Administrative Assistant Insurance
Resume:
Cathleen M. Perez
Fallbrook, CA
E-Mail: add1qp@r.postjobfree.com
QUALIFICATIONS
Experience working in healthcare field, and administrative assistant prior to that. Proficient in: Microsoft Word, Power Point, Excel, Access, Outlook, and Internet. Knowledge of CPT Codes and ICD9/ICD-10 Codes and of HCFAA 1500 claim forms. Reliable, efficient, well organized with the ability to work well under pressure with minimal supervision and as a team player. Able to handle many projects at once while prioritizing tasks. Good ability to learn any computer software quickly. Type 45 WPM, 10 key, and excellent phone etiquette.
EDUCATION
Larson Training Ctr -Computer & Md Claims Processing & Md Terminology 7/99 – 12/19
Pasadena City College – Business
Los Angeles Trade Tech College - Business
Rosemead High School
EMPLOYMENT HISTORY
NCHS
12/16/19 – 5/8/20
Referral Coordinator
1.Monitors Electronic Health Record (EHR) tasks throughout the day to capture referral requests in real time.
2.Gathers pertinent information as needed via EHR or from clinical team to accurately complete pre-authorization/referral process.
3.Prepares and accurately processes referral and pre-authorization paperwork; ensures that referrals are addressed in a timely manner, prioritizing urgent items appropriately.
4.Verifies insurance information and performs eligibility checks by telephone or electronically, as appropriate, for referral purposes.
5.Produces and submits all appropriate notification letters for patients and clinicians, as required.
6.Ensure complete tracking and follow-up on all referral requests and specialty report requests.
7.Answers, responds and documents phone calls, requests and questions from patients in a timely manner; reviews details and expectations about referrals with patients.
8.Responds to clinical support staff questions, requests and concerns regarding the status of patient referrals, care coordination or follow-up status.
9.Utilizes third party payer/insurance portals as needed.
10.Ensures proper use of Current Procedural Terminology (CPT) and current International Classification of Diseases (ICD) codes to meet the requirements of third party payers and specialty clinics to ensure minimal delay in securing referral appointments or pre-authorizations. Follow-up with clinicians as needed.
11.Responsible for proper documentation according to NCHS protocols.
12.Utilizes EHR functions and/or other software systems to document all pertinent referral or Patient Health Information (PHI).
13.Schedules referral appointments directly on behalf of patients, as needed.
14.Tracks referrals utilizing the EHR or other established system.
15.Properly follow-up with provider and patient regarding denials to referral requests.
16.Cross trains with other Referral Coordinators to learn each process related to the various service lines provided by NCHS completely to ensure coverage is available.
Experience in Billing Software
oValder, Green Integrity EHR, IEHP, Claim Remedi
Maintains confidentiality of PHI by following all applicable Health Insurance Portability and Accountability Act (HIPAA) regulations.
Acadia HealthCare
10/30/17 – 12/6/19
Benefit and Authorizationt Verification Specialist
Responsible for the timely verification of insurance benefits provided via websites and/or calling the payor.
Obtain precertification and authorizations for services being rendered
Review and resolves prior authorization/precertification/referral issues that are not valid and contacts insurance carriers to verify/validate requirements to ensure accuracy and avoid potential denial.
Validates all necessary referrals/prior authorizations/pre-certifications for scheduled services are on file and shared with all appropriate staff and are valid for the scheduled services performed.
Ensure all account activity is documented in the appropriate system and shared with all appropriate staff timely and thoroughly.
Identify and forward potential reimbursement problems with the Billing Team.
Proactively interacts with Clinics and other appropriate staff sharing benefits, authorizations and eligibility.
Maintain confidentiality
Experience in Billing Software
oNaviNet, Waystar, MDC, Methasoft, Tower
Ambry Genetics
1/10/13 - 10/2/17
System Process Biller
Contact patients and third party payers, collect payment, and resolve outstanding balances.
Review requisitions and all supporting documentation.
Perform insurance verification.
Review and enter demographic information.
Enter billing information into the system.
Identify and resolve problems in a timely manner.
Contact clients for missing information.
Review ICD-9 and CPT codes supplied for accuracy of billing carrier specifications.
Utilize multiple information systems and resources to research and enter data.
Prepare up doctor NPI information.
Doing appeal letters for insurance company.
Call patient doctor office and get medical records and LMN documents
Call insurance companies to obtain claim status for the patient.
Enter information you from the doctor; office and hospital after and enter them into billing software
Mail out claim forms with all documents to the insurance company
Maintain confidentiality.
Experience in collections and verify insurance benefits
Experience in billing software
oEZ Claim, Xifin, Telcor
Clarient –GE Healthcare Company
4/23/12-10/24/12
Temporary assignment thru Corestaff Agency
Enter medical, billing, and customer data into Clarient computer systems
Interface with customers to resolve conflicting information
Call patient regarding refund checks due to them.
Call insurance companies to obtain claim status for the patient.
Prepare adjustments, correct customer database information, and process Explanation of Benefits (EOB)
oPrepare account adjustments for Medicare billings
oProcess returned mail using TevixMD, XIFIN, or Laser Fiche to find the correct address
oGenerate EOB in XIFIN, print the EOB, attach it to the 1500 Health Insurance Claim Form, and mail to the vendor
AMMCOR (HOA Management Company)
12/07-10/11
Administrative Assistant/Receptionist
Provide administrative support:
Write checks for AMMCOR bills and prepare AMMCOR deposit for the bank
Log in checks and deposits in a journal
Log and file all individual homeowner association documentation
Perform searches for archived items
Appear at County Recorder’s Office for document recording
Answer phones and open/sort mail
Flavorchem
5/03-12/07
Receptionist, Customer Service, and Data Entry
Laguna Shores Management Corp.
1/03-5/03
Receptionist
Southern CA Edison
3/02-12/02
Office Clerk (Temporary)
Friess Company Builders, Inc
2/01-3/02
Receptionist
Southern CA Edison
3/00-2/01
Office Clerk (Temporary)
Northrop Grumman
11/85-7/99
Data Entry Operator Specialist: (1995-1999) / Senior Secretary: (1985-1995)
Secret Clearance/SAR (Special Access Required)
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