP, Priority Health to name a few * Experience with obtaining prior approval from insurance providers verbally, online, fax or through portals. HCPC knowledge for Diabetic/DME and Prosthetics and Orthotics * Teamwork/Collaboration Customer Service/Call Center *Scheduling * Organizational and Leadership skills * Time Management * Problem solving * Works well independently or in a team environment * Data Entry with billing information through AdvancedMD software to create claims for billing*Extensive Medicare and commercial insurance experience

Experience: 06/01/2013 – present Office Supervisor/Administrative Assistant/Insurance Verification Specialist Healthy Steps Medical Supply

Answered incoming/inbound calls from patients and Healthcare Professionals * Data Entry with patient, insurance information * Verified insurance coverage online or with a representative to check eligibility/ benefits which included deductible and coinsurance * Updated and verified all medical necessity forms before billing insurance providers *Answered office and incoming emails from Healthcare professionals, insurance providers * Explained coverage/benefits prior to scheduling appointment * Obtained prior approvals from Insurance Providers verbally and by fax and through web portals *Assessed and adjusted insurance policies * Worked with Healthcare Professionals such as Nurse Practitioners, Diabetic Educators, Physician Assistants * Entered patient data in billing software called AdvancedMD to generate claims *Investigated and resolved complaints pertaining to urgent requests from patients, physicians, Insurance Providers * Worked rejections from insurance provider’s to either dispute the non-payment/denials from a claim that wasn’t paid *Handled new enrollments and renewal patient accounts * Faxed/mailed out diabetic shoe Rx and foot exam forms to physician offices, patients Ordered/checked shoes in to deliver to the patients

08/05/2002 - 5/20/2013 Customer Service Supervisor/Insurance Verification Specialist Great Lakes Medical Supply/Brightsky

Answered switchboard and multi-line system * Managed operations in the absence of Managers/Leadership Team * Data Entry of patient input, cash sales * Verified insurance coverage for patients and informed them of their insurance deductibles/copays * Participated in Management training programs which allowed me to assist with interviewing and new hires and supervising personnel * Coordinated and managed daily work flow with assigning enrollments for inbound/outbound calls for diabetic testing supplies *Handled daily complaints * Scheduled and canceled appointments * Randomly reviewed department orders for accuracy * Facilitated and coordinated scheduled meetings/trainings * Developed and worked with over a 100 Special Accounts assigned to me through Healthcare Professionals, Physicians, Hospitals with inbound and outbound enrollments * Ordered and received office supplies for my department/staff * Scheduled hospital trainings for pediatric and gestational patients * Scheduled in house training for walk ins for glucometers/testing supplies, nebulizers * Processed DME orders which included wheelchairs, walkers, canes and crutches,etc.

Education: Kettering High School June/1989 References available upon request