Medical Office Collector/ insurance verifier
Resume:
Jennifer Johnson
Houston, TX *****
*********@*****.***
Qualifications
Certificate of Completion Claims Examiner Training (United Behavioral Health)
Certificate of Completion Data Entry Training (United Behavioral Health)
Certificate of Completion HIPAA
Certificate of Completion Customer Service Training (UBH, Coventry Health ,First Health)
Education / Classes
Graduate of North Shore High School , Houston , Texas 77015 1989, Diploma
Skills
Over 6 years in 10 key by Touch, typing 40 wpm, Xerox machines, fax machines, Multi-line phone. Windows 98,99,00,01,02, etc Excel, PowerPoint, online forms, Outlook Express, Lotus Notes
Other Experience
9/2011- Med Center EMS- Billing (ambulance claims ) update patient demographics, load billing of required information to bill out claims, check status of pending and approve, and check information…
7/2/07- Current Kingwood Pines Hospital , Collector/ Insurance Verifier/Billing
Check claim status claims. Calling insurance company checking claim status, finding out additional information needed to complete process. Contacting patient notifying what info is needed to complete process of claims, submit adjustment forms, resubmit claim when not received at the insurance company. Update demographics. Input all authorization numbers in the system, respond to all insurance payer correspondence and or request. Navinet, Availity, and all insurance online claim status. A/R and Denial Management. Resolving all claim issues that are not processing per out contract rate. Check appeal status. Updating system with most current correspondence. Also experience in billing office claims.
07/06-05/23/07 Coventry Health Care Client Service Coordinator
Answer incoming calls, give claim status, of Medical, Mental Health, Dental and Vision claims, give Pre-cert status. Quote benefits medical, dental and vision claims. Also give dental benefits and claims status. Research claim for non-payment, give Appeal status when needed. Search for PPO providers, set appt when necessary and assist with any needed service, Collections ,Verify patient insurance benefits to calculate patient responsibility for services rendered, also Coordination obtain auth and RQI when necessary. System Fusion Reis, Internet. Also took pharmacy call, override for exceptions. And give benefits for RX
05/05-06/06 United States Postal Service, Mail carrier
07/04-05/05 First Health, Member Service Representative
First point of contact for member and provider, insurance verification, check claim status, start pre-cert, verify eligibility. Research Mail out correspondence when needed, take pharmacy calls, assist in Override per guidelines, quote dental and vision benefits, View customer accts, to verify claims paid correctly, Ins verification and Collection View Explanation of Benefits to determine if claims paid correctly (pay Post correction, adjust, check claim status, appeal claims when needed, send additional correspondence needed to process pended or denied claims. Call Commercial Ins to verify claim status for that adjustment can be made, or pay post correction, Collections to get payment due from members when balance due. IDX , SMS
08/01-07/04 United Behavioral Health Claims/ Customer Service
Communicate orally with member and provider pertaining to Mental health insurance, quoting benefits, Updating eligibility insurance info, sending out correspondence requesting any additional info needed to process Claims. Pay all claims in timely fashion according to group guidelines, prioritizing and organizing and meeting daily production and ensure 100% quality.
Accomplishment started as Data Entry Clerk, OCR then promoted to Claims Examiner then assist in Customer Service
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