Professional Billing & Insurance Verification Specialist
Resume:
TONYA FAVORITE
FortWorth, TX *****
*************@*****.*** / 817-***-****
SUMMARY
Highly-motivated professional with strong worth ethic, adaptability, and exceptional interpersonal skills. Versed in resource loading and operations sequencing. Familiar with HIPAA compliance and documentation requirements. Seeking opportunities to expand my skills while facilitating company growth.
SKILLS
●Document Management
●Attention to Detail
●Critical Thinking
●Problem-Solving
●Microsoft Office Suite
●EPIC Certified
●Effective Multitasking
●Athena Training
Medical Terminology
●HIPAA Compliance
●Decision-Making
●Schedule Management
EXPERIENCE
Surgery Scheduling Specialist – Vascular Surgery / Texas Health Resources - Arlington, TX 01/2019 -04/24/2025
●Processed documents related to medical claims processing including authorizations, referrals, pre-certifications.
●Accessed patient information through various software applications, maintaining strict confidentiality to remain compliant with HIPAA regulations.
●Obtained insurance verification and authorization to submit financial clearance of patient accounts.
●Obtained proper authorization and identification to release confidential medical records.
●Schedules all inpatient and outpatient surgery and medical procedures, tests and studies ordered by the physician
Insurance Verification Specialist / Robert Half – Alliance RX-Walgreens Prime - Irving, TX 01/2018 - 01/2019
●Verified patient eligibility for insurance coverage by contacting insurance carriers and obtaining the necessary authorization numbers.
●Identified discrepancies in patient's insurance coverage or benefits, ensuring accuracy of data entered into system.
●Assisted in resolving claim issues related to billing and reimbursement inquiries.
●Analyzed complex health plan contracts to determine benefit coverage levels for services rendered.
●Maintained accurate documentation on all pre-authorization requests, denials and appeals.
Claim Liaison / Claimassist LLC,/ Texas Health Resource - Arlington, TX 01/2012 - 01/2018
●Assisted Attorney's with negations for settlement offers.
●Analyze trends in claims processing issues and assist in identifying and quantifying issues and reviewing work processes.
●Process daily reporting files for general liability and motor vehicle claims.
●Assisted in the preparation of documents for submission for settlement offers.
●Coordinated with various departments within the organization to resolve complex claims issues.
●Conducted research into specific cases, including gathering additional information as needed from clients and other parties involved in a claim.
Benefits Specialist / Dallas City Hall - Dallas, TX 01/2011 - 01/2011
●Analyze employee benefits data to ensure accuracy, including service from third party vendors
●Maintain and assist retiree benefit records and procedures for administration process
●Participate in preparation and communication to employees about benefit program, procedure, claims, and any other government-mandated disclosures.
●Processed benefit enrollment forms, changes, and terminations.
●EPIC Certified
Medical Eligibility Specialist / Texas Health and Human Services - Arlington, TX 01/2009 - 01/2009
●Process eligibility forms for services including Medicaid, SNAP, and TANF
●Work fraud and abuse reports and demographic change report.
●Reviewed applications and supporting documents to determine applicant's eligibility for Medicaid benefits.
●Conducted initial eligibility screenings for Medicaid applicants.
●Verified accuracy of applicant's financial information against third-party sources such as employers, banks or government agencies.
EDUCATION AND TRAINING
Medical Billing and Coding Certification 07/2010
Certified Training Institute - Arlington, TX
High School Diploma 06/1998
Broad Ripple High School - Indianapolis, IN
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