Insurance Physician
Resume:
Tinka O. Dumas
CLARKSTON, GA *****
**********@*****.***
OBJECTIVE: To obtain a position with a Revenue Cycle Team where I can utilize my knowledge of insurance and analytical experience to better enhance the growth of the company.
EDUCATION: Chamblee High School
PROFESSIONAL SKILLS:
Strong Customer Relations Skills
Proficient in Microsoft Word/Excel/Outlook, SMS, EPIC and insurance websites (BCBS, RADMD, WebMD, WellCare, Amerigroup and UHC).
Scheduling system: Epic, NueMD, RIS and SIS.
EXPERIENCE:
January 2006-Present: Children Health Care of Atlanta
Insurance Verification Specialist / Revenue Cycle Assistant
Interview patient and / or family members as needed to secure information concerning insurance coverage, eligibility, and qualification for various financial programs.
Coordinate and perform verification of insurance benefits by contacting insurance provider and determining eligibility of coverage and communicates status of verification/authorization process with appropriate team members in a timely and efficient manner.
Provide clinical information as needed, emphasizing medical justification for procedures/service to insurance companies for completion of pre-certification process.
Confirm referring physician has obtained prior authorization as needed from insurance company for all scheduling healthcare procedures within assigned department/area.
Contact referring physicians and or /patients to discuss rescheduling of procedures due to incomplete/partial authorizations.
Act as liaison between clinical staff, patients, referring physician’s office, and insurance by informing patients and families of authorization delays/denials, answering questions, offering assistance, and relaying messages pertaining to authorization of procedure / service.
Explaining insurance benefits, deductibles, and co-ins to patient for upcoming procedures.
Rebilling, posting payments and remastering payments on patient’s accounts
Maintain tracking of patients on schedule, ensuring that eligibility and authorization information has been entered into data entry systems.
Pre-screens doctor’s orders (scripts) received for new patients to ensure completeness / appropriateness of scheduled appointments
Responds to all inquiries from throughout the system and outside related to authorization/pre-certification issues. Provides on-going communication and training to physician offices, patients/families and others as necessary to resolve insurance authorization-related departmental issues.
May 2010-July 2016: Resurgens Orthopedics
Insurance Verification Specialist/Surgery Scheduler
Billing Department
Contacts insurance company to verify patient coverage and obtain information concerning extent of benefits, via phone, website or fax.
Verifies insurance information and benefits on all new patients, and on any patient with new insurance. Follows up with patient for additional information as needed.
Verifies referral status. Follows up with patient or PCP to verify that referral has been made if required.
Ensures all benefits are posted appropriately to the patients account as directed in the revenue cycle.
Communicates with PAR’s and front desk regarding needed information for the provider’s clinic.
Indicates the patient’s financial responsibility by highlighting deductible, co-pays or co-insurance on the superbill and enters the copay amounts in the information system (APM) as required.
Schedule Surgical ESI procedures/Obtain benefits and authorization for surgical procedures.
Acts as liaison between clinical staff, patients, referring physician’s office and insurance payers by informing patients and families of procedures authorization delays/denials, answering questions, offering assistance, relaying messages, pertaining to the authorization of procedure/service.
Perform revenue cycle activities required for pre-registration and registration, facilitating insurance pre-certification and authorization.
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