Patient Access Customer Service

ANN MALONEY

704-***-**** ************@*****.*** Matthews, North Carolina

PROFESSIONAL SUMMARY

• Dedicated healthcare and insurance professional with extensive years of experience in prior authorizations, medical claims processing, insurance verification, and patient access services.

• Skilled in reviewing benefits, eligibility, copays, and payer requirements across Medicare, Medicaid, and commercial insurance plans.

• Adept at handling claim denials by identifying root causes, submitting appeals, and ensuring accurate claim adjudication using ICD-9, ICD-10, CPT, and HCPCS codes.

• Experienced in collaborating with providers, patients, and payers to resolve coverage issues and facilitate timely reimbursement.

• Proficient in Microsoft Excel, Word, and Outlook for claim tracking, reporting, and workflow management, with a proven record of delivering excellent customer service in high-volume call environments while maintaining compliance with HIPAA standards.

• Holds a High School Diploma.

PROFESSIONAL EXPERIENCE

Cigna

August 2021 – July 2025

Supplement Claims Registration/Authorization Analyst (Remote-Assignment completed)

• Managed claims data information entering patients’ information into database.

• Processed and reviewed prior authorization requests for all denied services.

• Verified insurance coverage, copays, and patient eligibility across multiple systems, ensuring accuracy before claim submission.

• Maintained accurate documentation and reporting using Microsoft Excel, Word, and Outlook for claim tracking, provider correspondence, and workflow management.

• Interacted effectively with customers and providers regarding authorization denials.

• Worked under the guidance and assistance to ensure accurate of complete patient data and authorization.

Lash Group – Fort Mill, SC

September 2005-November 2020

Patient Access Specialist (Worked remotely for the last 8 years) ANN MALONEY

704-***-**** ************@*****.*** Matthews, North Carolina

• Contacted physician offices and insurance companies to verify patient eligibility, benefits, and coverage for procedures, medications, and treatments.

• Coordinated and processed prior authorization requests, ensuring timely approval for services by reviewing CPT, ICD-9, ICD-10, and HCPCS codes.

• Verified coverage under Medicare, Medicaid, and commercial insurance plans, explaining copays, deductibles, and out-of-pocket responsibilities to patients.

• Utilized Microsoft Excel to track authorization requests, denials, and claim outcomes, and maintained accurate documentation in Word and Outlook for communication and reporting.

• Managed 20 to 30 calls daily.

• Received applications from MD sites to check high-dollar medication procedures with patients’ insurance, called insurance companies, and obtained benefits for procedures the MD was going to perform.

• Completed benefit summaries for MDs, faxed them to the site, and then called patients and MD sites with benefit results; if not covered, referred patients to the free medication line.

• Collected and entered patient demographic and insurance data into the database to show patient accounts.

• Contacted insurance companies regarding patient medical coverage for high-dollar medication procedures.

• Secured patient information and confidential medical data in compliance with HIPAA privacy rule standards to protect patient privacy. Piedmont Healthcare Management Group – Charlotte, NC July 2004-September 2005

Medical Billing Representative

• Worked in billing department, billing inpatient services to different insurance carriers. Calling insurance carriers and checking on services, correcting denied claims, and posting accounts. Company outsources job.

• Posted and adjusted payments from insurance companies.

• Precisely evaluated and verified benefits and eligibility and completed claims paperwork, documentation, and system entry.

• Researched CPT and ICD-9 coding discrepancies for compliance and reimbursement accuracy.

• Submitted electronic and paper claims to insurance companies including Medicare and Medicaid to collect medical payments.

ANN MALONEY

704-***-**** ************@*****.*** Matthews, North Carolina Kanawha Health Plan – Lancaster, SC

July 2002-July 2004

Customer Service Representative

• Managed customer service calls from providers, members, and providers and hospital facilities.

• Verified co-pays, patient eligibility, benefits, claim statutes and prior authorizations across multiple systems.

• Took 60 to 70 calls in a high-pressure call center where 95% of all calls were answered within system metrics.

• Familiar with CPT, HCPCS and ICD 9 and 10 codes. Followed HIPAA guidelines. SKILLS

• Medical terminology * EPIC System

• Eligibility Determination * Patient Registration

• Insurance Verification * Insurance billing

• Data Entry * Front desk operations

• Claims * Medical insurance

• Medical coding understanding * Payment processing

• MS Word/Excell/Outlook * Fee Collection

• Avaya and Cisco Phone System * Information Collection EDUCATION

EL Modena High School

Orange, California

REFERENCES

Available Upon Request

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