Insurance Reimbursement Specialist Resume Samples

An Insurance Reimbursement Specialist is a staff member who undertakes administrative tasks on behalf of insurance companies and medical professionals. Typical work activities that are listed on the Insurance Reimbursement Specialist Resume are – ensuring the medical professionals and the physicians are paid correctly; identifying methods of payments for patients, correlating insurance coverage with services to be provided; managing financial and medical records; reviewing records, coding and billing practices to ensure compliance; submitting insurance claims to insurance carriers; preparing invoices, and following up on unpaid claims.

Those seeking this job role must mention on the resume the following skills and abilities – solid understanding of medical coding, billing, and record-keeping, sound knowledge of medical reimbursement processes and procedures, and well-versed in the policies and procedures of a specific employment setting. To be considered for hiring, a degree and relevant professional certification are needed.

Insurance Reimbursement Specialist Resume example

Insurance Reimbursement Specialist Resume

Summary : Excel, WordPerfect, copier, scanner, fax machines, mail machines, multi-phone line systems, and experience with customer relations. Familiar with medical terminology, ICD-9 codes, CPT codes, A/P, A/R, and collections.

Skills : Attention to Detail, Self-Starter, Data Entry, Banking, Customer Service, Fast Learner.

Description :

    1. Determined program eligibility.
    2. Verified patient benefits for all assigned patients within program-required timeframes.
    3. Facilitated prior authorization process within the required timeframes.
    4. Communicated patient responsibility timely and accurately.
    5. Assessed and refered appropriately for special programs when available.
    6. Acted as a single point of contact for an assigned group of prescribers.
    7. Effective and timely communication with prior authorization and/or patient enrollment status.
    8. Completed accurate entry of billing information to ensure timely payment and avoid delay in inpatient therapy.
    9. Communicated with payers for claim rejection resolution.
Years of Experience
Experience
10+ Years
Experience Level
Level
Senior
Education
Education
BS In Management Information Systems


Insurance Reimbursement Specialist Resume

Objective : Seeks to secure a position that will enable utilizing leadership, problem-solving, planning, and organizational skills, in a pharmacy, and call center environment.

Skills : Team Player, Organizational Skills, Interpersonal Skills.

Description :

    1. Conducted benefits investigation, verify insurance benefits, on behalf of patient and Physicians' office, and submit and obtain prior authorization as required by the payer.
    2. Accurately entered data in all required fields of the client database.
    3. Effectively utilize the client database to monitor outstanding items on each client case file.
    4. Ensured that all patient files are maintained and inclusive of all communications as well as medical and other documentation associated with each working case, allowing any other team member to clearly see what steps have been completed and determine current status.
    5. Participated in conference calls with Client Service Representative, Client Management, and Physicians' Offices regarding the status of the case, drug orders, and status of alternative funding.
    6. Participated in Call Center Activities, which entails triaging incoming calls from patients, insurance companies, physicians, sales representatives, pharmacies, and home care representatives.
    7. Responsible for good housekeeping techniques, adhering to quality and production standards while complying with all applicable company, state, and federal safety environmental programs and procedures.
Years of Experience
Experience
2-5 Years
Experience Level
Level
Junior
Education
Education
Diploma


Insurance Reimbursement Specialist Resume

Summary : Seeks to secure a position with advancement potential that will enable utilizing experience and interpersonal skills.

Skills : Customer Service, Insurance, Data Entry.

Description :

    1. Actively participated in outstanding customer service and accepts responsibility in maintaining relationships that are equally respectful to all.
    2. Undered general supervision, is responsible for processing insurance and billing insurance in a timely manner.
    3. Reviewed assigned electronic claims and submission reports.
    4. Resolved and resubmited rejected claims appropriately as necessary.
    5. Processed daily and special reports, unlisted invoices, and letters, error logs, stalled reports, and aging.
    6. Performed outgoing calls to Patients and Insurance companies to obtain necessary information for accurate billing.
    7. Answered incoming calls from Insurance companies requesting additional information and/or checking the status of billings.
    8. Adhered to all company policies and procedures.
    9. Adhered to the Hospital Corporate Compliance Plan and to all rules and regulations of all applicable local, state, and federal agencies and accrediting bodies.
Years of Experience
Experience
7-10 Years
Experience Level
Level
Management
Education
Education
Diploma

Insurance Reimbursement Specialist Resume

Headline : A quick learner and dynamic individual with adept skills in Medical Office Administration. Seeks to obtain a full-time position that will challenge and enable the use of 5 years of engineering experience and skills to add value to the industry.

Skills : Office Management, Filing, Data Processing, Administration.

Description :

    1. Maintained work queue daily to ensure timely follow-up. 
    2. Researched account specifics in order to follow up appropriately.
    3. A/R followed-up and insurance reimbursement to research account specifics and complete necessary follow-up actions, contact insurance payers on aged/.
    4. Knowledged of all facets of insurance claims filing, requirements, and regulations.
    5. Maintained complete and accurate follow-up on appeal and denial actions in the daily work tool system to ensure timely follow-up.
    6. Became a Certified Revenue Cycle Representative through the Healthcare Financial Management Association.
    7. Contacted commercial insurance carriers and assist patients with appeals and grievances for carriers to pay hospital visits.
    8. Liaised with the Department of Banking and Insurance regarding scheduling arbitrations for delinquent accounts.
Years of Experience
Experience
5-7 Years
Experience Level
Level
Executive
Education
Education
Certificate In Medical

Insurance Reimbursement Specialist Resume

Objective : Blends academic training in Business Management with hands-on experience in Process Improvement, Data Analysis, and Team Leadership and Training to offer employers a proven track record of successful results delivered accurately and efficiently. Known for providing exceptional Customer Service and interactions in any number of business settings. Proven track record of isolating problems and implementing solutions to increase overall practice or facility revenue received by reducing denials monthly and maintaining reductions at a steady rate.

Skills : Training, Account Management.

Description :

    1. Provided extensive account review of underpaid facility claims for resolution by phone, fax, and online within a quick and efficient manner.
    2. Contacted insurance carrier to take appropriate action to resolve obstacles with prompt payment and account review.
    3. Assisted coworkers and new hire employees with complex account questions and additional training.
    4. Demonstrated knowledge of medical terminology; ICD-9, HCPCS, and CPT codes; knowledged of Medicare and Medicaid, as well as Commercial payer's rules and regulations in accordance with HIPAA guidelines and collection and legal issues and billing guidelines.
    5. Handled incoming calls and correspondence from patients and insurance companies.
    6. Showed ability to work independently or within a group to isolate and identify trends as well as solve problems.
    7. Successfully passed the CRCR within the first week of employment.
Years of Experience
Experience
2-5 Years
Experience Level
Level
Junior
Education
Education
BBM In Business Management

Insurance Reimbursement Specialist Resume

Headline : Seeks to pursue a career in a professional business environment. Eager to leverage big data interpreting and visualizing skills at the company to drive growth and boost sales results.

Skills : 10-Key, Account Management, Billing, Data Entry, Word, Excel, Management, Medical Terminology.

Description :

    1. Reviewed collection accounts for both contracted and non-contracted providers in compliance with state and federal statutes as assigned.
    2. Communicated with payers to discuss timely and accurate claim processing.
    3. Investigated patient accounts and compose appeals to submit to payers for facilities and on behalf of the patient.
    4. Collaborated with peers to provide and present observations regarding payer's policies and practices.
    5. Obtained Certified Revue Cycle Representative Certification.
    6. Exceeded production standards Positive collaboration with peers to assist with investigating trends.
    7. Resolved high-dollar accounts for payment.
Years of Experience
Experience
5-7 Years
Experience Level
Level
Executive
Education
Education
Diploma

Insurance Reimbursement Specialist Resume

Objective : Would like to obtain a position in the medical coding and billing field. Have obtained certification and look forward to using skills for success in your company.

Skills : Hospital Revenue, Personnel Management.

Description :

    1. Obtained insurance benefits; which include provider Tax ID, NPI, patient Membership ID, effective date, co-payments, deductible, coinsurance, out-of-pocket maximum, lifetime maximum.
    2. CPT, HCPCS, and Diagnosis codes presented to the insurance agent on behalf of multi-specialty medical provider offices across the nation; thereby obtaining approval for a small surgical procedure performed in an outpatient office setting for the drug Testopel.
    3. Completed benefit investigation summary for all Commercial, Medicare, Medicaid, and Military coverage.
    4. Prior authorization, Pre-determination, Referrals, Medical Policy details are summarized and in some cases, our team offers assistance if requested by the provider or health care professional.
    5. Courtesy calls made to providers' offices to obtain missing information or handwritten illegibility clarity on enrollment forms submitted electronically.
    6. Entered information in the eHUB system for an electronic record of recorded call center conversations representing United BioSource - Express Scripts drug Testopel.
    7. Data entry work training received thereby achieving cross-training that enhanced the reimbursement process for closed cases.
Years of Experience
Experience
2-5 Years
Experience Level
Level
Junior
Education
Education
CPT In Medical Terminology

Insurance Reimbursement Specialist Resume

Objective : Seek a position as a clinic or office that will allow utilizing experience and training in a productive environment with opportunity for advancement.

Skills : Healthcare Administration, HIPPA, Medicare, Denial Management, Commercial And Medicare Risk Adjustment, Joint Operation Committees, Strategic Planning, Network Development, PPO, HMO, Managed Care, G&A, Complex Analysis/resolution, Claims, HEDIS, Provider Outreach And Education.

Description :

    1. Responsible for a southwest territory covering 8 states.
    2. Provided support and work directly with the regional sales team, patients, providers, and all payers to secure proper application of patient plan benefits and the highest level of reimbursement.
    3. Contractual liability coding reimbursement and policy analysis of all-payer types.
    4. Denial management, G&A, reconciliation of accounts.
    5. Successfully worked with Medicare auditor to secure and obtain DME certification.
    6. Resolved a 1.4 million dollar outstanding claim/billing issue with Anthem and recovered 74% of billable dollars.
    7. Prepared and reviewed claims to ensure billing accuracy according to payer requirements including codes, modifiers, pricing, dates, and authorizations.
Years of Experience
Experience
2-5 Years
Experience Level
Level
Junior
Education
Education
Healthcare Administration

Insurance Reimbursement Specialist Resume

Headline : Looking to obtain a teaching position utilizing my excellent communication and teaching skills while working efficiently to ensure our children and students have the best possible learning experience while providing love and strong instruction in a happy and safe environment.

Skills : Proficient In MS Word, Excel, PowerPoint, IDX, EHR, EMR, And NextGen Systems.

Description :

    1. Performed and processed accurate billing procedures using analytical skills to resolve debit and credit balances on accounts while ensuring expeditious payments.
    2. Evaluated and secured all appropriate financial information to maximize reimbursement, while demonstrating proficiency in billing.
    3. Resolved complex payer issues to completion on a daily basis within the guidelines of Federal and State regulations.
    4. Completed 50-100 accounts effectively and efficiently.
    5. Consistently met and exceeded goals put before me.
    6. Maintained a positive relationship with surrounding departments internally and externally.
    7. Provided support to several different hospital locations by handling their billing, collections and refunds.
    8. Billed out claims for the hospitals to the insurance companies.
    9. Collected on current and past-due claims from the insurance companies.
Years of Experience
Experience
5-7 Years
Experience Level
Level
Executive
Education
Education
Associate Of Arts In General Education

Insurance Reimbursement Specialist Resume

Objective : Seeks to obtain a position within a professional healthcare organization utilizing education, professional experience, and strong office skills. Detail orientated, able to work in a fast-paced environment both independently as well as within a group.

Skills : Healthcare, Data Entry, Quickbooks.

Description :

    1. Verified insurance eligibility and provide accurate information.
    2. Obtained patient coinsurance and deductible responsibility detail pertaining to procedures.
    3. Performed related work as required, including pre-authorizations, pre-certifications, and eligibility.
    4. Attended required meetings Comply with policies and procedures.
    5. Followed HIPPA guidelines.
    6. Responsible for contacting the insurance carrier specific to the assigned account queue and following up on the underpaid claims to result in payment on the account.
    7. Reviewed account specifics to evaluate how to follow-up with the Insurance payer on the aged or delayed claims, and be responsible for contacting them to move the account forward in the payment process.
    8. Filed clinical or 'good-faith' appeals and seek retro-authorizations when necessary.
Years of Experience
Experience
2-5 Years
Experience Level
Level
Junior
Education
Education
HS In General Studies