Insurance Medical

TANYA MARSHALL

**** **** *** # * • Long Beach, Ca • *****.**********@*******.*** • 562-***-****

PROFESSIONAL PROFILE

Occupation as an Admitting Representative and Medical Records Clerk for Five years and a Healthcare Professional with experience and strong knowledge, in Emergency Department and Insurance Verification Also Certified Nursing Assistant.

• Admitting Representative/Emergency Department Admitting Representative assist with patient needs and Verifying of medical insurance

• Insurance verifier for several Hospitals and Emergency Departments, contact managed care, and processed new enrollments on patients.

• Claims/Grievances/Appeals Process letters of denial for Grievances and Appeals department for Utilization Management.

• Surgery Scheduler/ Ambulatory Clerk in the OR Department for Surgeons, Anesthesiologist and Nurses.

• Proficient with Microsoft Office System (including PCX,IDX,P-Bar, Gers,Affinity) Healthcare systems, Passport Insurance Verification system.

PROFESSIONAL EXPERIENCE

Huntington Beach Hospital Long Beach, Ca 08/10-01/2011

Emergency Department Admitting Rep

Ask questions in accordance with instructions to obtain various specified information, Obtain All Demographics from Patient’s being seen in the ER. Compile, record, and code results or data from interview or survey, using computer or specified form. Contact individuals to be interviewed at home, place of business, For Pre-Registration, by telephone, submit completed assignments and discuss progress, Explain survey objectives and procedures to interviewees and interpret survey questions to help interviewees' comprehension. Perform patient services, such as answering the telephone or assisting patients with financial or medical questions.

Cedars Sinai Medical Center Los Angeles, Ca 06/07-09/07

Admitting Representative

Emergency Department Admitting Representative Verify Insurance information with patient’s and update Patient Demographics in the PCX system, Contact Healthcare Provider for Authorizations on patient’s with HMO’s, Collect money from patient’s with PPO health insurance. Explain the protocol for (NPP) Notice of Patient’s Privacy Act and (COA) Condition of Admission forms. Experienced with medical records and Retrieving authorization on insurances and Release of Information.

Pacific Hospital of Long Beach Long Beach, Ca 06/06-08/06

Patient Registration

Verify medical insurance with patient enter correct/or new patient’s demographics into the Affinity healthcare system for the Admissions department. Provide correct insurance copy’s for the verifier’s and schedulers for authorization on supplemental insurance to Medi-cal and Medi-care, State Disability insurance.Pre-admit pain management charts and retrieve authorization from the verifiers, provide compensation forms and legal documents that need Doctors signatures for Surgery’s. Behavioral Health admits from Two Psych campus verify medical insurance with case managers on patient’s admissions.

03/03-01/10 Agency Referrals

Insurance Verification Representative

Under the general guidance of the Insurance Verification Supervisor the Customer Service Representative, pre-Verifier’s and Orders patients Supply’s verify medical information by telephone and/or on Ontrac System. Major duties include: collection of accurate demographic information, review and interpretation of insurance benefits, obtaining prior authorizations, Authorization for Diabetes Supply’s place supply orders and update all notes on any changes in Medicines and Insurance .

Admitting Rep/Insurance Verifier/ Ambulatory Clerk

Provide medical services in the OR Dept; Assist with sudden changes in dept. Contact available Surgeons for emergency surgery’s and last minute add-on cases, Verify medical insurance with the doctor’s offices once surgeries are scheduled. Emergency Admitting Representative for several hospitals and insurance verifier, Utilization Coordinator for Managed Care. Strong knowledge of medical consent forms and Temporary Assistant within the Laboratory Unit process blood specimens and check-in patients with Medical prescriptions.

Claims/Grievances/Appeals

Process denial letters for Grievances and Appeals Department, review medical documents for the claims unit and verify eligibility status on patient’s insurance with Healthy families and Blue Cross/Blue shield health insurance. Review charts in portal from E-Copy; note the accounts with the final decision from Appeals Coordinator. Input patient’s visits into the spreadsheet with hospitals and days of admission authorization codes and discharge dates.

Member Services/ Claims Processor

Assist the Member Accounts rep in daily operations as well as Aetna Behavioral Health Representatives, provide assistance to the medical directors on the claims being paid out and assist with verification thru CHIPA, process and create eligibility list an exports (includes electronic, hard-copy paper and diskettes and validate membership enrollment for ID card vendor Processing. Retrieve Authorization from CHIPA for direct admits on behavioral health patients and alcohol abuse patients.

Education and Training

St.Francis Career College Certified Nursing Assistant/ Healthcare Law

Medical Records Clerk Release of Information

HS Diploma

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