Summary

Responsible for the verification of insurance benefits and obtaining prior authorizations for all procedural orders by successfully performing duties within the scope of the policy and procedures for over 9.5 years. Friendly Insurance Verification Specialist promoting a background in keeping sensitive patient data confidential while maintaining knowledge of Medicaid and private policy benefits. Possessing great relationship building and communication skills. Looking to tackle new challenges with a company that values dynamic skills and a strong work ethic. Demonstrated knowledge of admissions, insurance verification and authorization processes in hospital and medical office settings.

Skills

Reimbursement

Vervint

Customer Service

Medical Terminology

Data Entry

Salesforce

Patient Relations

Scheduling

Claims Filing

Prior Authorization/Pre-Certification

Insurance Verification

Electronic Medical Record/EPIC

CPR+

Care-Tend

Admitting

Utilization Management

Referrals

CRM

Medi-tech

Facets

Claims Processing

Discrepancy Resolution

Experience

05/2022 - Current

Billing Specialist, Bardavon Health Innovations, Overland Park, KS

Researched and resolved billing inconsistencies and errors through individual and collaborative analysis.

Also, responsible for the daily management of chat, emails, phone inquiries, and Salesforce inquiry tickets

Process CMS 1500 claims, via paper, email, fax and/or 837p/FTP

Work clearing house rejections with full resolution within 2 business days

08/2022 - 11/2022

Emergency Room Registrar, Saint Mary's Medical Center, Blue Springs, MO

Interviewed patients to obtain patient demographics and insurance information

Responsible for securing insurance and copay information, eligibility, benefits, and authorizations if applicable

Worked with agencies, insurance companies, affiliated and partnered firms to obtain authorizations, referrals and exchange medical releases when needed

Managed front office customer service, appointment management, billing and administration tasks to streamline workflow.

11/2021 - 04/2022

Field Liaison, United Bio-Source, Overland Park, KS

Formulates, interprets, and implements reimbursement policies to resolve complex dispensing or referral issues and ensure a positive patient and physician experience

Provided Program Specific Plan (PSP) support on special projects to enhance reimbursement, revenue and on-going support utilization opportunities

Gathers, analyses, and prepares data, including Adverse Event trending, for Quarterly Business Reviews (QBRs), FDA requirements, and other special projects and reports

Worked closely with disabled or impoverished individuals to locate helpful financial resources and community programs.

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07/2020 - 08/2021

Reimbursement Coordinator, WellSky, Overland Park, KS

Generated Home Infusion and Durable Medical Equipment (DME) claims for submissions to patients and/or third-party payers

Verified benefits for insurance companies for IV Home Infusion and Specialty RX within timeframe set by insurance carriers

Identify needs of patients that may qualify for financial assistance

Call Center Experience in taking over 75-100 calls a day

Contacted insurance carriers to obtain authorizations, notifications and pre-certifications for patients.

10/2019 - 07/2020

New Patient Intake Coordinator, University of Kansas Health System, Lenexa, KS

Performs initial insurance screening to identify self-pay or patients with high-risk insurance plans

Provided coverage for scheduling phone lines, eFax queue, O2 work queue and email referral Queue

Partners with clinical staff by collecting, following up on, and confirming receipt of all medical information identified that is necessary for successful, timely visit, including outside medical records, pathology slides and radiology films

Schedules and notifies patient of all ordered diagnostic tests and/or physician appointments as directed by clinical staff.

07/2015 - 10/2019

Lead Customer Care Representative, GEHA, Independence, MO

Brought Customer service Scores from A 65% to an 89%

Encouraged team members to improve productivity and service levels by modeling correct behaviors and coaching employees.

Processed insurance claims, including worker's compensation, auto insurance, private insurance, and Medicare / Medicaid.

Responds to telephone, web, emails, and chat inquiries from members, hospitals, doctors and other providers concerning verification of coverage and benefits

05/2011 - 07/2015

Senior Lead Representative, Core Source, Overland Park, KS

Promoted to customer service lead in six months owing to excellence leadership

Review various complex claim issues necessary in the benefit determinations involved in complex claims, large dollar claims, predetermination review and outpatient precertification of service reviews

Frequently set up training materials, therefore, improved the effectiveness of the customer service department by 20%

Brought Customer service Scores from A 72% to a 95% KPI

Education and Training

Associate of Occupational Studies, Occupational Studies, HealthCare Administrative

Heritage College, Kansas City, MO

GPA: 3.7

Tiffany Clayton

816-***-**** • adwulf@r.postjobfree.com

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