Insurance Verification Specialist
Resume:
Skills and Expertise:
Education:
Language:
About Me
Insurance Verification
Medical Authorization
Medical Terminology
Medical Coding/Billing
Data Entry
BSBA Major in Human Resources
Technological Institute of the Philippines (QC)
938 Aurora Blvd, Cubao, Quezon City, 1109
2013 - 2016
Tagalog English
Detail-oriented and innovative health insurance professional with 6 years of extensive experience in designing operational workflows for verification of benefits and obtaining medical authorization, aimed at ensuring compliance with standards while minimizing time expenditure by integrating with Google Sheets along with Google App Script.
Insurance Eligibility and Authorization Specialist Supervisor in Medical Billing and Authorizations
January 2022 - Present STAT CARE (Florida)
January 2019 - January 2022 Theradynamics (NY/NJ) Verifies the medical benefits of patients (urgent and elective cases)
Creates and oversees prior authorizations and referrals Generates, compiles, and stores SBC (Summary of Benefits & Coverage) for future use
Addresses inquiries related to benefits and service summaries concerning patient coverage
Locates in-network providers for patients requiring referrals Regularly reviews the contract roster for updates
Resolves issues related to clinical billing
Supports managers in formulating additional protocols Engages periodically with third parties regarding credentialing issues and contract grid enhancements
Develops comprehensive Google Spreadsheets to track tasks Creates intricate Google Sheets formulas, along with Google App Script, to produce reports based on the existing database Handled complete process of verification of patient's coverage and benefits
Properly audited EMR and resolved correction queues such as failed fax transmissions, expired authorizations, no future appointments, missing POC (Plan of Care) approvals, expired referrals
Obtained prior authorizations for physical and occupational therapy services from multiple commercial insurances such as Blue Cross Blue Shield, Health First, Fidelis Care, Aetna, United HealthCare, WellCare, Metro Plus, etc.
Corrected complex claims and charges denials such as patient cannot be identified as insured, non-covered services as not deemed a medical necessity, misrouted claims, incorrect denials due to PANO (Prior Authorization Not Obtained), etc. Reviewed EOB (Explanation of Benefits) received in Waystar to make sure that denials and proper contractual or clinic adjustments are correct
Worked with the billing department to send appeals for the denied claims whenever necessary and appropriate
Professional Experience:
JASPER
Health Insurance Specialist
Suarez
Google Sheets
Google App Script
Tebra/Kareo (EMR)
Clinicient (EMR)
ClickUp
Basecamp
*************@*****.***
03 Orion St.
Crestview Homes Subd.
Brgy. Mayamot
Antipolo, Rizal
1870
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