Verification Specialist Customer Service

Roseann Lewis

Mesquite, TX ***** ***********@*****.*** 913-***-****

Claims Denial Specialist

Dedicated, Claims Specialist skilled in reviewing and analyzing claim denials; working with payers to resolve denials, tracking denials by payer and denial category, researching trends, and recommending process improvement to eliminate future denials. Ensure that all claim documentation is complete, accurate, and complies with company policy; establish, maintain, and update files, databases, records, and other documents for recurring internal reports.

KNOWLEDGE/SKILLS

Adhere to HIPPA laws; protect patients' rights by maintaining the confidentiality of personal and financial information

Proficient in operating a standard desktop and Windows-based computer systems; Microsoft Word/Excel/Outlook/Teams.

Experience working with electronic medical record systems (EMRs), Dentrix, Eagle Soft, Easy Dental

Understanding of EOBs and Reimbursements

Knowledge of significant dental, health plans, and insurance processes

Knowledge of dental, medical, and pharmacy terminology; CPT-4 & ICD-10 Coding

Excellent written verbal and face-to-face communications skills

Effectively explain relevant insurance information to patients, insurance plans, and internal colleagues

Service-oriented; responsive, and courteous in approach

Ability to work independently and collaboratively in a team-oriented environment; professional and friendly demeanor

Good organizational and time management skills to effectively juggle multiple priorities and time constraints

Ability to exercise sound judgment and problem-solving skills; diffusing any potentially negative situation

PROFESSIONAL EXPERIENCE

6/2015 – 1/2022 Christus Health – Irving, TX Claims Denial Specialist

Tracked and documented all denials by payer, visit type, and denial category; reviewed and analyzed claim denials to perform the appropriate appeals necessary for reimbursement.

Communicated directly with the payer, re-submitted denied claims, underpaid claims, and claims; inaccurately processed by auditing accounts to check on proper payments, coding, balances, adjustments, etc., and using appropriate reports and working queues.

Identified, documented, and communicated recurring denials trends and recommended process improvements or system edits to eliminate future denials; worked with payers to understand specific reasons.

Maintained reconciliation log of all daily receipts posted; monitored payments to ensure appropriate reimbursement from the third-party payers.

Processed patient refunds promptly, submitting refund requests at the time of insurance payment/EOB receipt.

Provided financial counseling to customers who present payments at the counter or on the phone and need to arrange an approved payment plan.

Reviewed and analyzed past due amounts using aged accounts receivable reports, including patient and insurance accounts.

11/2014 – 5/2015 AmerisourceBergen – Plano, TX Verification Specialist

Provided intake services and set up for all new patients.

Coordinated patient care with physician offices, nurses, pharmacists, and patients.

Performed insurance verification for significant medical and pharmacy benefits.

Maintained current documentation related to the patient's drug therapy and pharmacy care plan; coordinated prescription deliveries and refills for patients.

Supported other team members in the healthcare team, proactively ensuring a continuous quality improvement customer service approach.

Identified areas of improvement and communicated those ideas to the healthcare team, flagging issues that need to be addressed.

Coordinated responses and resolutions to issues with appropriate internal and external parties.

8/2005 – 5/2014 Dr. Steven Pendleton, DDS – Kansas City, KS Dental Billing Specialist

Processed billing for services, including verification of medical coding.

Processed electronic and manual claims, reviewing claim forms for accuracy and corrections, as needed.

Completed client insurance verification and treatment authorizations; investigated and resolved denied or aged claims with insurance companies.

Provided assistance to clients with payment inquiries; explained statements and charges, established payment plans and answered related questions.

Performed routine posting of payments and prepared bank deposits.

EDUCATION

Kansas City Kansas Community College, Kansas City, KS - AAS/Liberal Arts

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