Description :

1. Greet and assist patients, ensuring a positive experience while collecting co-payments and verifying insurance benefits.
2. Process insurance claims and pre-treatment estimates, promptly contacting patients with updates.
3. Maintain comprehensive knowledge of various insurance plans, facilitating accurate submissions and resubmissions.
4. Post insurance payments to patient accounts daily, ensuring accurate financial records.
5. Generate and send monthly statements to patients with outstanding balances, following up as necessary.
6. Address patient billing inquiries, directing them to appropriate departments for resolution.
7. Update fee schedules and assist in credentialing new providers to ensure compliance.

Experience

5-7 Years

Level

Executive

Education

Business

Description :

1. Coordinated insurance claims processing, ensuring timely submissions and follow-ups.
2. Verified patient insurance coverage prior to appointments, reducing claim denials.
3. Analyzed and resolved billing discrepancies, improving revenue cycle management.
4. Maintained accurate patient records and insurance documentation for compliance.
5. Streamlined patient flow during office hours, enhancing service delivery.
6. Served as a liaison between patients, providers, and insurance companies to resolve issues.
7. Responded to inquiries from patients and staff, providing exceptional customer service.

Experience

5-7 Years

Level

Executive

Education

Planning

Description :

1. Manage and process insurance claims and prior authorizations in compliance with established protocols.
2. Communicate effectively with healthcare providers and pharmacies regarding claims status and resolutions.
3. Resolve inquiries and issues from providers, ensuring timely and accurate responses.
4. Address concerns related to insurance benefits, claims processing, and coverage options.
5. Provide administrative support to the insurance team, enhancing workflow efficiency.
6. Compile and analyze data for monthly reports on claims performance and trends.
7. Train new staff on insurance processes and best practices to ensure compliance.

Experience

10+ Years

Level

Senior

Education

Diploma

Description :

1. Managed insurance claims processing, ensuring accurate benefit information is obtained and entered into the system.
2. Resolved claim rejections by researching issues, ensuring timely medication access for patients.
3. Communicated with patients to gather necessary information for accurate claim adjudication.
4. Documented all actions taken on orders, maintaining clear communication with team members regarding order status.
5. Handled incoming calls in the insurance queue, providing prompt and professional service.
6. Collaborated with pharmacy teammates to ensure timely and accurate processing of all orders.
7. Adhered to company policies and maintained strict confidentiality of patient information.

Experience

2-5 Years

Level

Junior

Education

Pharmacy Program

Description :

1. Managed incoming insurance calls and processed member requests via phone and email.
2. Resolved billing, pharmacy, and medical issues for members efficiently.
3. Coordinated and assisted with insurance-related events and workshops.
4. Provided administrative support to the front office during peak times.
5. Greeted visitors, answered multi-line phones, and sorted incoming mail.
6. Updated member information in internal databases and insurance systems.
7. Assisted walk-in clients with insurance inquiries and requests.

Experience

2-5 Years

Level

Executive

Education

Diploma In General

Description :

1. Evaluate patient insurance coverage and financial responsibility before appointments.
2. Verify patient eligibility with insurance providers to ensure coverage.
3. Investigate and resolve denied claims to expedite payments.
4. Create detailed insurance worksheets for front desk staff to facilitate patient check-in.
5. Train referring physician offices on authorization processes to improve patient access.
6. Maintain accurate records of patient interactions and insurance communications.
7. Collaborate with billing teams to ensure timely claim submissions and follow-ups.

Experience

10+ Years

Level

Senior

Education

Medical Billing And Coding

Description :

1. Coordinate communication between patients, healthcare providers, and insurance companies to ensure seamless claims processing.
2. Manage and track insurance authorizations, keeping patients informed of their status and requirements.
3. Address patient inquiries regarding unpaid balances and insurance coverage details.
4. Prepare and circulate necessary documentation for insurance reviews and audits.
5. Ensure accuracy of insurance information and authorizations, preventing delays in patient care.
6. Maintain strict confidentiality of medical records and sensitive patient information.
7. Oversee all aspects of insurance program coordination, ensuring compliance with regulations.

Experience

10+ Years

Level

Senior

Education

Diploma

Description :

1. Reviewed and verified insurance claims for accuracy and compliance with regulations.
2. Coordinated with healthcare providers to ensure timely authorizations for patient services.
3. Maintained up-to-date knowledge of insurance policies and patient financial responsibilities.
4. Provided exceptional customer service, addressing patient inquiries regarding insurance coverage.
5. Processed and submitted insurance claims, ensuring adherence to coding standards.
6. Collaborated with billing departments to resolve discrepancies in patient accounts.
7. Trained and mentored junior staff on insurance procedures and best practices.

Experience

7-10 Years

Level

Management

Education

Spanish & Beginning Spanish

Description :

1. Coordinated with national and local insurance companies to efficiently process medical claims.
2. Filed federal and state forms electronically, ensuring compliance with regulations.
3. Ensured timely filing of patient insurance claims, reducing delays.
4. Maintained accurate client demographics and insurance information in the AS400 system.
5. Collaborated with IT to design software that expedited claim filing, enhancing customer satisfaction.
6. Served on the Task Force Committee to improve operational efficiency.
7. Followed up on Medicare and Medicaid payments, accurately posting received funds to accounts.

Experience

2-5 Years

Level

Executive

Education

Master's In Healthcare

Description :

1. Managed insurance claims processing, ensuring timely and accurate submissions.
2. Verified patient insurance coverage and coordinated benefits with providers.
3. Educated patients on their insurance options and coverage details.
4. Generated monthly reports on claims status and account receivables.
5. Resolved billing inquiries and discrepancies, enhancing customer satisfaction.
6. Collaborated with healthcare providers to facilitate referrals and authorizations.
7. Trained new staff on insurance protocols and billing procedures.

Experience

2-5 Years

Level

Executive

Education

Diploma

Description :

1. Trained and mentored staff on insurance policies and procedures, ensuring compliance and efficiency.
2. Developed and maintained a comprehensive insurance claims tracking system to monitor progress and outcomes.
3. Managed patient financial accounts, including posting insurance payments and verifying coverage details.
4. Coordinated with insurance providers to obtain pre-authorization for treatments and services.
5. Resolved discrepancies in billing and claims, improving accuracy and reducing denials.
6. Conducted regular audits of insurance claims to identify trends and areas for improvement.
7. Collaborated with healthcare providers to streamline the claims process and enhance patient experience.

Experience

5-7 Years

Level

Executive

Education

M.A In Human Resource Management

Description :

1. Examine claims forms and records to determine insurance coverage and eligibility.
2. Review insurance policies to ensure compliance and coverage accuracy.
3. Prepare and review insurance claim forms for completeness and accuracy.
4. Educate patients on insurance benefits and assist with appointment scheduling.
5. Answer calls and direct inquiries to appropriate departments for resolution.
6. Greet patients, ascertain their needs, and provide necessary assistance.
7. Receive and route messages or documents to relevant staff members.

Experience

2-5 Years

Level

Junior

Education

GED

Description :

1. Obtained and coordinated health insurance quotes using carrier portals and in-house systems.
2. Initiated new insurance groups, processing enrollments, renewals, and terminations efficiently.
3. Collaborated with insurance carriers to resolve discrepancies and improve service delivery.
4. Processed monthly commission statements, reconciling discrepancies to ensure accurate payments.
5. Coordinated enrollment for new business council members, enhancing member engagement.
6. Managed event logistics, including registration, invoicing, and statistical reporting for business council events.
7. Performed administrative tasks to support office management and operational efficiency.

Experience

5-7 Years

Level

Executive

Education

Bachelor's In Psychology

Description :

1. Managed insurance eligibility verification and secured authorizations from various payers.
2. Developed comprehensive guidelines for insurance processes, improving team efficiency.
3. Negotiated favorable terms with non-contract insurers, enhancing revenue recovery.
4. Prepared and submitted necessary documentation for timely claim adjudication.
5. Analyzed aging reports to recover outstanding balances from insurers and patients.
6. Facilitated appeals for denied claims, achieving a high success rate.
7. Conducted training sessions for staff on precertification and claims processes.

Experience

10+ Years

Level

Senior

Education

Diploma

Description :

1. Verified patient insurance eligibility for Medicaid, Medicare, and managed care plans through various channels.
2. Secured authorizations for medical equipment and services, ensuring compliance with insurance requirements.
3. Reviewed and validated ICD-9 and CPT codes to facilitate accurate claim processing.
4. Calculated patient financial responsibilities based on verified benefits, enhancing transparency.
5. Updated and resubmitted unpaid claims, improving collection rates through diligent follow-up.
6. Developed and maintained Excel spreadsheets to track eligibility for Medicare and Medicaid members.
7. Conducted monthly re-certifications for authorizations, ensuring up-to-date patient and insurance information.

Experience

2-5 Years

Level

Junior

Education

Diploma

Description :

1. Communicated with insurance carriers to verify patient coverage.
2. Accessed insurance websites to obtain eligibility and benefit information.
3. Entered detailed benefit breakdowns into the central database.
4. Monitored performance metrics and reported challenges to management.
5. Collaborated with team members to share best practices for eligibility verification.
6. Ensured compliance with all relevant regulations and standards.
7. Maintained accurate records of all interactions with insurance providers.

Experience

2-5 Years

Level

Junior

Education

A.S. in Health Admin.

Description :

1. Verified insurance benefits for durable medical equipment (DME) and ensured compliance with company policies.
2. Managed prior approvals and authorizations, ensuring timely processing to facilitate patient care.
3. Tracked authorizations, maintaining up-to-date records and initiating renewals as necessary.
4. Collaborated with billing departments to analyze accounts receivable and resolve denial issues.
5. Provided support to discharge planners and social service workers to coordinate patient services.
6. Facilitated communication between patients and insurance companies to clarify benefits and coverage.
7. Monitored and reported on authorization expirations, ensuring continuous patient coverage.

Experience

7-10 Years

Level

Management

Education

B.S. Health Admin.

Description :

1. Executed comprehensive verification on accounts from registration systems, ensuring accuracy and compliance.
2. Communicated with various insurance companies to obtain necessary verification and make timely updates.
3. Maintained patient accounts and ensured accurate financial classifications when needed.
4. Registered patient visits and created or updated patient accounts in the system.
5. Managed daily and monthly counts of incoming mail to ensure timely processing.
6. Utilized various systems, including CB and hospital-specific software, for efficient data management.
7. Ensured adherence to compliance standards while processing claims and verifications.

Experience

2-5 Years

Level

Junior

Education

AAS HIT