Insurance Verifier Resume Sample
Lawson Larkin
2240 Jimmie Mountain,
Philadelphia,
PA
+1 (555) 863 5203
Work Experience
Lead Insurance Verifier / Trainer
12/2015
-
PRESENT
Boston, MA
- Meets expectations outlined in Commitment To My Co-workers, and supports unit action plans
- Works under general guidance
- Able to establish priorities and meet tight deadlines with strong problem solving ability
- Inputs and updates all insurance information in appropriate screens, including correct COB order. Verifies eligibility of all insurances available on line or by phone. For Worker's Comp and Auto Insurance, obtains claim numbers and verifies that claims are established
- Performs insurance verification, obtains pre- and retro- certification information for outpatient/inpatient activity. Communicates appropriate information to the PAS/Utilization Management teams as required. Follow up on all verification issues in a timely manner, and communicate information to proper departments
- Identifies the need for pre-authorization information, makes decisions relating to insurance eligibility utilizing several on line systems available at MMC. Scheduled patients: Obtains and documents pre-authorization as appropriate for procedure. Urgent patients: obtains pre-authorization guidelines and communicates information to proper departments. Assists Cancer Research dept. in this area
- Identifies and documents patient financial liability. Refers patients to Financial Counselors/Navigators to obtain financial assistance and /or payment arrangements when appropriate
- Responsible to keep current on billing requirements from third parties such as, Blue Cross/Blue Shield, Medicare, Medicaid, and all other health insurance carriers
Insurance Verifier
08/2009
-
09/2015
Dallas, TX
- Responds to patients professionally in person and over the telephone. Responds effectively and in a customized manner to patients and families
- Solves problems and anticipate peak periods of patient traffic and/or volume in order to plan workload accordingly
- Documents patient messages/requests in EHR and forward to appropriate clinical staff/physician
- Submits medical records required by payers, for audits, and assists with appeals
- Keeps educational information, manuals and guides at team level updated and current
- Serves as support to other clerical staff, including training and problem solving
- Works various reports
- Meets productivity and quality standards
Insurance Verifier Days
09/2003
-
06/2009
Phoenix, AZ
- Utilizes all available resources to obtain and enter insurance coverage information for ordered services into patient’s file
- Reviews monthly doctor’s schedules and makes changes accordingly
- Acts as liaison between clinical staff, patients, referring physician’s office, and insurance by informing patients and families of authorization delays/denials, answering questions, offering assistance, and relaying messages pertaining to authorization of procedure/service
- Pre-screens doctor’s orders (scripts) received for new patients to ensure completeness/appropriateness of scheduled appointment
- Ensures all insurance. demographic , and eligibility information is obtained and entered into the syste'Tn in an accurate manner
- Completes routine audits to determine staffs’ compliance with best practice processes to identify reeducation needed
- Verifies all Medicaid approval letters from PATHS and saves to network shared drive
- Updates the system timely upon receipt of the approvals and ensures accounts are sent to correct authorization work queues
Education
Indiana Wesleyan University - Kokomo Campus
1998 - 2003
School's Degree in Computer
Professional Skills
- Communicates with all customers (patients, families, staff, physicians, vendors, etc) in a helpful and courteous manner while extending exemplary customer service. Anticipates and responds to inquiries and needs in an assertive, yet courteous manner
- Pre-registers all scheduled events in an accurate and efficient pace, completing accounts within 15 minutes or less. Maintains knowledge of all insurance plan requirements, Inpatient and Outpatient pre-registration processes, and collects on all opportunities
- Meets or exceeds accuracy standard goal determined by Pre-Access Leadership. Ensures integrity of patient accounts by working RQi daily, entering accurate data, and documenting all attempts made to collect and/or to obtain missing documentation
- Provides timely and continual coverage of assigned work area in order to ensure all accounts are completed well in advance of the scheduled appointment, or within 24 hours of admission. Meets attendance requirements, and is flexible during periods of short staffing, and or high volume
- Demonstrated multitask and problem-solving skills
- Typing skills equal to 27 words per minute net
- Sophisticated interviewing, communicaiton and negotiation skills
How to write Insurance Verifier Resume
Insurance Verifier role is responsible for insurance, typing, customer, training, security, compensation, reporting, research, travel, events.
To write great resume for insurance verifier job, your resume must include:
- Your contact information
- Work experience
- Education
- Skill listing
Contact Information For Insurance Verifier Resume
The section contact information is important in your insurance verifier resume. The recruiter has to be able to contact you ASAP if they like to offer you the job. This is why you need to provide your:
- First and last name
- Telephone number
Work Experience in Your Insurance Verifier Resume
The section work experience is an essential part of your insurance verifier resume. It’s the one thing the recruiter really cares about and pays the most attention to.
This section, however, is not just a list of your previous insurance verifier responsibilities. It's meant to present you as a wholesome candidate by showcasing your relevant accomplishments and should be tailored specifically to the particular insurance verifier position you're applying to.
The work experience section should be the detailed summary of your latest 3 or 4 positions.
Representative Insurance Verifier resume experience can include:
- Experience obtaining pre certifications
- Experience calculating benefit information
- Experience obtaining insurance verification, authorization, and precertification for physician and hospital services
- Experience in a hospital facility, handling insurance verification
- Demonstrated working knowledge of ICD-9 and CPT codes
- 2~3 years of related experience in Patient Access, billing, insurance company work or higher education with an emphasis in health services
Education on an Insurance Verifier Resume
Make sure to make education a priority on your insurance verifier resume. If you’ve been working for a few years and have a few solid positions to show, put your education after your insurance verifier experience. For example, if you have a Ph.D in Neuroscience and a Master's in the same sphere, just list your Ph.D. Besides the doctorate, Master’s degrees go next, followed by Bachelor’s and finally, Associate’s degree.
Additional details to include:
- School you graduated from
- Major/ minor
- Year of graduation
- Location of school
These are the four additional pieces of information you should mention when listing your education on your resume.
Professional Skills in Insurance Verifier Resume
When listing skills on your insurance verifier resume, remember always to be honest about your level of ability. Include the Skills section after experience.
Present the most important skills in your resume, there's a list of typical insurance verifier skills:
- Able to effectively communicate in English, both verbally and in writing. Additional languages helpful
- At least twelve (12) months prior registration or insurance billing experience is required
- Obtaining prior authorizations on all applicable procedures
- Obtaining required referrals and authorizations priorto services via phone, fax, online etc
- One or more years of working experience in Insurance Verification preferably in an Ambulatory Surgery setting
- One or more years of working experience in Patient Registration, preferably is an Ambulatory Surgery setting
List of Typical Experience For an Insurance Verifier Resume
1
Experience For Escalated Insurance Verifier Resume
- Act as a resource to the CIVU Team, Lead and manager by researching issues, recommending solutions and aiding in the implementation and follow up
- Work closely with collectors and the supervisors regarding previous account balances, high deductibles (over $500) and special billing circumstances
- Performs revenue cycle activities required for pre-registration and registration, facilitating insurance pre-certification and authorization
- Acts as resource in pre-screening physician’s orders to ensure completeness/appropriateness of scheduled appointment
- Verify eligibility to include identifying primary and secondary insurance, obtained claim numbers as necessary
- Check if authorization is required by portals or calling insurance
2
Experience For Insurance Verifier Days Resume
- Collaborates with Appeals department to provide all related information to overturn claims denial
- Provides ongoing communication and training to employees, physician offices, patients/families, and others as necessary to resolve insurance authorization issues
- Orients new employees to the department and acts as resource for staff to resolve/handle difficult situations or answer questions
- Identifies, obtains and documents all pre-authorizations as appropriate
- Input insurance information in the appropriate Munson system
3
Experience For Insurance Verifier & Procedure Scheduler Resume
- Follow up on all verification issues and communicate to proper departments in a timely manner
- Print schedule of the day
- Call insurance companies and to verify and complete all insurance information and benefits
- Enter insurance information in the computer
- Handle add-on surgeries in the same manner
- Create verification schedule of coverage for the month
- Print daily schedule and confirm all referrals/authorizations have been obtained and patient monetary responsibility is recorded on schedule
- Shred all paperwork, which displays private patient information
4
Experience For Lead Insurance Verifier / Trainer Resume
- Translate if applicable to assist at patient calls with any collector, if needed
- Attend in-services and feedback sessions for updates on insurance changes, policy modifications, and discussion of current verification issues and goals
- Learn and understand the different practice management systems
- Review electronic worktool for team to identify / report any issues in a timely fashion
- Utilize all available resources for optimum achievements, (i.e., Websites, Publications, payer and 21C managed care updates, coding policy updates/changes and apply these changes to the authorization, Peer to Peer, appeals & documentation process
5
Experience For Medical Insurance Verifier Resume
- Assist Lead, collectors, insurance verifiers, and Manager with identifying areas of opportunity with regard to streamlining processes, automation, goals, and the overall team goals/metrics, process improvement and productivity
- Coordinating any insurance verification needs from the patient with the office/ Central Plan Selection Unit
- Updating the patient account with details of the insurance verification of authorization in the CIVU questionnaire
- Researching account presented with questions from CIVU Team to find the correct answer
- Assist Lead with implementation of initial training, ongoing training & training workshops as assigned
- Identify issues that arise throughout the week to determine if re-education is needed and prepare and deliver training in weekly team meeting
6
Experience For Insurance Verifier Rep-franciscan Medical Group Resume
- Assist with CIVU reporting
- Weekly review of the NAO report to identify needed enhancements in the CIVU process
- Assist Manager and/or Team Lead in assigned tasks and special projects as requested by the deadline
- Weekly review of Authorization denials to identify process improvements and/or team re-education
- Perform weekly audits of authorizations obtained by staff to determine if all steps were followed and/or if re-education is needed
- Contact the physicians, FD, FC, RD, VP of Revenue Cycle & your manager when a Peer to Peer is requested
7
Experience For Medical Office Insurance Verifier Resume
- Ensures proper eligibility is obtained and processed correctly
- Verifies medical insurance eligibility of patients
- Updates the system with new eligibility information
- Receives and files reports from the insurance companies
- Terminates insurance of patients who are no longer eligible
8
Experience For Lead Insurance Verifier Resume
- Ensures eligibility guarantee forms are properly billed
- Responds to phone calls from providers to verify eligibility
- Researches waivers from organization’s medical groups
- Update accounts in GPMS with information obtained through correspondence and telephone (ie; insurance, authorization, baby’s name, etc.)
- Provides notification of urgent orders to the Senior level or Group Supervisor and communicates with other departments when an urgent need for filling a prescription or delivery is necessary; Places outbound calls to patients or physician’s offices to obtain additional information needed to process the script or to notify of delay in processing script
List of Typical Skills For an Insurance Verifier Resume
1
Skills For Escalated Insurance Verifier Resume
- Knowledge and experience with State, Federal and other regulatory Compliance Regulations, including: Medicare Secondary Payer, EMTALA, and ABN
- Healthcare experience in a hospital or clinical setting, health insurance or medical office, or previous registrar
- Works to ensure referring physician obtains prior authorization from insurance company for all scheduled healthcare procedures within assigned department/area
- Experience in insurance verification and authorization required
- Accountable for maintaining a close working relationship with team mates, point of service registrars, departmental staff, physician’s offices, etc
- Updates the system upon receipt of the Medicaid eligibility denials to ensure correct system discounting occurs for patient billing
- Compiles weekly/monthly statistics as needed for monitoring progress. Places data in appropriate spreadsheets for review
2
Skills For Insurance Verifier Days Resume
- Basic understanding of web~based systems, proficiency in data entry
- Work hours that verify based on needs of the organization including evenings, weekends and holidays
- Clinical background and understanding of medical terminology required
- Medical insurance verification and surgery scheduling REQUIRED
- Controls workflow processing in order to minimize the company's loss potential. Tracks verification services provided on appropriate daily log
- Corrects all insurance information in the system and reviews other previous accounts to ensure all claims have accurate billing information
3
Skills For Insurance Verifier & Procedure Scheduler Resume
- Verify insurance eligibility for scheduled patients by telephone, internet, and/or facsimile
- Ensure the insurance verification sheet is filled out legibly, accurately, and completely
- Calculate the patient portion due and document accordingly
- Experience in a fast paced medical office or facility setting with patient registration, appointment scheduling or medical billing experience. 3 years’ experience with medical insurance verification and authorizations. Comprehensive knowledge of managed care. Excellent customer service skills
- Experience as a Insurance Verifier
- Demonstrated knowledge of Medical Terminology work
- 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
- Accurately completes data entry necessary including authorizations and benefits as well as patient communication in the appropriate module of AdvantX
4
Skills For Lead Insurance Verifier / Trainer Resume
- Makes financial arrangements after consulting with CBO Director/BOM when patient is unable to pay amounts due in full the day of surgery
- Maintains insurance plan request database; ensuring data is entered accurately and in a timely manner, as determined through facility processes
- Assists in registration and/or scheduling when necessary to maintain the department’s efficiency
- Notifies CBO Director/BOM of any insurance carrier information changes
- Comprehensive medical, dental, and vision
- Attends Department, staff meetings, and education seminars as requested
- Identifies problems and recommends the appropriate resolution
5
Skills For Medical Insurance Verifier Resume
- Position requires access to confidential information (financial, medical, census) in the Meditech system. Responsible for the security of patient’s demographic, clinical and insurance information. Responsible for maintaining confidentiality relative to sensitive security issues
- Successful completion of a data entry assessment
- PC Proficiency in MS Windows and Office applications. Or Demonstrates knowledge of and utilizes electronic and automated work tools (e.g., online access tools to payers, work drivers)
- Verification or third party payer experience
- One year of hospital experience or in a related field
- Insurance verification experience, preferably in a fast paced physician practice
6
Skills For Insurance Verifier Rep-franciscan Medical Group Resume
- College level coursework
- Completion of college level medical terminology or Medical Assistant course
- Experience in a fast paced medical office or facility setting with patient registration, appointment scheduling or medical billing experience. 1-2 years’ experience with medical insurance verification. Knowledge of managed care. Good customer skills
- PC with knowledge of Excel, Word, and Outlook
- Web navigation and /or web based applications
- Obtain, verify and create accurate documentation
- Keep up with continued advanced education requirements and adapt to changes in a professional manner
- Knowledge related to Microsoft Excel and Outlook
7
Skills For Medical Office Insurance Verifier Resume
- Updates insurance and patient demographics in system as needed
- Enters detailed benefit verification notes in the system with any deductible information available
- Makes Case Management aware of any changes made to patient admission information as soon as possible via electronic tools utilized in system
- Verifies information received in the weekly / monthly Medicaid eligibility reports and ensures the system is updated accordingly
- Identifies underinsured, unsecured cases and communicates issues to admission departments’ Financial Counselors promptly for follow up
- Interfaces on a daily basis with insurance carriers, individual insurance provider authorizers, medical groups, and scheduling coordinators to maximize efficiency
- Consistently meets or exceed individual production and quality standards, as well as overall company and department service standards
8
Skills For Lead Insurance Verifier Resume
- Follows company/department policies and procedures as well as compliance standards. Notifies management staff when problems arise
- When providing scheduling services, maintains communication with the ordering physicians and their secretaries to schedule patients for a variety of imaging procedures
- Verifies insurance coverage and obtain benefits for all emergent, urgent inpatient admissions, observation and transfer cases for the network
- Researches accounts with incorrect insurance information to obtain accurate data to verify
- Meets or exceeds productivity and quality performance standards
9
Skills For Insurance Verifier Resume
- Contacts primary care physician for referral when needed for Observation cases
- Check in house greater than 30 day queries to see if patient’s benefits still active and keeps track of Medicare days
- Ensures revenue cycle activities are completed daily, including verification and authorization of healthcare services to prevent claims denials and appointment cancellation/rescheduling
- Performs daily quality audits to ensure all healthcare services are authorized and documented accurately and timely
- Acts as resource for employees to handle/resolve difficult authorization issues or answer questions
- Contacts referring physicians and/or patients to discuss rescheduling of procedures due to incomplete/partial authorizations, review prep instructions, or provide/obtain other information
- Monitors insurance authorization issues to identify trends and participates in process improvement initiatives, including generating reports or monitoring work queues to review denials or other key performance indicators
- Acts as liaison between clinical staff, patients, referring physician’s office, and insurance by informing patients and families of procedures authorization delays/denials, answering questions, offering assistance, and relaying messages pertaining to authorization of procedure/service
- Insurance Verifiers demonstrate ability to type 40+WPM required (alphanumeric & 10-key typing)
10
Skills For Escalated Insurance Verifier Resume
- One year Hospital experience
- Notify patients of financial responsibility prior to the day of surgery
- Scanning authorization requests, approvals & denials into imagining in Intergy
- Communicating with management on all cases that pose a financial hardship for the patient
- Obtaining retro authorizations in a timely manner when required
- Informing the Front Clinical Appeals unit, FD, FC & your manager when a treatment or service is denied
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