Insurance Verification Data Entry

Candidate Location:

San Antonio, TX

Open interview availability

Ph: 210-***-****

Email: *******@*****.***

Relevant Skill Set:

•18+ years of healthcare experience

•Knowledgeable with the authorizations and referrals process, medical terminology, ICD-9, and ICD-10 coding, data entry, medical records, office management, medical office, CPT coding, medical scheduling, and insurance verification.

•MS office proficient, EMR systems, eClinicalWorks, QuickBooks

OMG Technologies

Molina Healthcare - Care Management Processor

October 2023 – January 2025

•Processing of authorizations and follow-ups for DME, MHM, DAHS,PAHS, RESPITE and reductions/denials

•Follow ups with members, maintaining extremely accurate tracking for reporting, satisfactions surveys, emails, and urepointploads into TruCare upon work completion and receipt of completed forms.

•Submit referrals, review BID and follow-up on status of BIDs.

•Obtain required forms (landlord approval, 2416) • Submit cases for medical review when necessary.

•Obtained proper documentation for DME from Assigned Reps for equipment

•Generated authorities

•Insurance Verification

•Excel

•Microsoft Word

•HERO

•Web Del

•Spreadsheets

•Microsoft Teams

•Sharepoint

•QNXT

•CCA

•PEGA

Aston Carter

3M KCI USA

March 2023-June 2023

•Obtained proper documentation for DME from Assigned Reps for equipment

•Generated authorities

•Insurance Verification

•Excel

•Microsoft Word

•HERO

•Web Del

•Spreadsheets

•Microsoft Teams

•Sharepoint

Professional Experience:

Superior Health Plan

August 2022-February 2023

Program Coordinator (Specialty Authorization Team)

•Processing of authorizations and follow-ups for DME, MHM, DAHS, and reductions/denials

•Follow ups with members, maintaining extremely accurate tracking for reporting, satisfactions surveys, emails, and urepointploads into TruCare upon work completion and receipt of completed forms.

•submit referrals, review BID and follow-up on status of BIDs.

•Obtain required forms (landlord approval, 2416) • Submit cases for medical review when necessary.

Dr. Robert Nobles

December 2017 to August 2021

Front Office Coordinator

•Check in and check out patients.

•Answer multiple phone lines • Insurance verification

•Generated referrals.

•Checked patient vitals

•Worked on MOMS system

•EKG’S and ABI’S

Renal Associates LLC

November 2013 to August 2017

Referral Coordinator

•Generated referrals in a timely manner

•Verified insurance.

•Worked with ECW

Dr. Arthur Hernandez

September 2011 to November 2013

Front Office Coordinator

•Pleasantly welcomed visitors, answered phone calls, and maintained front reception desk.

•Oversaw insurance verification.

•Generated referrals and authorizations.

•Worked on MOMS and DUXWARE EMR

•Pleasantly welcomed visitors, answered phone calls, and maintained front reception desk.

•Oversaw insurance verification.

•Generated referrals and authorizations.

•Worked on MOMS and DUXWARE EMR

Institute For Women's Health

August 2009 to August 2011

Insurance Verification Specialist/Patient Referral Coordinator

•Verified that patients had the proper insurance coverage prior to any procedures or appointment scheduling.

•Called insurance companies to ascertain pertinent information regarding policies and payment benefits for patients.

•Updated all patient and insurance data regularly and carefully inputted changes into company's computer system.

•Instructed clients on amounts covered under benefits plans in easy-to-understand terminology.

•Provided excellent service and attention to customers when face-to-face or through phone conversations.

Education:

High school diploma, McCollum High School - San Antonio, TX

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