Healthcare Admin & Billing Specialist
Resume:
Patrice Wince
Aurora, IL
**********@*****.***
Summary of qualifications: I have displayed the ability to be highly skilled in providing data, products, and services of a company. I possess in-depth knowledge of computing charges and administering billing and payments. I consistently demonstrate hands-on experience in reviewing, updating and making changes to customer accounts. I have exhibited the capacity to think critically when answering questions and providing solutions
Work History
CVS Specialty Pharmacy, Benefits, Verification Specialist
- Pharmacy or healthcare benefits experience.
- Prior Authorizations and Major medical
- Various insurance plans offered by both government and commercial insurances (i.e., PPO, HMO, EPO, POS, Medicare, Medicaid, HRA’s) and coordination of healthcare benefits, including requirements for referral, authorization, and pre-determination.
- Reading, and understanding medical policy information, and utilizing insurance benefit and coverage information to calculate estimated patient responsibility, taking into consideration pre-determination, referral, authorization, and contract terms.
- Receiving and making outbound calls to patients to explain insurance benefits related to health insurance, and/or discussing patient financial responsibilities
- Knowledge with using Epic, Avaya-One X, Availity, Change HealthCare, CoverMyMeds
PLCCA Inc. Methadone Clinic
January 2022- September 2024
Intake Coordinator/Admission
•Insurance verification through Medi System
•Answer all emails and calls
•Process payments
•Welcome, register, and admissions
•Schedule appointments
•Process referrals from hospital
•Inventory Clerk
Allied Universal Security
Sept 2018-March 2020
Front desk answer all calls and inquire every guests and if non-employee have each person sign in.
Warehouse clerk/ Shipping/ Receiving clerk.Observe and Report, monitor cameras and follow each post order per site
Illinicare Health
January 2015 - May 2019
Provider Specialist/Claims Processor
●Claims payment processing in government programs and managed care. Knowledge of claims billing and processing functions, Medicaid benefits, and/or customer service.
●Receive and respond to internal and external claims related issues.
●Complete claims related research projects use of epic systems and data energy
●Investigate and communicate reimbursement and benefit changes with providers
Skills:
•Appraisable customer service skills
•Excellent oral, written, organizational and motivational skills
•Extensive experience with the use of all Microsoft offices, Excel, and E-mail
•Experience with multiple screens/multiple programs/multi-tasking in a fast-paced environment
•Experience in Epic, Passport and medical systems
•Type 65 wpm
Education/Certifications
Rasmussen associates health science degree
Rasmussen University-Medical Assistant Diploma 12/2024
Genesis Healthcare Institute-Certified National Medical Biller/ Knowledge of IDC10 Coding 11/2016
Genesis Healthcare Institute-CNA (Certified Nursing Assistant) current, Issued by the state of Illinois 01/2012
CPR/AED
Waubonsie Valley High School-High School Diploma
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