Experience

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  Kennedy Krieger Institute

  • United States

  • Benefits and Authorization Specialist

    • May 2021 - Present
    • United States

    • Verify insurance coverage and benefits utilizing all available verification and eligibility tools and calls payers when needed. Documents all ascertained information into the registration system.• Verify and/or obtains the necessary referral, authorization, or pre-certification prior to services being provided as required by the payer.• Obtain the patient’s information to facilitate the verification of the unique patient identifiers for clinical purposes, billing and collections process, and compliance with state and federal regulatory requirements.• Estimate self-pay portions after benefits have been determined (deductibles, co-pays, non-covered services).• Document and follows up on efforts to promote team and clinic awareness.• Collect up-to-date demographic information from patients and families.• Maintain regular communication and follow-up with patients, families, as well as KKI programs/departments, to include: team leaders, Patient Accounting, Finance, etc. Keeps all applicable parties informed of pending referrals, authorizations, unanticipated delays, and/or other potential issues.• Responsible for the accurate, complete, and timely capture and data entry of patients’ demographic, financial, and clinical information into the various information systems including pre-registration and/or scanning information systems.• Handle telephone calls in a timely fashion, following applicable scripting and customer service standards. Appropriately manage all calls by either working with the customer or referring the call to the appropriate party.• Work collaboratively with the practices to resolve registration, insurance verification, referral or authorization issue to the extent that these unresolved issues impact the ability to obtain a referral/authorization.

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  Chase Brexton Health Care

  • United States

  • Patient Coverage Verification Specialist/Authorization Specialist

    • Sep 2018 - May 2021
    • United States

    • Verified eligibility, coverage and benefits for all scheduled patients. Confirm patient insurance coverage prior to initial appointment and documents benefits for all new insurances in the Centricity Practice Solution System and also into the Phreesia system. • Determined any copays/coinsurance/deductible amounts that are patient responsibility and makes a note in the appointment comment for the Patient Service Representative to collect. • Maintained a 2-day window of coverage for all scheduled appointments. Ensure Medicaid coverage is active for the date of service on the date of service. • Detected and corrects errors, completes forms, obtains needed information and maintains logs and files. • Maintained knowledge of insurance information as it relates to provider credentials. • Obtain Mental Health and Substance Abuse authorizations by use of the Optum/Incedo authorization system.• Assisted in coverage for other service lines.

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  The Centers for Advanced Orthopaedics

  • United States

  • Medical Secretary/Authorization Specialist

    • Jan 2018 - Sep 2018
    • United States

    • Screened incoming phone telephone calls and record and transmit messages to the physician. • Scheduled follow up and new patient appointments for providers. • Arranged for referrals to be sent to other health care providers. • Scheduled appointments for x-rays, lab tests, physical therapy, MRI’s, CT scans, etc.• Prepared medical reports and summaries, patient histories, operative notes, and correspondence. • Documented patient vitals on Clinic Visit Sheet. • Managed document scanning and indexing of patient forms (Medical History, Registration, and Outside Reports).• Demonstrated the ability to remain calm, providing continual customer service in adverse situations. • Demonstrated proficiency on the Patient Management, EMR and Surgery Systems in order to perform required job functions.• Reviewed schedule and ensure all order entry is done on a daily basis, X-ray, MRI, CT & Labs. • Ensured all patient messages have been returned according to policy guidelines. Retrieval of patient portal messages answered same day. Document all messaging statuses through the EMR. • Completed billing records within 1 business day of clinic and submit to billing office. • Performed proactive review of physician’s clinical schedule the day before to ensure all studies/reports are in the patient’s chart for the provider. • Conducted self in accordance with CAO/OACM employee guidelines and policies.• Obtained Prior Authorizations for Pain Management Procedures. • Performed other duties as assigned.

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  University of Maryland

  • United States

  • Medical Secretary II

    • May 2017 - Jan 2018
    • United States

    • Scheduled and confirmed patient diagnostic appointments, surgeries and medical consultations using the Epic system.• Compiled and recorded medical charts, reports, and correspondence.• Answered telephones, and direct calls to appropriate staff.• Greeted visitors, ascertain purpose of visit, and direct them to appropriate staff.• Interviewed patients in order to complete documents, case histories, and forms such as intake and insurance forms.• Performed various clerical and administrative functions, such as ordering and• Completed insurance and other claim forms.

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  Johns Hopkins Hospital

  • Patient Service Coordinator III

    • Feb 2016 - Feb 2017

    • Exhibited courtesy and open communication with patients, visitors, and referral sources while promoting positive guest relations by providing excellent customer service.• Exhibited skills in managing provider schedules and scheduling appointments accurately and effectively, including communicating patient responsibilities (Obtaining a referral, bringing a co pay, presenting identification and an insurance card at check in) and other events as part of the practice pre-visit activities.• Demonstrated the ability and understanding the Johns Hopkins Systems policy for cash collection and patient encounter, including collecting copayments, outstanding balances and posting accurately and efficiently in the Epic Front Desk module. • Scheduled patients for evaluations, re-evaluations and treatment in Ormis, GE Centricity, Kiosks, and utilized Forms on Demand. Accepted referrals from physicians and insurance companies.• Obtained and inputs all pre-authorization insurance and pertinent demographic information into the EPIC scheduling system.• Answered telephone lines and triaged calls to appropriate physicians and nurses.

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  University of Maryland Faculty Physicians Incorporated

  • United States

  • Medical Practice Representative/Central Eligibility Specialist

    • Jul 2012 - Jan 2016
    • United States

    • Completed pre-registration, insurance verification, pre-certification and authorizations for departmental staff to ensure that the patient has an ideal experience. • Informed the patient/guarantor of all financial liabilities including referrals and co-payments needed at the time of service and documented pertinent information into the appropriate systems (i.e. IDX/Epic) • Responded promptly to requests received from departments regarding patient registration or insurance information. Maintained file of all resolved and pending requests for information.• Demonstrated knowledge of the Faculty Physicians, Inc. practices including payer contracts, policies and best practices.

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  HENRICO DOCTORS FAMILY MEDICINE LLC

  • United States

  • Patient Registration Representative

    • Jan 2011 - May 2012
    • United States

    • Welcomed patient and family members in a professional manner and answered patient and visitor questions. • Interviewed incoming patients, relatives, or other responsible individuals to obtain identifying and biographical information with insurance and financial information.• Verified insurance benefits and determined pre-certification status. If precertification is needed, call the insurance pre cert department and initiate review or verify authorization number provided by scheduling staff. Entered all information and authorization numbers into the registration system.• Explained policies regarding services, charges, insurance billing, and payment of account. Requested full or partial payment for services rendered according to collection policies. • Collected co-pays, deposits, and deductibles and document collection status in the system and chart. Received payments from patient for services rendered and prepare daily deposits.

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  Union Memorial Sports Medicine

  • United States

  • Patient Access Associate

    • Oct 2006 - Nov 2010
    • United States

    • Interviewed patients, families, or outside sources to obtain complete and accurate demographic and financial information and inputting data into the computer for registration, billing, and patient tracking.• Ensured that all necessary questionnaires and specific forms are completed according to pre-determined requirements by government regulatory agencies or hospitals.• Confirmed insurance coverage by utilizing an online verification system (HDX), EVS (Electronic Verification System), or other resources.• Obtained authorizations and referrals based upon insurance information. • Complied with Maryland reimbursement and regulatory requirements and state regulations regarding insurances. Completed MSP questionnaire for Medicare patients. HIPAA regulations strictly adhered to. • Working knowledge of insurances, third party payers, and health care spending accounts.