Insurance Verification Patient Care
Resume:
Denise Gooding-Dudley
Supervisor Insurance Verification
Danvers, MA 01923
*********@***.***
#readytowork
Authorized to work in the US for any employer
Work Experience
Supervisor of Insurance Verification
LifeStance Health - Lynnfield, MA
September 2020 to Present
Insurance verification for eligibility and coverage, including but not limited to coinsurance, deductible and copayments and Authorization requirements. Entered Insurance benefits into EHR System, Sign off on Employee timesheets, Create user name and password for new Insurances, Managing worklist for patients self schedule appointments, Ongoing maintenance of training guides, knowledge of credentialing process and utilizing credential information, Cross trained in payers for various states, Managed escalated verifications, Demonstrated ability to manage multiple changing priorities and attended all team meetings. created Training Manuals. Entered time cards into ADP system. Facilitated the establishment of Single Case Agreements (SCAs) for clinicians,ensuring seamless negotiation and implementation is specialized patient care agreements to meet individual healthcare needs. Collaborated closely with the analyst team to successfully set up new carrier request, demonstrating strong teamwork and coordination skills in streamlining processes and ensuring efficient delivery. Octopus
Patient Service Coordinator II
Fertility Centers of New England - Reading, MA
June 2020 to August 2020
• Verified benefits for initial consults and all follow-up appointments,surgeries, and obtained appropriate referrals or authorizations for all Infertility service
• Provided prompt response to patients regarding Cost/Fees for Infertility treatment.
• Responsible to meet/speak with patients to review benefits prior to and /or at the conclusion of all consults.
• Responsible to register patient’s insurance information into patient Portal, IDX and Ferti Soft and update as needed.
• Contacted primary care physician office/Utilization Management or Health plan on status of patient authorization/referrals.
• Used Microsoft Outlook appointment scheduler with the ability to input patient information for Physician and other daily schedules, which may include surgeries.
• Screened and directed all incoming telephone calls in an effective and efficient manner.
• Assisted patients in problem solving potential issues related to the Health Care system, financial or social barriers. Relayed messages to staff and took necessary action when required.
• Communicated with the Self Pay Coordinator for services not covered by patient’s insurance.
• Obtained credit card payments from patients over the phone for out-standing balances on accounts not covered by their insurance using the Clover credit card machine.
• Contacted patients on approval of authorizations for upcoming treatments.
• Presented necessary medical information such as history, diagnosis and CPT codes for billing purposes.
• Obtained daily reports from Ferti software regarding outcome of potential pregnancies. Senior Insurance Verification Rep
SLEEP MED, INC - Peabody, MA
May 2002 to June 2020
• Responsible for prioritizing all request and verified patient eligibility and benefits using the Bright Tree and Pulse system.
• Coordinated with clinical teams to conduct and clear all visits and out-patient procedures prior to patient's appointment.
• Verified eligibility and benefits via online insurance website, telephone, fax back or through automated services.
• Documented patient benefit information in the Brightree and Pulse system for Co-insurance, deductible and out of pocket expenses.
• Contacted primary care physician office/Utilization Management or Health plan on status of patient authorization/referrals.
• Communicated with department i.e. billing and Patient Financial Services regarding authorization denials and or re-direction of the patient by the health plan or PCP office.
• Verified that the (CMN) Certificate of Medical Necessity form had correct patient name, DOB, Patients CPT and diagnosis code (ICD a brief description of patients signs and symptoms and the Ordering Physicians signature.
• Trained new hire employees on various applications and procedures.
• Assisted receptionist by answering and directing calls to various departments and assisted patient walk ins scheduled in the office.
• Verified Workman's Comp./Auto insurance medical notes for accuracy in meeting guidelines for approval.
• Answered and returned telephone calls in a professional manner.
• Independently worked on multiple schedules for different sites in a timely/efficient manner.
• Contacted scheduling dept. when additional information is required or missing on patient demographics.
Accounts Receivable Staff Accountant for Commercial Accounts TLP LEASING - Boston, MA
December 1998 to December 2001
Accounts Receivable Staff Accountant for Commercial Accounts
Disbursed checks for travel and entertainment expenses.
Reconciled Partnerships and updated Account Receivable Spreadsheets monthly.
Analyzed unapplied entries to verify payment received and applied payment to appropriate Lessee.
Maintained Commercial Lease database. Inputting new Commercial Leases and updating existing Leases.
Developed and generated A/R reports from accounting software.
Prepared A/R closing books for staff auditors.
Reconciled bank statements.
Handled daily cash receipt reports.
Education
Some College in Business
North Shore Community College - Lynn, MA
July 1989 to September 1990
Skills
• Motivated and accomplished health Care professional with over 17 years of experience with Diagnostic Medical Insurance. good communication skills, attention to detail. able to take initiative, prioritize and multi task, and manage workload, and have the ability to work with HIPPA compliant patient information.
• -Issue Resolution
• -Multi-tasking
• Microsoft Outlook
• -Detail oriented
• -Empathy
• -Data Entry
• -Team Player
• -Demographics
• -Scheduling
• -Customer service
• -Accounting
• -Bank Statements
• -Microsoft/Office
• Word
• Excel
• Insurance Verification
• ICD-10
• CPT Coding
• Medical Office Experience
• EMR Systems
• Medical Records
• ICD-9
• ADP (1 year)
• Staff training (2 years)
• SOP Standard Operation Procedures (1 year)
• Onboarding Process
• Microsoft Teams (2 years)
• Customer service
• Leadership
• Front desk
• ICD-9
• ICD-10
• Accounts receivable
• HIPAA
• Training & development
• Supervising experience
• Communication skills
• Microsoft Access
• Accounting
• Accounting software
• Medical office experience
• Computer skills
• Data entry
• Healthcare management
Assessments
Customer service — Proficient
July 2020
Identifying and resolving common customer issues
Full results: Proficient
Indeed Assessments provides skills tests that are not indicative of a license or certification, or continued development in any professional field.
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