Insurance Verifier
Resume:
Carla Graves
Easton, PA *****
********@***.***
Professional Experience
Community Health System, Franklin, TN
Insurance Verifier (March 2021 - November 2024)
•Ensured insurance coverage, confirmed precertification requirements, calculated patients’ financial responsibility, educated patients on their insurance policies, and resolved any issues with coverage.
•Communicated with patients, medical offices, and hospitals to complete all necessary documentation to ensure a smooth admitting process once patients are on site and all hospital and regulatory policies comply.
•Contacted patients and received calls for multiple hospitals regarding their benefits.
•Assisted coworkers, hospitals, doctor's offices, and patients with difficult accounts.
•Assisted in training coworkers.
•Researched CPT, ICD 10 codes, medical policies, and new guidelines for insurance companies.
•Provided updated information to leadership.
Community Health System, Sarasota, FL Insurance Verifier (December 2020 - March 2021)
•Ensured insurance coverage, obtained precertification, calculated patients’ financial responsibility, educated patients on their insurance policies, and resolved any issues with coverage.
•Communicated with patients and medical offices to complete all necessary documentation to ensure a smooth admitting process once patients are on site and all hospital and regulatory policies comply.
•Contacted patients and received calls for multiple hospitals regarding their benefits.
Mid Atlantic Retina, Bethlehem, PA
Insurance Verifier (October 2020-December 2020)
•Verify for retinal injections.
•Confirm that patients are within the time frame for injections per guidelines.
•Calculate patient responsibility.
•Check medical necessity.
•Check for authorizations.
•Check for eligible funds from the Chronic Disease Fund.
•Enroll patients if eligible for additional Chronic Disease Funds, if necessary.
•Apply payments to the Chronic Disease Fund.
Community Health System, Bethlehem, PA
Insurance Verification Supervisor (December 2014 – July 2020)
•Supervised a staff of 40 employees for 12 hospitals for inpatient, surgery, radiology, wound care, and physical therapy.
•Confirmed all accounts were verified and authorizations obtained before the appointments.
•Confirmed medical necessity and CMS guidelines are met before the appointments.
•Handled patient and doctor office complaints and assisted in financial situations/discrepancies.
•Worked denials to assist in appeals and held weekly staff meetings.
Community Health System, Bethlehem, PA
Insurance Verifier (June 2014 – December 2014)
•Ensured insurance coverage, obtained precertification, calculated patients’ financial responsibility, educated patients on their insurance policies, and resolved any issues with coverage.
•Communicated with patients and medical offices to complete all necessary documentation to ensure a smooth admitting process once patients are on site and all hospital and regulatory policies comply.
Fresenius Medical Care North America, Bethlehem, PA.
Precertification and Referral Representative (May 2008 – October 2012)
•Actively assisted in implementing an internal Authorization and Referral Department and generated a tracking system for referrals and authorizations for outpatient dialysis (Hemodialysis and Peritoneal).
•Obtained new, ongoing, and retro referrals and authorizations. Travelled to various departments in both billing offices and clinics to educate on the process of obtaining authorizations and referrals.
•Learned contracts for various insurance companies for all our clinics (both PAR and NON-PAR).
•Oversaw admission paperwork for seven different internal billing groups by confirming accuracy and scanning documents into DI (Document Imaging).
•Interacted with clinical staff daily and patients specifically who were concerned about insurance coverage.
P.C. Gastroenterology, Chatargy S. Kaza, M.D., Easton, PA. Office Manager (January 2005 – May 2008)
•Performed day-to-day office operations: scheduled outpatient procedures for 4 separate facilities, made appointments for 2 different offices, ordered supplies (for both patient and office use), obtained referrals and authorizations for procedures and office appointments.
•Verified insurance benefits and pre-certifications of medications.
•Assisted in appeals for patients with their insurance carriers and created and updated patient charts.
•Assisted patients with their forms, collected copays, handled deposits, and followed up with noncompliant patients.
•Conducted office hours, created a filing system for the office, recalled patients for repeat and yearly procedures to schedule, and filed charts.
•Obtained pathology results and called/faxed results to other physicians.
Warren Hospital, Phillipsburg, NJ.
Unit Secretary in I.C.U. (September 2000- January 2005)
•Assisted with patient care, transcribed medications, and entered doctor orders into the computer system.
•Arranged for the transportation of patients, copied charts for transfer, obtained previous records, and followed EMTALA protocol.
•Trained the entire hospital staff on the use of their new computer system, entered staff schedules, and submitted them to the nursing office for finalization.
Education
Penn State University- classes taken
Easton Area High School- Diploma obtained
References
Nicole Shelton – Verifier - 239-***-****
Christine Phillips – Verifier - 610-***-****
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