Front Office Insurance Verification
Resume:
Pamela Williams
**************@*******.***
EMPLOYMENT HISTORY:
**/**/** – 8/16/24 HCA ASD – Insurance Verification Supervisor
Supervise a team of 8 insurance verifiers with insurance verification process daily. We verify for 8 Ambulatory Surgery centers (ASC) completing roughly 7000 verifications monthly. We obtain all eligibility, authorizations, benefits, claim address information from insurance payers. We determine and documents accordingly patient portions due, amounts to be billed, contractual discounts to be taken, or any other authorized discounts that may apply. Once that information is calculated we notify the patients of their out of pocket expense at least 3 business days prior to the day surgery. Explaining the copay’s, deductible, co-insurance and/or out of pockets amounts per the setting of which the procedure is performed. All information is then documented accurately into the appropriate system as with patient communication notes. This information with estimate is then emailed to the sites and advise them of any problems that may arise with the verification of benefits.
We identify all patients accounts accurately based on what PPO, HMO or other Managed Care organizations the insurance plan will fall under via our AdvantX registrations system. Making sure the right plan is selected for billing purposes to get the correct insurance reimbursement. I track staff productivity, insurance and authorization denials, profiling errors, trouble shoot issues and patients complaints. We process self-paying cases, workers compensation and automobile cases. We interview patients daily checking insurance and demographic information for accuracy. We have weekly huddles to discuss urgent issues, system and process changes etc.
11/2015 – 6/20/21 Naples Community Hospital – Revenue Cycle Trainer 1
Train front end staff for all areas, Admitting Department Downtown and North Collier, ER Downtown, ER North Collier, North East FSED, Bonita FSED, Bonita ENDO, OPIS, Wound Centers, Outpatient / Inpatient Rehab Centers, OB, Pulmonary Rehab, Cardiac Rehab, North East Radiology, Community Blood Bank and Marco Urgent Care. Create educational modules for staff to complete during shifts via Health Stream. Send educational emails system wide on various new process and procedures. Train and educate staff on using various verification tools during registration process. 100 percent audits on all new hire staff for 3 months, audit season staff that need further training assistance per supervisor/manager request. Random audits on various training material to observe the effectiveness of training provided. Attend meetings and training sessions to improve departmental overall work progress. Interacts with all department leaders within the hospital system to keep them abreast to all new training task that will impact their areas. Work as back up for the supervisory team on an as needed basis. Trouble shoot and problem solve issues in all areas when needed.
08/2013 – 11/2015 Naples Community Hospital – Supervisor Patient Access
Supervise personnel within the Admitting and ER Department, ensuring that all staff is trained on all functions of the department. We problem solve and troubleshoot any and all daily issue that arise internal and external. Reviewing charts for errors, making corrections and documenting for review with the patient registrar. Monitoring registrations to ensure accuracy and make sure they are accomplished in a timely manner, ER and admitting department patients. Monitoring insurance verifications and collections daily on all patients being processed. Provide work schedules for shift responsibility ensuring staffing levels are matched to the demand of patient volumes. Assist patient and visitors with issues or concerns as needed while maintaining knowledge and learning new processes of the revenue cycle to adequately resolve concerns. Prioritize and delegate daily departmental activities to ensure goals and objectives are met. Manages staff performance to ensure individual goals are met. Establish and maintain policies and procedures for all area ensuring they are maintained. Responsible for assisting management in developing, monitoring and reporting department productivity measures and statistics. Motivates, provides feedback, addresses performance issues while including staff making sure their feedback is included on all departmental decisions making.
02/2012 – 08/2013: Naples Community Hospital – Revenue Cycle Operations Trainer
Developed and maintained all training materials, teaching strategies, conducting new hire training and presented training updates to all hospital staff on a regular basis. Work closely with managers and directors identifying and developing process and procedures based on departmental needs. Refined existing process for ancillary departments as well. Developed process for promoting great customer service internal and externally. Implemented new process for better work ethics and patient care services. Developed and implemented standardized policy and procedures related to all functions of NCH. Implemented new hire training manuals and computerized based learning modules for all staff. Initiated random audits assuring that NCH was compliant. Developed standards of excellence within departments making sure all staff understood all policies and procedures within NCH.
7/2011 – 02/2012: Naples Community Hospital – Financial Counselor
Obtains and enters accurate patient financial information and codes for a complete verification process. Ensures insurance benefits are verified and authorized prior to all testing. Determines if information collected is applicable for services requested, reports any issues with insurances to patients and supervisor. Evaluate patient’s/guarantors financial status to determine their financial responsibility. Counsel patients about financial ability to pay and or financial hardship. Counsel all patients on covered benefits for various testing prior to testing date. I have vast knowledge with all health insurance types and very computer savvy.
05/2008 – 04/2011: Children's Healthcare of Atlanta - Insurance Verifier
Statistically meets productivity standards established by my department. Assures data integrity of insurance information that has been entered into the patient hospital account. Interacts effectively with medical staff, other departmental associates and all other Children's associates. Maintains confidentiality of patient information. Uses telephone, on-line computer system or facsimile machine to contact insurance companies and doctor offices to obtain precertification’s, authorizations and plan of care forms in a timely manner. Able to work independently, accurately and rapidly handling a wide range of duties. Strives to remain updated on all procedures and policies, performing them accurately and precisely as stated. Contact parents for high deductible and insurance policy exclusions. Follow-up all pending cases, worked insurance denials and appeals.
07/2003 - 11/2007 DeKalb Medical - Patient Access Supervisor
Supervised and managed daily operations in the Diagnostic Imaging Center, Diagnostic Breast Center, Outpatient Lab and ER Department. Operated and trained staff on the following programs: RCO Invision, SMS, Net Learning, Healthcare Data Exchange (HDX), and Forms on Demand, Medicare, Medicare Replacements, Medicare Questionnaire, Medicaid and various online verification/eligibility sites. Registered patients for ER Department, Surgery, Outpatient Lab, OB Admissions, Diagnostic Radiology Imaging and Inpatient Admissions. Monitored point of services collections and tracked collection goals within the department.
09/2002 - 07/2003 Radiology Assoc of Clayton - Front Desk Registration
Scheduled patients for various diagnostic tests. Obtained demographics and proof of insurance coverage. Verified proof of insurance and obtained authorization and pre-certification for exams. Collected co-payments, coinsurance and deductibles. Maintained medical reports and files as requested. Closed-out account daily by calculating checks, credit cards and cash collections.
01/2002 - 09/2002 Pines Radiology Center– Insurance Verifier / Scheduler
Assisted patients and family members with all insurance questions, financial assessments and made financial arrangements for uninsured patients. Verified all insurance coverage prior to diagnostic testing. Followed-up claims for reimbursement. Worked closely with registrars on collections, verifications and problem solving. Submitted daily verbal reports to physicians. Scheduling various diagnostic test/requesting lab work prior to procedure.
09/1999 - 01/2002 Comprehensive Medical Imaging - Medical Records Supervisor
Managed staff and daily operations for medical records. Trained staff on report documentation/submission of film readings for emergency reports to physicians. Organized patient orders and pulled charts for daily testing. Maintained and organized patient films. Dictated reports and answered multiple phone lines. Planned and implemented many processes and procedures. Worked closely with radiologist for films/reports & films for comparison.
EDUCATION
BAUDER COLLEGE, Criminal Justice- Associate’s Degree, Atlanta, GA. APRIL 2010
CLAYTON STATE COLLEGE, Medical Terminology-Diploma, Morrow, GA JUNE 1997
ADVANCED CAREER TRAINING, Medical Administrative Asst.-Diploma, Atlanta, GA
Contact this candidate