Patient Account Representative - Insurance Verification
Resume:
MARSHA J. DENNIS
Hampton, VA 23669
Phone 770-***-****
g1ifa4@r.postjobfree.com
PROFESSIONAL PROFILE
An accomplished claims adjuster for seven years
Expertise evaluating patient insurance coverage for eligibility
Experience with medical insurance collections techniques to reduce write-off’s
Recognized for increasing the number of accurate claims for payment approval
Commended for improving claims verification by correcting rejections, denials and submitting timely filing
Knowledge of healthcare billing and reimbursement concepts
ACCOMPLISHMENTS
Medical Administration
• Processed commercial insurance claims for ER physicians for Greater Florida Emergency Group resulting in 100% of the claims being approved.
• Obtaining billing information from insurance payers, Medicaid, Medicare, PPO’s and HMO providers leading to increased collections and reduced write-offs and denials.
• Processed 1500 claim forms and submit EOB’s according to medical guidelines.
• Resolved insurance claim in the appropriate timely filing.
• Expedited the processing of 1000 denied/rejection claims to insurance carriers and/or clearinghouses.
• Used the web portal, the electronic filing process and paper submissions to successfully process claims.
• Utilized knowledge of medical terminology and CPT codes leading to the determination of pricing.
• Use of Centricity, Gateway EDI, Verinet to verify Florida Medicaid/Medicare Eligibility.
Claims Adjustment
• Investigated and determined liability resulting in the settlement of automobile property damage and bodily injury claims.
• Completed appropriate level of investigation resulting in the determination of coverage and liability.
• Negotiated with claimant carrier or attorney contributing to equitable settlements.
• Assisted the insured/claimant leading to the receipt of estimates for damaged vehicles.
• Assisted in subrogation and arbitration that contributed to the effective control of legal activity of claims.
• Adhered to regulations when verifying inbound and outbound calls.
• Determined coverage leading to the reporting of claims for general liability, workers compensation, auto and property claims to insurance companies and TPA.
• Issued endorsements, renewals, cancellations leading to retention of policies.
• Managed accounts for personal and fleet vehicles leading to completion of the repair process.
• Reported total loss claims to adjusters contributing to the completion of claims investigations.
• Obtained estimates, photos and appraisals resulting in the processing of claims.
• Managed auto claims by investigating, evaluating, recording statements and negotiating resulting in settlements.
• Processed billing and payment information leading to the resolution of auto claims.
Customer Service
• Served as a liaison between the hospital and patient with financial arrangements resulting in decreased debt.
• Communicated successfully with patients leading to the establishment of payment arrangement with patients.
• Adhered to the HIPAA regulations when verifying pre-authorization on inbound calls.
• Recognized for excellent customer service, assisting patients and families with outpatient ER visits, surgery, Ambulatory Care, Cat-lab and/or OB/Gyn patient visits.
• Commended for extending personal care, warm greetings and directing each guest to their appropriate destination.
• Verified insurance coverage for 100% of the patients receiving ER services.
• Collected payments promptly for pre-admission and inpatient visits.
• Adhered to regulations when verifying inbound and outbound calls for claims.
• Assisted Citi Mortgage clients resulting in the resolution of homeowner’s insurance claims.
• Received heavy phone volume for California loss draft claims for fire and flood contributing to the processing of claims.
• Verified coverage, damages and issuing insurance claims checks to owners leading to repair services.
• Collected annual premium payments, renewals, cancellations and insurance updates contributing effective account management.
• Communicated with appropriate personnel leading it the transport of vehicles to CoPart, body shops and tow yards.
• Communicated effectively with clients leading to the settlement of claims.
EXPERIENCE
Medical Insurance Verification, Durham Staffing, Atlanta, GA-12/09-01/10
Processed commercial insurance claims for ER physicians for Greater Florida Emergency Group resulting in prompt processing of approximately 1000 claims. Adhered to HIPAA regulations at all times.
Financial Counselor, Northside Forsyth Hospital, Atlanta, GA-08/09-11/09
Face-to-face contact with patients while visiting ER inpatient/outpatient care. Collecting insurance coverage and payment for services.
Claims Adjuster, Temporary Claims Professional, Mount Laurel, NJ-09/05-11/05; 01/01-10/02
Settling property damage (Auto) and bodily injury claims Client; Rockingham Insurance Group, Venue, PA & VA.
Medical Concierge/Escort, Kelly Services, Atlanta, GA-02/08-08/09
Assisted patients and families at Northside Cherokee Hospital during inpatient/outpatient care. Directing visitors to Triage, Ambulatory Care, Cat-lab and Ob/Gyn units to ensure prompt service according to schedule.
Insurance Customer Care Specialist, First Pro Agency, Atlanta, GA -08/07-01/08
Assurant specialty Property, managing homeowner’s claims for California fires, issuing loss draft checks.
Accident Management Representative, Insurance Overload, Atlanta, GA -10/06-08/07; 10/02-03/04
Managing auto claims by investigating, evaluating, recording statements, negotiating and settling auto claims Clients; AIG and AAA Clients; Omega Claims and Crawford & Company and Nobilas Claims.
Claims Representative, Palmer & Cay-03/04-05/05
Working with producers and account managers with multi-lines claims. Reported resolutions to appropriate authorities in a timely manner.
SKILLS
• Medical Software: AS400, TRAC, STAR
• Windows XP/Vista/2003 & 2007
• MS Office: Word, Excel, PowerPoint, Outlook, Lotus Notes
EDUCATION
• Rutgers University, New Brunswick, New Jersey -1977-1980
• R.S. Thomas Training Association GA, Property and Casualty-2003
• National Alliance for Insurance Education & Research, Commercial Casualty-2004
• Rimkus Consulting Group, “Fire Origin & Cause” -2004
• Centricity, Gateway EDI, Verinet, Florida Medicaid/Medicare Eligibility Portal -2009
• Urological and Incontinence patient supply care, Heath Care Support training, Florida -2010
References furnished upon request
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