SUMMARY:

• A healthcare professional offering versatile advanced customer service, insurance follow - up and Administrative skills, spanning over 5 years. Strong planner and problem solver who readily adapts to change, works independently and exceeds expectations. Able to juggle multiple priorities and meet tight deadlines without compromising quality.

TECHNICAL SKILLS:

SKILLS: MS Word MS Excel MS PowerPoint MS Outlook USA Raintree MS Access MS Publisher Healthcare reports IBEX Meditech Carelink Bed board Invision Stockamp TRAC Intergy Quickbooks

PROFESSIONAL EXPERIENCE:

Confidential

Clinical Guidance Bariatric Specialist

Responsibilities:

• Taking inbound calls from members who are interested in bariatric/weight loss surgery. Giving guidance to members that may not qualify for surgery with other weight loss options.
• Prepare benefit quotes for members that are interested in bariatric surgery.
• Help members find surgeons/providers that will perform bariatric surgery.
• Retrieve voicemails from the department voice mail & assign calls to specialist.
• Return phone calls from members.
• Submit discharge dates onto member authorizations.
• Request clinicals as needed from providers for case managers to complete case.
• Call Hospital/Facilities to get member discharge dates from surgery.

Confidential —Louisville, KY

Administrative Specialist

Responsibilities:

• Scanned medical records into EMR system. Scheduled, rescheduled, cancelled and verify Confidential t appointments.
• Triage Confidential ts when medical assistant was busy with other duties/absent.
• Schedule UGI s/EGD s when needed.
• Reviewed and completed fee tickets for billing.
• Completed and sent out medical records request.
• Handled all incoming and out coming mail.
• Orders all supplies for office.
• Take Pre - Cert/Authorizations over the phone from insurance companies.
• Register new Confidential ts into EMR system.
• Call insurance s and check new Confidential t s bariatric benefits, requirements and began authorization if apply.
• Handles inventory in office, by counting product and updating prices.
• Consult with Confidential ts on bariatric pre-op diet.

Confidential —Louisville, KY

Access Specialist

Responsibilities:

• Verified and updated Confidential t’s insurance information and demographics.
• Collect ER Co-pays and deductibles from Confidential ts.
• Posted payments on Confidential t’s accounts.
• Assist in setting/negotiating payment arrangements once Confidential t has been seen by doctor.
• Completed Surgery Schedule reports by reactivating accounts for the following day procedures and listing Confidential t’s responsibility for different departments.
• Schedule and registered Confidential t’s for out Confidential t procedures.
• Admitted and placed Confidential t’s that were being transferred from other hospitals into beds on assigned floor.
• Received inbound phone calls from nurses, doctors and operator’s regarding Confidential t information, bed swaps, Confidential t status’s and ect.
• Print and place wrist bands and medical notifications on Confidential t’s once registered.
• Resource for Confidential t’s regarding questions and directing to correct department.
• Take inbound and make outbound calls in call - center/dialer atmosphere regarding Confidential t s insurance, billing, payments, refunds and review claims and charges that occurred.
• Collect payment from Confidential ts regarding hospital debt and arrange payment plans according to guidelines.
• Reviewed and assisted A/R with month end cash posting reports.
• Screen Confidential ts for financial assistance and DSH to those whom qualified. Scheduled and set appointments for Confidential ts to meet with financial advocates regarding assistance.
• Clerical duties such as faxing, copy, data entry, bookkeeping/filing, scanning and create and work reports for management regarding bad debt numbers and conducting bad debt projects.
• Posted bad debt Confidential t payments to accounts.
• Support In-house Vendor s with cleaning out A/R with duties such as posting adjustments and posting insurance discounts.
• Reviewed and analyzed accounts to see if eligible for refunds per request.
• Complete reactivation request from Confidential t accounting department regarding bad debt accounts.
• Sent delinquent accounts to collection agencies or appropriate vendor.
• Process and file bankruptcy notices to US Courthouse.
• Process death s and sent demand letters to county clerk office to see if estate is available.
• Communicate with Attorneys and law offices regarding lawsuits, subpoenas and answering request regarding medical records.
• Contact for Lenders/Attorneys with questions regarding file/releasing judgment liens.
• Approved suit authorizations regarding Confidential t s delinquent accounts.

Confidential —Louisville, KY

Charity Support/Processor

Responsibilities:

• Took inbound calls and made outbound calls regarding screening Confidential t s for charity, making sure Confidential t was strictly self - pay and/or making sure third party insurance was not involved.
• Received and processed information that was sent to collection agencies from the Confidential t regarding charity.
• Collect on delinquent accounts and set up payment plans with Confidential t s that was denied for assistance.
• Contact insurance companies to verify and correct balance if any discrepancies regarding claim or Confidential t balance.
• Researched and helped Confidential ts regarding finding food banks, clothing and basic essential needs.
• Supported customer service/charity department and management by filing, book keeping, copying, faxing, sorting mail, and maintaining daily calendar for management.
• Assisted management with charity related projects.
• Scheduled department meetings in conference rooms.
• Assisted in preparing department Agenda s for meetings.
• Ordered office supplies and took request regarding supplies.

Confidential —Louisville, KY

Insurance Follow-up Dialer

Responsibilities:

• Collect payments, copay, and deductibles from Confidential ts regarding debt.
• Posted and adjusted insurance and Confidential t payments on accounts.
• Assisted management with collection and cash posting reports/documents.
• Processed medical records request from Confidential t or insurance company.
• Correct and add to Confidential t s demographics.
• Screen Confidential ts for financial assistance.
• Set Confidential ts on balance resolutions if applicable.
• Reviewed claims/incorrect codes per insurance companies request due to error in billing.
• Analyze and work denials from insurance companies.
• Called insurance companies regarding delayed payments on accounts.
• Entered data pertaining Confidential ts on assigned accounts
• Scanned important documents such as death s, bankruptcy notices or payments to Confidential t s accounts.