Precertification Coordinator Resume Samples

Description :

1. Improved productivity, and resolving complex departmental issues.
2. Collaborated with Human Resource department to ensure efficient office environment for staff and supervise office operations for staff of 20 employees.
3. Coordinated meetings with other department managers and served as main liaison between denials management dept.
4. Managed daily office operations, maintenance of equipment, and maintaining accurate records for all business supplies.
5. Updated patient accounts and information daily, verified and created claim numbers by communicating with various insurance companies, verified payments done by insurance companies were accurate and according to contract guidelines.
6. Created spreadsheets to improve inventory management and reporting accuracy.
7. Managed incoming and outgoing calls for busy pre-certification department, assisted in all areas of administrative work including data entry, receptionist duties, file organization, research and development managed hundreds of accounts receivable accounts working directly with the Financial Management Office.

Experience

2-5 Years

Level

Junior

Education

GED

Description :

1. Administered financial counseling to patients and their families.
2. Coordinated financial care with Case Managers of appropriate insurance plans to obtain approvalsand benefits for pre transplant evaluation and listing phase.
3. Secured authorizations for all post transplant surgeries, procedures, office visits and labs.
4. Obtained referrals from PCP if required from benefit plan.
5. Verified eligibility and benefits for all patients.
6. Maintained the Status spreadsheet of all pre and post transplant patients.
7. Organized a system that maximized authorization rate by using a QA process that allowed me to capture every office visit, procedure, labs etc so verification and benefits can be performed on all patients.

Experience

7-10 Years

Level

Management

Education

Bachelor's

Description :

1. Obtained referrals and/or precertification of ordered services such as office visits, procedures, therapies, referrals, radiology tests and medications for MCR/MCD, MCR/MCD products, commercial carriers and occasionally BWC.
2. Kept current on various clinical guidelines, CPT & ICD-9 coding practices.
3. Liaisoned between staff, insurance carriers and patients regarding insurance policy practices, precertification processing and/or an appeal process.
4. Created documents for efficiency of precertification(s)/appeals, spreadsheets/graphs for statistical purposes, forms and form letters.
5. Scanned and assigned documents into the McKesson EMR system.
6. Verified insurance eligibility/benefits.
7. Able to implement my own templates and computer set up for the highest efficiency.

Experience

5-7 Years

Level

Junior

Education

Diploma

Description :

1. Responsible for acting as a liaison between the physician's office and the insurance company.
2. Obtained precertification of procedures for physician's offices from various insurance carriers.
3. Obtained applicable benefits for hospitals.
4. Used payer-specific websites to obtain benefits and complete certifications.
5. Met daily minimum productivity standard and score 95% on all audits.
6. Conveyed gained insights and knowledge to other team members.
7. Documented all emergency admitted patients for 45 physicians within several departments.

Experience

10+ Years

Level

Senior

Education

MS

Description :

1. Managed detailed patient flow from admission to discharge.
2. Used programs such as Eclipsys, Epic, and IDX for patient demographic entries, admissions, and discharges.
3. Established and maintained effective working relationships with Drug Reps.
4. Standardized department filing system so secretarial staff could easily locate information in any filing center.
5. Remained up-to-date with all insurance requirements, including the details of patient financial responsibilities, fee-for-service, and managed care plans.
6. Calculated Coordination of Benefits (COB).
7. Hired as an Admit Clerk and 6 months later promoted to Precertification Coordinator.

Experience

2-5 Years

Level

Junior

Education

Diploma

Description :

1. Recorded and filed patient data and medical records.
2. Reviewed diagnostic and procedural terminology for consistency with acceptable medical nomenclature.
3. Consistently ensured proper coding, sequencing of diagnoses and procedures.
4. Quickly responded to staff and client inquiries regarding CPT codes.
5. Demonstrated knowledge of HIPAA Privacy and Security Regulations by appropriately handling patient information.
6. Confirmed patient information, collected copays, and verified insurance.
7. Evaluated the accuracy of provider charges, including dates of service, procedures, level of care, locations, diagnoses, patient identification, and provider signature.

Experience

2-5 Years

Level

Executive

Education

High School Diploma

Description :

1. Provided necessary information for authorization and stay/visit re-authorization.
2. Reviewed information for admission and visit management including type and duration of service, authorization and treatment codes, re-authorization and visit requirements necessary for ongoing treatment and payment.
3. Actively membered in a patient-centered-team approach in the care of the patient and families.
4. Worked collaboratively with all team members in achieving shared goals with a consistent focus on quality care.
5. Participated in quality improvement activities including data analysis, implementing recommendations, evaluating changes and outcomes.
6. Experienced in ambulatory/physician office setting preferred. 
7. Knowledged of insurance and managed care companies preferred.

Experience

2-5 Years

Level

Executive

Education

GED

Description :

1. Primary contacted outpatient families regarding insurance referring them to the patient accounting department as needed.
2. Responsible for obtaining complete and accurate insurance information, benefits verification, accurately interpreting benefit plans, and investigating pertinent details.
3. Notified supervisor of known or potential insurance coverage issues.
4. Reviewed information for admission and continued visit management including type and duration of service, authorization and treatment codes, re-authorization, and continued visit requirements necessary for ongoing treatment and payment.
5. Responsible for explaining benefits, the billing process, and financial responsibility to parent/guardian.
6. Responsible for obtaining and communicating pre-authorization as needed per insurance company requirements.
7. Worked with a lot of elderly patients and if I could just make one person's day I felt like I accomplished a whole lot.

Experience

5-7 Years

Level

Executive

Education

GED

Description :

1. Responsible for overseeing case management of insurance, including verifying insurance Pre-Authorizations, Certifications, and Re-Certifications.
2. Managed multiple insurance contracts/exclusions and negotiate carve-outs.
3. Reviewed and communicated the plan of care for the delivery of services covered during stays in skilled nursing facilities.
4. Ensured appropriate insurance level of payment including proper ICD9 coding.
5. Reviewed clinical information provided with the request and determines if it meets UM criteria.
6. Prepared a detailed, organized analysis of information for the daily management reports.
7. Initiated effective and timely insurance case management interface.

Experience

2-5 Years

Level

Executive

Education

GED

Description :

1. Involved communication with Commercial Insurance Companies and Workers Compensation Nurse Case Managers to verify patient coverage and benefits.
2. Demonstrated and completed training processes for Knowledge of ICD9 diagnosis coding Knowledge of CPT4 procedural coding Knowledge of Medical terminology Ability to summarize clinical information in writing or orally for Medical Management or Adjusters Knowledge of Mysis and Tiger computer software from registration through finalization of printing charge tickets Required extensive knowledge of medical billing and follow-up, practice management, accounts receivables, in addition to other accounting procedures such as accounts payable and account reporting used for orthopedic practices.
3. Reviewed of accounting skills see Hertford Gates Health Department on Other related employment.
4. Responsible for checking insurance eligibility for outpatients at least every 90 days and annually in January and July via electronic medical records and insurance websites.
5. Appealed for additional services (extended stays, visits, authorization extension, and letter of medical necessity) and refers to additional resources when necessary.
6. Progressed through career ladder from Rep to Coordinator in three years Responsible for reinventing the training process for new employees, and creating paperless reference and training material.
7. Worked with insurance companies and MD offices to obtain authorizations for patient's needed medical tests and procedures.

Experience

2-5 Years

Level

Junior

Education

MS