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Insurance Verification Specialist Resume Samples
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0-5 years of experience
Verified health insurance policies for all major commercial carriers, as well as government healthcare agencies.
- Served as a cost containment resource for Medicaid by ensuring they remain the “payer of last resort” by checking for other primary payer coverage.
- Ensured accurate data entry into healthcare verification applications.
- Entered pertinent information in a timely manner while paying special attention to detail.
6-10 years of experience
Trained new hires on standard operating procedures, safety rules, procedure manuals, operating and maintenance instructions
- Assisted with implementing departmental programs to improve performance and employee morale
- Offered recommendations to management for improvements in operational efficiencies
- Complied with federal regulations, including HIPAA provisions
- Examined pertinent information to determine the accuracy of client requests and related paperwork
- Maintained and revised procedural lists, control records and coded schemes to process source data
- Supported and complied with all company policies, processes and procedures including the Compliance Program and the Code of Conduct
- Reviewed and resolved discrepancies in received data and performed data verification routines in accordance with company procedures
- Assisted in scanning and re-scanning overlooked requisitions
0-5 years of experience
Verified insurance information by phone as well as via website, updated files with the most accurate coverage updates
- Assured that all requirements necessary are present per insurance verification
- Reported any errors found as well as recommended resolution
- Reported training issues to management to improve quality control
- Updated insurance codes to ensure claims process successfully
0-5 years of experience
Initiating contact with insurance companies for verification of benefits and authorization of inpatient and outpatient services.
- Ensuring that all insurance information needed for billing and collection processes are appropriately obtained and recorded in the computer system.
- Contacting patients and pre-registering outpatients as assigned.
- Ensures medical necessity is completed prior to testing.
- Informs patients of their financial responsibility for services to be rendered.
0-5 years of experience
Verified patients coverage for all patients needing genetic testing’s performed: Medicare, Medicaid, Commercial coverage plans
- Initiated the pre-authorizations/pre-determinations for insurance to get verified and processed correctly
- Followed up with decisions from providers
- Communicated with both patients and primary care physicians (PCP’s) and/or specialists in regards to standings
- Communicated with patients about their estimated out of pocket payments
- Followed up with doctors office with authorizations
- Faxed and emailed LOMN (letter of medical necessity) with clinical notes to provider for authorizations
0-5 years of experience
Contact insurance companies as required to obtain and enter accurate benefit information to positively impact insurance processing and minimize rejections.
- Effectively research and resolve prescription processing rejections to ensure patients receive medications within established patient standards.
- Answer and respond to calls regarding insurance related issues in courteous, professional manner.
- Effectively electronic medical claim billing according to insurance policies and regulations.
0-5 years of experience
Generated billings for many major insurances throughout the United States for prescription and medically billed medications, including overrides, J codes, ICD-9 diagnosis codes and special billing codes.
- Medicare B billing experience with oncology and transplant medications.
- Online and phone representative insurance verification and COB billing, as well as manufacturer, grant or other secondary funding.
- Ability to multi-task and resolve issues independently, as well as assist others with issues.
- Training new employees in the department.
0-5 years of experience
Conducted insurance verifications and authorizations
- Initiated the admissions process for patient referrals
- Investigated type and level of insurance coverage to assess patient eligibility
- Documented referral request for coordination of care
0-5 years of experience
Processing Emergency, Urgent and Routine patient specialist referrals for 38 medical offices.
- Complete Prior Authorization, Insurance Verification, Scheduling Appointments and coordination all patient medical and demographic information necessary to process the referral.
- Follow up on patient appointment and receipt of appointment notes to close referral.
- Use problem solving, customer service and adapt to changing priorities to overcome issues that arise.
- Familiarity with EPIC, ICD-9 and CPT coding, Medical Terminology and all patient demographics.
- Verifying patient insurance / demographics in a timely manner prior to or for same-day appointments to ensure error-free claims processing in a fast paced environment.
- Correcting errors in various work queues to ensure correct claim filing or refiling of denied claims.
0-5 years of experience
Project Manager for ICD-10 implementation
- Verifies all patient eligibility, authorizations and benefits, claim information with insurance companies, and 3rd party payers prior to surgery.
- Determines patient portions due, amounts to be billed, contractual discounts to be taken, or any other authorized discounts that may apply. Communicates this information with appropriate personnel for preparation of the pre-admission process.
- Identifies all patient accounts accurately based on what PPO, HMO, or other Managed Care Organizations the patient’s insurance plan might fall under.
- Contacts patients and provides updates on benefit verification information, requests additional information, insurance cards, and explains to the patient his or her financial responsibility such as co-pays, co-insurance, co-deductibles, at time of service.
- Notifies CBO Director/BOM of any insurance carrier information changes.
- Maintains insurance plan request database; ensuring data is entered accurately and in a timely manner, as determined through facility processes.
0-5 years of experience
- Verified patients eligibility and benefits coverage
- Updated any change of insurance within computer system
- Followed Medicare, Medicaid and Commercial Insurance guidelines for verification purposes
- Obtained prior authorizations when needed
- Contacted patients to verify orders as well as modified and collected copayments when necessary
- Prepared and finalized orders for shipping department
0-5 years of experience
Investigate queries and complaints pertaining to dental insurances
- Research insurance policies and verify benefits
- Scan documents into charts and explain benefits to clinics
- Train new hires
- Aided customers with network outages and bill payments issues
- Advertised products, services, and established new service accounts
- Met the departments’ quotas of 20 calls per hour, and up-sold new services and products
0-5 years of experience
Verify medical benefits and eligibility to determine if various products are covered by insurance company.
- Verify out of network/in network benefits with insurance companies such as, United Health Care, Well care, and Medicare.
- Make 50-100 daily outbound calls to customers and insurance companies for updates of medical insurance information.
- Assist customers with finding products covered by their insurance.
- Continuously update myself with guidelines of HIPPA policies and regulations also remain knowledgeable with new products and its functions.
0-5 years of experience
Complete insurance verifications to determine eligibility, co-pays, co-insurance and deductibles
- Contact patients to collect co-insurance and deductible if applicable
- Document insurance benefit verifications into patients accounts and through tasks for billing, clinical staff, and management
- Enter patients insurance information in Greenway when necessary
- Code using CPT and ICD-9 codes for specific procedures, surgeries, and intrauterine devices
- Collect past due balances by charging patients stored credit cards on file in Phreesia database
- Assist in scheduling mammography appointments: check patient’s previous mammogram results and look into history and physical and make sure patient has not had breast cancer or mastectomies.
0-5 years of experience
Verifying insurance eligibility and benefits for patients of the healthcare facility.
- Obtaining verbal and written authorization for planned medical treatment of patients from appropriate sources.
- Validating insurance information of patients for accuracy and completeness; resolving all discrepancies as needed.
- Operates basic functions and features of common e-health systems, such as Virtual, Works with an Internet-based healthcare information system. (Navinet, Zirmed, Availity)
- Create verification note explaining benefits and other necessary information.
- Update Sales Staff with pertinent information.
0-5 years of experience
- Provided financial counseling and highly personalized customer service to the 50,000 seniors and homebound patients who comprise the Visiting Physicians Association.
- Resolved patient complaints regarding medical services in a sensitive and empathetic manner.
- Performed registrations and insurance verification for incoming patients.
- Verified relevant medical diagnoses while maintaining HIPAA compliance.
- Headed a pilot program for Podiatry/Specialist referrals within the Patient-Access department.
0-5 years of experience
Contact insurance insurance companies to verify primary and secondary insurance coverage for both in-network and /or out of network physical therapy benefit coverage.
- Researched benefits available on internet web sites
- Obtain initial prior authorizations/pre-certifications as required by patients’ insurance plan.
- Entered clear and concise documentation of all calls and benefits information into the current billing system.
- Coordinate information from the patient, clinical staff, front office staff, physicians office, and employers as needed to complete the verification process.
- Adhered to all HIPPA rules and regulations.
0-5 years of experience
Processing insurance claims for six long term care facilities
- Contacting commercial, private and governmental insurance companies to get claims paid
- Coding hospice and skilled patience via EMR
- Following up daily with the Nusing facility’s business office to assure that patients are billed correctly
- Experienced billing Medicaid, Medicare, Commercial insurance and their TPA’s
- Familiar with CMS 1500s, ICD-9 & HCPC/Modifiers, Timely Filing and Prior Authorizations
- Closing out A/R, mailing bills and collecting on past due accounts.
0-5 years of experience
Verified all commercial insurance, workers’ compensation insurance and state insurance programs by telephone or online means
- Determine patient’s estimated financial responsibility if applicable
- Counsel patients on financial responsibility and set up payment schedule prior to scheduled visit
- Work with community resources to provide financial assistance to patients
- Obtain precertification for hospital inpatient admissions
- Responsible for training department personnel on current insurance policies and regulations within the industry
- Resolved disputes in collaboration with contract administrators
- Helped research and manage denial reports and appeals process
- Maintained high work volume while meeting all required deadlines
- Investigated and resolved inquiries and complaints pertaining to insurance and billing
0-5 years of experience
Efficiently gathers and inputs patient/guarantor’s demographic and financial information.
- Contacts appropriate payers, verifies benefits and obtains necessary authorizations.
- Coordinates patient services and information with case managers.
- Identifies customer service issues and resolves or initiates necessary follow-up.
- Explains necessary forms to and obtains signatures from patient/guarantor; answers basic customer billing questions.
- Utilizes appropriate reports to contact insurance payers for resolution to accounts that are pending or denied.
- Documents insurance benefits, co-payments, deductibles and self-pay portions in the account to allow for collections due.
- Pre-registers patients scheduled for medical services through Central Scheduling.
0-5 years of experience
Responsible for answering phone calls and scheduling patient appointments. Triages phone calls as necessary.
- Pre-verification of insurance for new patients. Ensures insurance coverage by telephone, resolves any issues with coverage and escalates complicated issues to a manager.
- Uses coded data to produce and submit claims to insurance companies
- Working directly with the insurance company, healthcare provider, and patient to get a claim processed and paid.
- Reviewing and appealing unpaid and denied claims
- Verifying patient’s insurance coverage
6-10 years of experience
Insurance Verification Specialists
- Excellent written, oral, and communication skills
- Verify all classes of insurance i.e.: Medicare, Medicaid and Commercial.
- Complete monthly reports
- Maintain a daily log of work completed.
- Complete work request within a 24-48 hour turnaround time.
- Communicate with collectors, IMS, and facilities for a full understanding of accounts.
0-5 years of experience
Obtain referrals and prior authorizations for various surgeries, high-tech radiology and diagnostic procedures
- Communicate with physician offices and insurance companies on a daily basis to decipher authorization and referral requirements
- Responsible for precepting and training new hires
- CPT and ICD coding
- Made SOPS and organized drives in Windows
- Print HICFA 1500 forms
- Schedule meetings and send meeting invites
- Electronic medical records & dictations
0-5 years of experience
DNB Work Edit Report- Work Discharged not billed accounts
- Verify insurance, obtain pre-authorization and Research overlap claim for date of service
- Update accounts requested from Customer Services Department .Enter data on the UB 92 report
- Assist with referrals using ICD-9, CPT, HCPC’s coding. Apply the appropriate Patient Accounting System insurance code for insurance plan, third party administrator, and/or payer on charge entry batches. Research and resolves correspondence from insurance carriers or patients concerning claims
- Research claim processing logic to verify accuracy of claim payment, member eligibility and billing/payment status prior to initiation of appeal process
- Process UB92, UB04 and CMS 1500 claims using Xactimed software
0-5 years of experience
- Initiate the admissions process for patient referrals by collecting demographic and insurance information on patients over the phone
- Verify patient insurance for IV Home Infusion and obtain authorization if needed
- Experience with commercial, Medicare, Medicaid, Workers compensation and No fault insurance
- Process Medicare Drug claims through program CE2000
0-5 years of experience
Health Insurance Verification
- Obtain insurance coverage and demographic information via various sources.
- Add/update patient benefit information in IDX and verify existing information is accurate.
- Benefit Coordination.
- Collect claim information from insurance company/employer and generate case in IDX.
- Knowledge of insurance company and products.
0-5 years of experience
Data Entry of patient enrollment forms
- Research and verify patient insurance information
- Maintaining spreadsheets of medical and dental prior authorizations
- Coordinate and organized provider’s schedules, agendas, and patient visits
- Provide patient follow up via email, fax, and phone
- Maintaining HIPPA confidential records via filing system
6-10 years of experience
Verify, interpret and document patient health insurance
- Pre-register all Value Options patients
- Document authorizations, clearances and follow up efforts
- Maintain contact with patients and families to keep them informed of insurance clearances and/or coverage and issues
- Submit family therapy without patient authorizations to Value Options
- Submit medication management authorizations to Value Options
0-5 years of experience
Extensive training and knowledge acquisition of all state insurance coverage types including: HMO, PPO, EPO, POS, Medicaid, Medicare, Tricare
- Work with insurance companies to obtain coverage and requirements for insulin pump orders
- Process insulin pump supply orders
- Follow up with insurance companies regarding authorizations for supplies
- Obtaining prescriptions and medical documents from physicians needed for supply orders
- Handle inbound/outbound calls in order to assist customers with account/order challenges
- Sales, Customer Service, Marketing
- In charge of opening and closing multiple salons, timecards, money drops and all corresponding paperwork
- Manage maintenance and cleaning of all salons
0-5 years of experience
Use telephone and online tools to verify patient insurance for outpatient dialysis in facility setting
- Use CPT, ICD-9, and contract information to obtain correct benefit information
- Load and adjust patient coverage in insurance management system (MIQS) as necessary
- Request and obtain authorizations for treatment as necessary
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Insurance Verification Specialist
Last edited by: Gabriela Barcenas, CPRW, Content Writer II -
Gabriela Barcenas
CPRW, Content Writer IIGabriela is a Certified Professional Resume Writer (CPRW) and career adviser. With 10 years of digital media experience and five years of resume writing expertise, her publication history includes fashion, education, travel, social justice, equitable design and career advice.
