Medical Records Scheduling Coordinator
Resume:
Britanie Gibson
Current Location: Killeen, TX ***42
Summary:
Britanie is an experienced Insurance Verification Specialist and Patient Scheduling Coordinator with a strong background in healthcare administration.
She is a detail-oriented professional with comprehensive experience in medical Benefits, billing procedures, including the use of CPT and ICD-10 codes, and collecting payments while ensuring accurate financial records through end-of-day counts and deposit preparation.
She is proficient in verifying insurance coverage, obtaining referral authorizations, and counseling patients on co-pays, deductibles, and surgical fees.
She is skilled in reviewing and documenting data entries for accuracy, handling inbound and outbound calls, and verifying insurance benefits.
She is experienced in managing the authorization process for medical and pharmacy services, extending or voiding requests as needed, and maintaining accurate electronic logs.
Adept at supporting medical claims review, determining eligibility and medical necessity, and educating members, families, and caregivers on medical reviews and coverage determinations.
Additionally, she is proficient in Microsoft office, Epic, Medical Records, HIPAA, ICD-10, Medical Benefits Experience, verifying insurance and provider eligibility.
Education:
SNHU May 2022 – Present
Bachelor's degree in Child Psychology
Remington college Garland, TX 2012 – 2013
Diploma in Medical in billing and coding
North Texas job corps
GED
Skills:
Microsoft office (6 years)
Customer service (6 years)
45 wpm (5 years)
Medical Billing (2 years)
Insurance Verification (2 years)
Payment Processing (3 years)
Document review (4 years)
Nextgen (2 years)
Oracle (4 years)
Salesforce
Epic (2 years)
Medical Records
Analysis skills (6 years)
Microsoft Access
DME
Physiology Knowledge
Data Entry
Scheduling
Medical Terminology (6 years)
Medical Records (4 years)
MS Office
ICD-10
Medical Benefits Experience
Utilization management
Health coordination
CPT Coding
Preauthorizations (2 years)
HIPAA
Documentation review
Account management
Medical Scheduling
Patient Care
Umk2
Encoderpro
ASAM
Professional Experience:
Molina Healthcare Remote September 2024- Current
UM Care Review
Establish and maintain efficient methods of ensuring the medical necessity and appropriateness of hospital admissions/prior auths.
Perform concurrent reviews for patients to ensure that extended stays are medically justified and are so documented in patient's medical records.
Calculate the lengths of stay and continued-stay days for patients.
Ensure compliance with policies, procedures & regulations; maintains quality of records.
Accurately enter incoming client information into electronic medical record systems.
Ensure consumers referred to Residential/Inpatient program meet the identified ASAM level of care and that pre-authorizations are approved prior to admission or prior to transfer/discharge to other levels of care.
Being responsible for performing a variety of concurrent and retrospective UM-related reviews and functions and for ensuring that appropriate data is tracked, evaluated, and reported.
Facilitate peer review calls between facility and external organizations.
Opthalmology Associates Irving, TX Nov 2023 – August 2024
Insurance Verification Specialist
A skilled professional with experience in providing comprehensive support in an ophthalmology setting.
Proficient in conducting visual field exams, administering vision tests, and preparing patients for provider visits, including dilation procedures.
Adept at utilizing ophthalmology terminology while scribing and ensuring accurate documentation.
Expertise in verifying insurance coverage, obtaining referral authorizations, and counseling patients on co-pays, deductibles, and surgical fees.
Skilled in billing procedures, including the use of CPT and ICD-10 codes, collecting payments, and ensuring accurate financial records through end-of-day counts and deposit preparation.
Strong ability to manage patient check-in/check-out processes and efficiently schedule follow-up appointments.
Village Medical-Balch Springs, TX Mar 2022 – Oct 2023
Patient Scheduling Coordinator
A highly organized professional with extensive experience in managing scheduling and administrative tasks in a healthcare setting.
Proficient in using Athena Health to manage provider schedules, coordinate appointments, and create automated reminders to minimize patient no-shows.
Skilled in following complex scheduling guidelines, interpreting treatment plans, and coordinating patient appointments across multiple clinics.
Expertise in reviewing data entries for accuracy and providing training to new administrative staff on scheduling procedures and data management.
Adept at handling inbound and outbound calls, gathering necessary information, verifying insurance benefits, and collecting fees.
Experienced in generating necessary documentation, such as return-to-work letters, and resolving scheduling-related issues for providers and supervisors.
W3r / Remote Jun 2021 – Feb 2022 Health Coordinator
A detail-oriented professional with expertise in managing the authorization process for medical and pharmacy services in accordance with Utilization Management guidelines.
Skilled in reviewing benefit coverage, extending or voiding requests per policy, and maintaining accurate electronic logs and files.
Experienced in documenting decisions using clinical guidelines, supporting medical claims review, and determining eligibility, benefit levels, and medical necessity.
Proficient in educating members, families, and caregivers on medical reviews and coverage determinations, and collaborating with Managed Care Coordinators for discharge planning.
Adept at conducting thorough research to support determinations, staying updated on contracts and network statuses, and referring cases to appropriate departments.
Committed to compliance with required licenses, certifications, and participation in mandatory meetings.
Tata Consultancy Services (TCS) - Remote Oct 2020 – Mar 2021 Annuity Specialist
A customer service professional with experience in handling incoming calls from policyholders and beneficiaries.
Proficient in processing loans, cash values, and surrender requests, as well as accepting and adjusting policy premium payments and loan repayments.
Claims Processor Remote Apr 2020 – Aug 2020
Update demographics, input weekly certification answers. Check for holds on payments, authorize and
process benefit payments.
UT Southwestern Medical Center Dallas, TX Jun 2019 – Mar 2020
Medical Claims Specialist
A knowledgeable professional with expertise in reviewing, researching, and appealing partially denied claims for reconsideration.
Skilled in contacting patients to resolve outstanding insurance balances, communicating debt relief options, and interpreting insurance policy coverages, managed care contracts, and Medicare/Medicaid regulations.
Proficient in validating payments, contacting payers for reimbursement of unpaid accounts, and following up on denials and additional information requests.
Experienced in preparing appeals for denied services and managing interactions with various payers, including Managed Care, Commercial, Medicare, and Medicaid.
Teleperformance/United healthcare Dallas, TX Jul 2015 – Mar 2018
CSR Trainer
An experienced professional with a strong background in training and developing employees on company policies and procedures, ensuring high-quality customer service.
Skilled in monitoring calls for quality assurance, creating effective training materials, and implementing corrective measures to meet company standards.
Proficient in training new hires on managing Medicare Part C and D accounts, updating COB billing, and advising patients on benefits.
Experienced in collecting billing information, scheduling appointments, updating patient demographics, and verifying insurance and provider eligibility through various systems.
Capable of preparing recommendations to enhance efficiency and client satisfaction.
Inogen Richardson, TX Jun 2016 – Jan 2017
Medical Billing Representative
A detail-oriented professional with experience in handling incoming calls, mail, and email correspondence related to oxygen concentrator billing.
Skilled in verifying insurance information, resubmitting claims to Medicaid, Medicare, and private insurers, and informing patients of copays and deductibles.
Proficient in explaining EOBs and insurance denials, verifying CMNs and chart notes for service approval, and entering patient account information into Oracle, including demographics, insurance changes, and medical necessity.
Experienced in coordinating with provider offices to obtain missing information and assisting the customer service department with delivery logistics.
Psi exam center Dallas, TX Aug 2013 – Feb 2014
Test proctor
Organized professional with experience in registering test candidates for state and federal exams, including postal workers, golfers, and RNs.
Skilled in verifying identities, scanning fingerprints for background checks, and informing candidates of policies and procedures.
Proficient in monitoring exams through walk-throughs and surveillance footage to prevent cheating, and in advising testers of their exam scores.
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