Mary Ellen OBrien

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

Telford, PA 18969

Cell: 267-***-****

ad3d7c@r.postjobfree.com

Qualifications

Lead Insurance Specialist with over twenty years of documented experience in the medical industry including hospital setting, private surgical practice and therapy center. Highlights

Systems: Raintree Systems, Casamba Skilled, EPIC, Navinet, Availity (as well as all Insurance web sites) Cerner Scheduling and Insurance Verification Systems, HDX Insurance Verification System, Huron Scheduling and Tracking System, GroupWise Mail System / Microsoft Outlook, Microsoft Office Suite, specifically Work and Excel

• Has excellent interpersonal and communication skills

• Has excellent organizational skills and strong attention to detail

• Ability to work alone with minimal supervision as well as ability to function in a team-based environment, working with patients, therapists, and leadership

• Ability to review EMR audit/prebill reports relevant to job responsibilities

• Knowledge of HIPAA requirements

• Skilled in using Electronic Medical Records Software

• Strong Multi-tasking and problem-solving skills

• Maintains total confidentiality of personal and financial data Work Experience

8/2021 to Current

Lead – Insurance Specialist

Solaris Health and Wellness – Bonita Springs, FL

• Established in-house Verification Department drawing on knowledge from years of experience in the medical verification and precertification field. Created protocol, procedures as guidelines for patients and staff notification of approval.

• Review medical records and insurance to ensure patient meets the guidelines and medical policy of insurance for physical, occupational, and speech therapy

• Communicates with insurance company to verify eligibility, authorization requirements and patient financial responsibility for therapy

• Communicates with physician offices to obtain referral/authorizations for therapies, acquire authorization thru various websites

• Communicates therapy requirements to Intake Staff for review with patients/POAs

• Monitor therapy schedules to ensure all visits are within visit limits based on insurance guidelines, monitor, and maintain authorizations for continuation of treatment

• Identifies trends that may result in potential billing issues and communicates with Billing Department

• Works closely with Billing Department to assure prompt and correct payment for services

• Performs and review activities within the guidelines, policies, and procedures of the Business Office

• Identifies trends in variations of data entry that may result in potential billing issues

• Trains new staff to assure they follow guidelines and policies of Solaris as well as the guidelines of the Insurance Verification Team

09/2015 to 08/2021

Lead – Surgical Pre-Cert Specialist for 3B Orthopedic Surgeons ARIA HEALTH SYSTEMS (Jefferson Health System) – Langhorne, PA

• Review medical records to ensure patient conditions meet guidelines and insurance medical policies for Inpatient and Outpatient scheduled surgeries.

• Surgical Pre-Cert Specialist communicates with insurance companies and patients to update Information, obtain referrals and/ or pre-certifications as needed.

• Copay Specialist, compile patient financial obligations based on insurance coverage and communicates this information to the patient to secure payment.

• Identify trends in variations of data entry that may result in potential billing issues and make relevant suggestions for the improvement of data collection.

• Review and update various reports for patient management related issues.

• Maintains status via daily status update for all scheduled Inpatient and Outpatient surgeries. 04/2014 to 09/2015

Inpatient Insurance Verifier / Co-pay Specialist / PAT Surgical Scheduler ARIA HEALTH SYSTEMS (Jefferson Health System) – Philadelphia, PA

• Performs and review activities within the guidelines, policies, and procedures of the Business Office.

• Review and verify insurances and patient information for ED admissions and direct admissions.

• Pre-Cert Specialist communicates with insurance companies and patients to update information, obtains referrals and/ or pre-certifications as needed.

• PAT Specialist, schedules patients for elective surgical inpatient and outpatient procedures

• Copay Specialist, compile patient financial obligations based on insurance coverage and communicates this information to the patient to secure payment.

• Identify trends in variations of data entry that may result in potential billing issues and make relevant suggestions for the improvement of data collection.

• Review and update various reports for patient management related issues. 04/2002 to 04/2014

Outpatient Insurance Verifier

ARIA HEALTH SYSTEMS (Jefferson Health System) – Philadelphia, PA

• Perform and review activities within the guidelines, policies, and procedures of the Pre-Encounter Unit.

• Review and verify insurances and patient information for scheduled outpatient testing and services.

• Pre-Cert Specialist communicates with insurance companies, physician offices and patients to update information obtain referrals and/ or pre-certifications as needed.

• Communicates with insurance companies and physician offices to obtain retro pre-certifications and/or referrals to insure payment of studies performed.

• Compile patient financial obligations based on insurance coverage and communicate this information to the patient to secure payment.

• Identify trends in variations of data entry that may result in potential billing issues and make relevant suggestions for the improvement of data collection.

• Review and update various reports for patient management related issues.

• Started as Registrar, promoted to Outpatient Insurance Verifier.

• Assist in identifying the educational needs of the staff within assigned parameters and the development of interdepartmental solutions.

• Provide assessments of findings from review activities.

• Act as liaison with other departments who do SMS Invision data entry with the patient management system.

• Productivity consistently exceeds 135%.

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