Information Technology Insurance Verification

TIFFANY R. MOLDEN

678-***-**** *************@*****.***

CAREER SUMMARY

Experienced insurance verification and claims processing specialist with a strong background in authorization management. Proficient in verifying insurance coverage, securing pre-certifications, and ensuring compliance with healthcare regulations to facilitate seamless patient care. Adept at processing claims efficiently, resolving discrepancies, and maintaining accurate documentation for timely approvals and payments. Skilled in collaborating with healthcare providers, insurance companies, and patients to streamline authorization processes and enhance the overall patient experience. AREAS OF EXPERTISE

Microsoft Office Insurance Verification Claims Management Verbal/Written Communication Skills Insurance Benefits Electronic Health Records Medical Terminology Key Performance Metrics Data Entry HIPAA Account Management Medical Billing Regulatory Compliance Time Management Patient Support Conflict Resolution EDUCATION/CERTIFICATIONS

Southwest Georgia Institute of Education/Associate of Arts in Information Technology/Healthcare IT University of Phoenix/Bachelor of Science in Information Technology/Health Management Healthcare Information Technology Certified/CPR Certified/American Red Cross Certified/Risk Management Certified President’s List

High School Diploma

PROFESSIONAL EXPERIENCE

Insurance Verifier Specialist September 2021-Current Children’s Healthcare of Atlanta at Egleston

Responsible for management of patient accounts, updated client records and ensure needed information is on file.

Post patient charges and payments within a timely manner in order to minimize loss or denial of payment by insurance.

Review and resolve discrepancies in received data and performed data verification according to company procedures.

Verify patient information and ensure compliance with all HIPAA regulations in support of patient privacy.

Scan all documentation into the system for easy follow-up, entering pertinent information within a timely manner while paying attention to detail.

Review and resolve discrepancies in received data in accordance with company procedures.

Effective communication with staff/management/patients and medical offices in order to retain needed information. Front Office Coordinator March 2020-September 2021 Piedmont Atlanta Hospital

Managed daily front office operations, ensuring smooth patient check-ins, scheduling appointments, and handling inquiries with professionalism and efficiency.

Coordinated communication between medical staff and patients, providing accurate information and directing calls to the appropriate departments, enhancing overall patient experience.

Maintained patient records and updated electronic health systems with accurate information, ensuring compliance with hospital policies and HIPAA regulations.

Handled patient billing and insurance verification, assisted with pre-authorizations, co-pays, and payment processing, while addressing any billing-related questions.

Supervised and trained front desk staff, fostering a collaborative and efficient work environment to meet department goals and provide excellent patient service.

Assistant Front Office Manager January 2019-March 2020 WellStar Healthcare System

Managed scheduling for seven physicians across cancer support, pulmonary, pediatrics, and psychology services, ensuring seamless coordination of patient care.

Consistently demonstrated superior customer service and professionalism while addressing patient needs and inquiries.

Verified insurance coverage, obtained pre-certifications, and conducted accurate preregistration for bariatric and neurology testing prior to scheduled visits.

Ensured timely distribution of the daily Admit List and identified potential CVCP patients for processing by the pre-certification staff.

Verified physical therapy benefits, coordinated DME orders, and facilitated discharge planning to rehabilitation centers.

Resolved scheduling conflicts and testing concerns to maintain high patient satisfaction and retain loyal business. Assistant Office Manager August 2020-January 2021

Lennox Specialty Group

Educated patients on lumbar epidural and TPI injections, scheduled appointments, and ensured accurate billing and coding entries into the system. Prepared correspondence, memos, and tracking spreadsheets, and managed pre-registration, cash handling, and key holder responsibilities.

Utilized E-Clinical Works, EPIC, and insurance verification platforms to efficiently complete assigned tasks.

Handled prescription refills, responded to patient and insurance inquiries, and managed the mailing of outpatient information and storeroom orders.

Addressed case management issues and effectively managed administrative tasks, consistently prioritizing and multitasking to meet organizational demands.

Team Leader July 2016-April 2018

Emory Orthopedic and Spine Hospital

Managed incoming calls, addressed escalated service concerns, and provided process improvement recommendations to enhance the daily operations of the call center.

Served as a Subject Matter Expert, offering constructive feedback to new hires and leading professional development meetings on company processes.

Handled an average of 350 inquiries, setting performance benchmarks and collaborating with management to streamline workflows and improve overall efficiency.

Secured procedure authorizations, maintained documentation, and facilitated peer-to-peer reviews. Coordinated surgery scheduling with patients at local hospitals or surgical centers.

Accurately recorded and maintained insurance information through the referral and verification process, ensuring effective communication with therapists, coding, and finance teams. IT Specialist January 2015-July 2016

Teletech

Greeted inbound calls with the highest standards of courtesy and professionalism, remaining committed to the achievement of those quality standards by guaranteeing that each customer's concerns were skillfully resolved.

Ensured timely and accurate information was provided to customers in a professional manner, responded to inquiries through phone, mail and email contact with customers.

Guaranteed troubleshooting guidelines were executed appropriately by accurately capturing customer product complaints within company's margin of error standard. Unit Secretary February 2011-July 2015

Phoebe North Hospital

Provided administrative support to healthcare staff, managing patient records, filing, and updating electronic health records

(EHR) with accuracy and confidentiality.

Coordinated patient admissions, discharges, and transfers, ensuring smooth communication between departments and prompt action on patient needs.

Scheduled appointments, diagnostic tests, and procedures for patients, ensuring timely coordination with the medical team and other departments.

Prepared and maintained patient charts, ensuring all necessary documentation was completed and filed appropriately in compliance with hospital protocols.

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