Administrative/Clerical Specialist with Insurance Verification
Resume:
DENITA TAYLOR
Durham, NC *****
*************@*****.***
Professional Summary
To obtain a challenging opportunity with a progressive organization where my training, experience, skills, and abilities will be utilized. Due to my skills and experiences that have gained over time I am best fitted in the administrative/clerical position.
Work Experience
Clinical Access Coordinator I, Insurance Verification Coordinator Transitions Lifecare Hospice-Raleigh, NC
February 2024 to Present
• Verifying Insurance Coverage and Benefits in a timely manner for new patients to all service lines.
• Communicating coverage to Access Team.
• Accurately inputs current payer information into the billing system.
• Serving as a resource to patients and families regarding coverage questions for all new incoming referrals.
• Ensuring all communication and follow-up is clearly documented in the patient’s electronic health record.
• Ensuring eligibility and benefit information obtained electronically or by phone is clearly documented in the patient’s electronic health record.
• Preparing letters detailing eligibility and benefit information for patients and families.
• Direct Insurance Eligibility and Benefits inquiries for self-pay and any insurances requiring prior authorization to the Business Office for processing.
• Directs Insurance and billing questions for patients already admitted for service to the Business Office for processing.
• Serving as insurance verification expert for the Intake Team. Fields any questions regarding eligibility and benefits to the Business office as appropriate. Secondary Responsibilities include:
• Reviewing referrals and conduct phone interviews with all referral source and attending physicians to determine potential new patient needs.
• Processing intakes/referrals from all referral sources (physicians, hospital discharge planners, insurance case managers, patient’s families, provider relations etc.).
• Coordinating admission schedules for Admission Nurses and Admission Social Workers.
• Scheduling patient start of care evaluation assessments/admission and information visits.
• Adhering to clinical guidelines for documentation to meet Federal, Sate, regulatory and agency guidelines.
• Set-up new patient charts, and accurately document all actions taken and contacts made in course of referral processing.
• Documents telephone calls/referrals, including follow up service calls to non-admissions or recent admissions.
• Present appropriate service line information to patients, families, and referral sources.
• Participating in the identification of clinical or operational performance improvement opportunities and in performance improvement activities.
• Providing appropriate orientation to new intake employees.
• Collaborating with the clinical providers and administrative staff across service lines to provide excellent customer service.
Patient Referral Coordinator/Customer Service Billing Representative Rotech Healthcare Inc.-Raleigh, NC
August 2022 to February 2024
• Reconciled previous day’s route and checking all paperwork for accuracy and completeness and communicating with patients/clients and referral sources both verbally and in writing to ensuring patients/clients questions and concerns are being processed in a timely manner
• Comply with all applicable company policies and procedures to meet JCAHO and company standards
• Coordinated all patient information, processing paperwork, including preparation of file for Billing Department, and completing batch reports for UPS deliveries
• Provided service for all retail/walk-in equipment requests, technical assistance to customers
• Verified Medicare, Medicaid, and private insurance coverage information and obtaining authorization for durable medical equipment
Supervisor of Patient Accounts/Patient Account Representative Patient Intake Specialist
WakeMed/MidCarolina HomeCare Specialist LLC/UNC Homecare Specialists-Morrisville, NC January 2009 to December 2022
• Verified patients’ insurance for Durable Medical Equipment, Enteral Therapy and Home Infusion Therapy.
• Obtained and tracking authorization for Durable Medical Equipment, Enteral Therapy, Home Infusion and Home Health Services.
• Conducted Chart Auditing.
• Collaborated with Leadership Team with process improvements, Discharging Planning with Physicians and Case Managers for Post- Acute Care Services.
• Worked with Human Resource with recruiting, interviewing new hire employees.
• Developed staff goals and monitored metric.
• Managed a Team of 10, Provided Training and Education on Durable Medical Equipment.
• Overseeing Daily Workflow of the Department.
• Completed Timesheets for Payroll Submission.
• Utilized negotiation skills for payments and contracts with Payers.
• Analyzed and resolved day to day operational issues related to billing and processing of claims. Patient Access Representative/Insurance Verifier
Bayonne Medical Center-Bayonne, NJ
January 2002 to December 2008
· Updated patients’ demographic information, abstracted accounts for billing purposes
· Obtained patients’ information to insurance companies to ensure authorization for inpatient and outpatient services
· Performed clerical duties: data entry, photocopying, faxing, scanning documents and answering the telephone
· Pre-registered patients for outpatient services
· Accepted payments for outpatient services via credit card, cash, and check
· Bed Placement Coordinator for inpatient services Education
Computer Applications (Certificate)
Worldwide Educational Services-Jersey City, NJ
January 1999 to June 1999
High School Diploma
Bayonne High School-Bayonne, NJ
September 1986 to June 1990
Upper secondary education
Skills
Forklift Attention to detail Microsoft Excel Organizational skills Driving Balancing cash drawers Healthcare privacy protection Mobile devices Retail sales - Retail sales experience (3–5 years) Computer skills Phone etiquette Medical Scheduling Healthworks/Passport Onesource Host/hostess experience Time management Negotiation Retail management English Computer operation Medical terminology Clothing store experience Clinical documentation HIPAA Management Insurance prior authorization Cash register operations Retail math Electronic health records
(EHR) management Office management Epic Warehouse experience Microsoft Office Suite: Word, Access, Excel, PowerPoint, Outlook Internet/ Web Research, Data Entry and Epic Cash handling Inpatient Client rapport building Microsoft Powerpoint Medical office experience Medical Coding Health insurance information Payroll Leadership Restaurant experience Medical administrative support Collaborate with healthcare professionals Revenue cycle management Convenience store experience Medical records Supervising experience Home care Research Computer literacy Phone communication Communication skills Cash register Front desk Concurrent review in utilization management Microsoft Word Retail sales transactions Depositing cash ICD coding Delivery driver experience Records management Meditech/CPR Plus Typing Case management ICD-9 Financial auditing Hospitality Senior care Epic/EMR Clinic experience Managed care Documentation review Care plans Health insurance authorizations Administrative experience Customer inquiry handling Greeting customers Decision making Medicare regulations Customer service Making change ICD-10 Clerical experience
Links
https://www.linkedin.com/in/denita-c-taylor-61600785 Certifications and Licenses
Driver's License
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