Surgical Coordination & Insurance Verification Expert
Resume:
Karen Clem
Antioch, CA *****
*****************@*****.***
Professional Summary
Experienced Surgery Coordinator and Insurance Verification Specialist with over 32 years in medical office settings. Skilled in scheduling surgeries, obtaining insurance authorizations, patient counseling, and maintaining confidential records. Adept at managing complex workflows, resolving patient inquiries, and ensuring compliance with HIPAA. Seeking to leverage expertise in surgical coordination and insurance processes in a dynamic healthcare environment. Authorized to work in the US for any employer
Work Experience
Surgery Coordinator
Golden State Orthopedics and Spine
March 2022 to December 2025
* Scheduled surgeries and preoperative tests, ensuring all necessary steps were completed before surgery.
* Counseled patients about their financial responsibility prior to surgery and answered related questions.
* Acted as a liaison between physicians, patients, and hospitals or surgery centers to coordinate care.
* Received instructions from physicians and communicated recommended surgeries or tests to patients.
* Obtained pre-certification and pre-authorization from insurance companies for all procedures and tests.
* Discussed preoperative instructions with patients as directed by physicians.
* Scheduled operating room time and faxed H&P to hospital admitting departments according to protocols.
* Coordinated all business and clinical paperwork prior to surgery, ensuring paperwork was ready for the surgeon.
* Responded to written and telephone inquiries from patients and insurance carriers regarding planned surgeries.
* Maintained clear communication among physicians, patients, insurance companies, and hospitals at all times.
Medical Insurance Verification Specialist
BASS SURGERY CENTER-Walnut Creek, CA
October 2020 to March 2022
* Verified insurance benefits and eligibility for patients prior to procedures.
* Calculated fees, deductibles, and copayments due from patients, ensuring accuracy.
* Checked for authorizations of equipment and implants needed for surgeries.
* Communicated with patients regarding their insurance benefits and financial responsibilities.
* Supported the surgery scheduler as needed to ensure smooth workflow.
* Coordinated with doctors and offices regarding operative reports and necessary corrections.
* Contacted patients if claims were denied and assisted with coordination of benefits. Surgery Coordinator
Golden State Orthopedics and Spine
August 2007 to October 2020
* Scheduled surgeries for multiple surgeons specializing in Ortho Trauma, Total Joints, and Sports Medicine.
* Acted as a liaison between physicians, patients, hospitals, surgery centers, skilled nursing facilities and insurance companies while keeping the patients with any updates and / or changes.
* Obtained pre-certification / pre-authorization, deductibles, out of pocekt and coinsurance from insurance companies for all procedures and tests.
* Discussed preoperative instructions with patients as directed by physicians.
* Scheduled operating room time and faxed scheduling sheet, Demos, H&P and authorizations to hospital / ambulatory surgery centers.
* Obtained all pre-op testing prior to preop appts with their surgeon to get signed off for surgery.
* Maintained communication with surgeons, patients, insurance companies, and hospitals within a timely manner.
Call Center Lead
Golden State Orthopedics and Spine-Walnut Creek, CA June 2012 to November 2017
* Managed department in supervisor's absence, providing guidance and support to staff.
* Trained staff and assisted with questions to ensure accurate scheduling and decision-making.
* Conducted staff meetings and handled escalated calls from patients.
* Scheduled appointments, entered patient demographics, and insurance information.
* Maintained physician schedules, referrals, and messages, ensuring accuracy and confidentiality.
* Worked multiple department reports, including audits, recalls, and waitlists.
* Maintained detailed knowledge of NextGen and other relevant software.
* Ensured compliance with HIPAA and practice guidelines. Call Center Customer Service Representative
Works in NextGen
August 2007 to June 2012
* Answered multi-line phone system and scheduled appointments for multiple physicians.
* Transferred calls to correct departments and confirmed doctor appointments.
* Assisted in maintaining physician schedules and handled 70-100 calls daily.
* Worked in a fast-paced environment and demonstrated strong multitasking skills.
* Applied working knowledge of insurance processes. Patient Financial Services (Temp)
UCSF Temp Agency-San Francisco, CA
June 2006 to August 2007
* Answered multi-line phones and explained charges to patients.
* Assisted patients with charity programs and discussed hospital charges in detail.
* Collected payments from patients and provided financial guidance. Account Representative
Anesthesiologist Associated Inc-Walnut Creek, CA
March 2006 to June 2007
* Collected outstanding balances and followed up with insurance companies.
* Communicated with patients about balances and payment plans.
* Investigated and followed up on unpaid, self-pay, and litigation accounts.
* Processed mail from physicians, insurance companies, and patients regarding accounts.
* Made adjustments to accounts, including referrals to collections and insurance adjustments. Clerical Support
Anesthesiologist Associated Inc-Walnut Creek, CA
June 2004 to March 2006
* Assigned physician, CRNA, and resident numbers and determined financial classes.
* Assigned insurance codes and obtained relationship codes for claims.
* Corresponded in writing for verification and clarification of charges.
* Handled NEIC rejections and processed claims.
* Received, batched, and logged charges; processed copy checks and EOBs; performed reception duties. Education
High school diploma
Upper secondary education
High school diploma
Upper secondary education
Skills
• Multi-line Phone Systems
• Office experience
• Training & development
• Technical Proficiency
• Affordable Care Act (ACA)
• Health insurance knowledge
• TRICARE health insurance
• ICD-10
• Typing
• ICD coding
• Anatomical terminology
• Writing skills
• Client interaction via phone calls
• Productivity software
• Medical referrals
• Medical billing
• Analytics
• Point of service (POS) health insurance
• Appointment scheduling
• Grammar Experience
• Phone communication
• Microsoft Word
• Medical diagnostic terminology
• Medical billing modifiers
• Health insurance network providers
• Interpersonal communication
• Microsoft Office
• Sales
• Phone etiquette
• Managed care
• Interpersonal skills
• English
• High-deductible health plan (HDHP) insurance
• Coinsurance in health insurance
• Computer operation
• Health insurance out-of-pocket maximums
• Microsoft Outlook
• Veterans Affairs (VA) health insurance
• Calendar management
• Medicare
• Mobile devices
• EPO health insurance
• Surgery scheduling and coordination (Less than 1 year)
• EHR systems
• CRM software
• Healthcare provider information
• Health insurance verification via manual review
• Organizational skills
• Conducting sales calls
• Background checks
• Health insurance verification via phone
• Research
• Client email correspondence
• HMO health insurance
• Electronic health records (EHR) management
• Health insurance co-pays
• Maintaining patient confidentiality
• Time management
• Financial software
• Medical terminology
• Live chat
• Health insurance referral requirements
• Patient financial counseling (Less than 1 year)
• Health insurance verification via real-time eligibility check
• Centricity
• Health insurance verification via online portal
• Medical scheduling
• Escalation handling
• Medical terminology and anatomical terminology (Less than 1 year)
• Customer service
• Epic
• Medical Coding
• Health insurance verification via internal database
• Health insurance information
• Health insurance verification via payer websites
• Trauma medicine
• Medical office experience
• HIPAA
• Patient demographics
• Health insurance policy knowledge
• Basic math
• Customer support ticket management
• Attention to detail
• PPO health insurance
• Credit report analysis
• Insurance verification - Insurance verification experience (More than 20 years)
• Health insurance deductibles
• Customer complaint resolution
• Health insurance authorizations
• Staff training
• Task prioritization
• Health insurance benefit levels
• Debits & credits
• CPT coding
• Insurance prior authorization
• Computer literacy
• ICD-9
• Administrative experience
• Managing patient records
• Data entry
• Achieving HIPAA compliance
• Medical procedure terminology
• Microsoft Excel
• Customer inquiry handling
• Medical records
• Google Docs
• Health insurance pre-authorization requirements
• EMR/EHR
• NextGen
• Editing
• Windows
• Meditech
Certifications and Licenses
BLS Certification
Driver's License
Contact this candidate