Data Entry Insurance Analyst
Resume:
E
Krystle Edwards
**************@*******.***
Spring, TX 77373
SUMMARY
Results-driven professional effective in implementing positive change while overseeing multiple tasks. A team player with great time management and organizational skills. Pursuing an Insurance Analyst position with an established company.
SKILLS
Proficient in Epic Software
Adaptability
Clerical and Filing Support
Claims Handling and Coverage Verification
Insurance Authorizations
Credit Balancing
Insurance verifying
Account Reconciliation
Accurate payment position
Revenue Cycle Management
EXPERIENCE
Insurance Analyst II
Houston, TX
Kelly Service (Abbvie) / Jun 2024 to Current
Provide subject matter expertise on medical and prescription insurance coverage/verify, claim billing, medication pre-authorization and appeal filing and alternative financial assistance.
Accurately document information in the appropriate system and formants.
Use internal web tools, and communicate and collaborate with health insurance payers and providers to investigate pharmacy and medical benefits.
Obtain and confirm information to maintain Pharmacy Solution's payor intelligence resources.
Investigate an problem solve for patients experiencing escalated issues such as disadvantaged or complex
Verify DX, HCPC, CPT and ICD Coding
Verified Medical Commercial and Government plans design such as HMO,PPO, Medicare/Medicaid, VA and Tricare also contacted Pharmacy Benefits Manager.
Utilize excel, pivot tables, charts, word document and any other coverage processor.
Evaluated policies and procedures related to Insurance Verification activities.
Verified patient eligibility for insurance coverage by contacting insurance carriers and obtaining the necessary authorization numbers.
Sr. Dental Billing Specialist
Spring, TX
Visualutions/ Sep 2023 to Jun 2024
Audited and corrected billing and posting documents for accuracy.
Used data entry skills to accurately document and input statements.
Monitored outstanding invoices and performed collections duties.
Generated monthly billing and posting reports for management review.
Reconciled accounts receivable to general ledger.
Handled account payments and provided information regarding outstanding balances.
Prepared insurance claims for submission to clearinghouses or insurance companies.
Filed and tracked insurance claims and communicated claims status to patients.
Obtained prior authorization and pre-certification for outpatient procedures.
Researched denied claims and contacted insurance companies to resolve these issues.
Prepared and distributed denial letters, detailing reasons for denial and possible appeal measures.
Input all patient data regarding claims and prior authorizations into system accurately.
Department Support Specialist II
The Woodlands, TX
Kelsey-Seybold/ Aug 2022 to Sep 2023
Reviews account information explains charges and other related inquiries from patients and insurance carriers in-person or via telephone.
Informs patients of self-pay balances owed to facility.
Quickly learns and adapts to new skills and applies them to daily tasks, improves efficiency and productivity and navigates different floors of the clinic.
Assist Patients with check-in/out functions including registration and cashiering accurately.
Review all procedure charges, resolve site rejections, handles encounters, completes work-queue's.
Coordinates with nurses to contact patients that may not have appropriate coverage.
Coordinated with facilities to set up surgeries for Gastroenterologist.
Verified insurance coverage and obtained pre-authorizations.
Took pre-operative orders from surgeons and anesthesiologists for smooth operation planning.
Communicated surgery requirements to nursing teams for smooth operation delivery.
Arranged pre-operative and post-operative appointments for surgical patients.
Insurance Coordinator
Houston, TX
ABC DENTAL/ Jan 2011 to Apr 2022
Checked patients in and out, obtained data such as patient demographics, insurance information, and medical codes to properly file insurance claims.
Prepared insurance claims for submission to clearinghouses or insurance companies, Filed and tracked claims and communicated claims status to patients.
Used data entry skills to accurately document and input statements.
Managed all payments processing, invoicing and collections.
Educated patients about surgeries and provided treatment plan documentation.
Obtained pre-authorizations and pre-certifications ahead of scheduled surgeries.
Arranged pre-operative and post-operative appointments for surgical patients.
Adhered to strict HIPAA guidelines to protect patient privacy.
Completed patient referrals to other medical specialists.
Helped patients complete necessary medical forms and documentation.
Understood dental terminology and insurance
Secured sign-in sheets, dental charts, and encounter forms to safeguard sensitive data and information.
Provided excellent customer service to create positive experiences and build patient trust.
Verified insurance and communicated coverage to staff and patients.
Researched customer inquiries regarding eligibility for Medicare programs.
Assisted customers with completing the application process for Medicare enrollment.
EDUCATION AND TRAINING
High School Diploma
Houston Can Academy
Houston, TX
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