Healthcare Professional
Resume:
Britanie Gibson
Current Location: Killeen, TX ***42
Summary:
Experienced Insurance Verification Specialist and Patient Scheduling Coordinator with a strong background in healthcare administration. Proven expertise in prior authorizations, UM review/coordination, medical benefits verification, billing, and patient financial counseling, with in-depth knowledge of CPT, ICD-10 codes, HIPAA compliance, and electronic health record systems (Epic). Skilled in verifying insurance coverage, obtaining referral authorizations, managing authorizations for medical and pharmacy services, and ensuring accuracy in billing and payment processes. Adept at handling high-volume inbound/outbound calls, reviewing claims for eligibility and medical necessity, and educating patients and caregivers on coverage determinations. Proficient in Microsoft Office, Epic, and medical records management..
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 Sep 2024- Aug 2025
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.
Facilitate peer review calls between facility and external organizations.
Obtain initial and continuing authorization for treatment services.
Manage authorization denials including referral for peer review
Monitor and track new and ongoing authorization cases.
Collaborate and communicate with clinical staff to ensure necessary information is obtained and timely reviews are performed
Opthalmology Associates Irving, TX Nov 2023 – August 2024
Insurance Verification Specialist
Conducted visual field exams, administered vision tests, and prepared patients for provider visits, including dilation procedures.
Utilized ophthalmology terminology while scribing and ensuring accurate documentation.
Verified insurance coverage, obtaining referral authorizations, and counseling patients on co-pays, deductibles, and surgical fees.
Managed, patient check in, copay collections, new and est paperwork completion.
Village Medical-Balch Springs, TX Mar 2022 – Oct 2023
Patient Scheduling Coordinator
Organized scheduling and administrative tasks in a clinic office space.
Using Athena Health, managed provider schedules, coordinate appointments, and create automated reminders to minimize patient no-shows.
Followed complex scheduling guidelines, interpreted treatment plans, and coordinating patient appointments across multiple clinics.
Reviewed data entries for accuracy and provided training to new administrative staff on scheduling procedures and data management.
Verified insurance benefits, and collecting fees.
W3r / Remote Jun 2021 – Feb 2022
Health Coordinator
Review benefit coverage, extending or voiding requests per policy, and maintaining accurate electronic logs and files.
Document decisions using clinical guidelines, supporting medical claims review, and determining eligibility, benefit levels, and medical necessity.
Educate members, families, and caregivers on medical reviews and coverage determinations.
Tata Consultancy Services (TCS) - Remote Oct 2020 – Mar 2021 Annuity Specialist
Managed incoming calls from policyholders and beneficiaries.
Processed 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
Review, research, and appeal partially denied claims for reconsideration.
Contacting patients to resolve outstanding insurance balances, communicating debt relief options, and interpreting insurance policy coverages, managed care contracts, and Medicare/Medicaid regulations.
Prepare 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
Train and develop employees on company policies and procedures to ensure high-quality customer service
Monitor calls for quality assurance, create training materials, and implement corrective measures to meet company standards
Train new hires on managing Medicare Part C and D accounts, updating COB billing, and advising patients on benefits
Collect billing information, schedule appointments, update patient demographics, and verify insurance and provider eligibility across multiple systems
Prepare recommendations to enhance efficiency and improve client satisfaction
Inogen Richardson, TX Jun 2016 – Jan 2017
Medical Billing Representative
Handle incoming calls, mail, and email correspondence related to oxygen concentrator billing
Verify insurance information, resubmit claims to Medicaid, Medicare, and private insurers, and inform patients of copays and deductibles
Explain EOBs and insurance denials, verify CMNs and chart notes for service approval, and enter patient account information into Oracle, including demographics, insurance changes, and medical necessity
Coordinate with provider offices to obtain missing information and assist the customer service department with delivery logistics.
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