Resume Sample for Senior Patient Account Rep


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The following is an example of Senior Patient Account Rep resume sample. Reviewing the candidate's full work experience, outlining key-qualifications, duties and responsibilities for the Accounting job title/field.

Resume Writing Example for Senior Patient Account Rep | CV Format

Senior Patient Account Rep – Childrens Hospital

Cambridge, MA

To secure a position in the field of Human Services to become a case manager or social worker.

Willing to relocate: Anywhere

Authorized to work in the US for any employer

Work Experience

Senior Patient Account Rep

Childrens Hospital

Boston, MA

July 2015 to Present

• Performs insurance verification and eligibility for patient’s elective and emergency accounts. This includes, verifying insurance coverage by phone or managed care company web-sites. 
• Performs daily duties in preparation for future (7-14 days) scheduled appointments to ensure patient demographics, insurance information, verification and eligibility have been established and documented 
• Verifies Pre-certifications and obtains edits if needed; verifies by phone or by managed care website 
• Responsible for Site Specific Insurance – In advance of scheduled appointments and/or same-day appointments, contacts insurance companies and documents contact to; ensures precerts are for the correct exams ordered, CPT codes match and ensures any precert obtained are for the correct facility. 
• Preparing and submitting accurate insurance claims to payer within proper timeframes. 
• Accepting, rejecting, and reconciling claim runs daily. Ensuring prompt resolution of outstanding insurance claims. 
• Effectively works payer scrubber and denial reports daily. 
• Reviewing claims for accuracy and correct errors as needed. 
• Collaborating with referral/authorization staff to resolve issues 
• Resolving claims processing issues with 3rd party payers and provides all requested information timely; engaging patients and family members to resolve claim or insurance issues when needed. 
• Providing documentation to have claims processed and paid. Researches, prepares, and provide 3rd party payer appeals. Request account adjustments in accordance with payer contractual agreements 
• Documenting all actions taken on account with clear and concise account notes and maintaining billing logs as required. 
• Preparing reports as required. Monitors and identifies trends, denials / claim errors by payer and refer as appropriate. 
• Maintaining a thorough understanding of 3rd party payer contracts. 
• Verifying insurance eligibility utilizing available technologies, payer websites, or by phone contact with third party payers. 
• Ensuring that correct insurance company name, address, plan, and filing order are recorded in the patient accounting system 
• Monitored all delinquent accounts and managed collection activities 
• Assisted to resolve billing issues for customers through regular inquiries 
• Performed medical collection activities as per established guidelines 
• Ensured compliance to HIPPA laws and federal regulations 
• Administered credit balances for all patients and players 
• Coordinated with customers to answer patient payment plans 
• Responsible for requesting clinical information for concurrent review with strict adherence to guidelines 
• Responsible for presenting, preparing, and submitting all recommendations for denial to the medical director and plan liaison, including arranging any peer-to-peer reviews, if requested by hospitalist, attending, or primary care physician 
• Assisted and/or provided facility interdisciplinary teams benefit information for in network providers/facilities, DME, home healthcare, acute, sub-acute rehab, skilled nursing facilities, and out-of-network benefits, if needed 
• Communicated frequently with assigned case managers for unplanned admissions, inpatient status, and discharge plan with orders 
• Collaborated with assigned case manager to identify members frequent hospital readmissions

Senior Patient Account Rep/Pre-Authorization/Medicare Medical biller

Brigham and Women’s Hospital

Boston, MA

January 2015 to July 2015

• Performs insurance verification and eligibility for patient’s elective and emergency accounts. This includes, verifying insurance coverage by phone or managed care company web-sites. 
• Performs daily duties in preparation for future (7-14 days) scheduled appointments to ensure patient demographics, insurance information, verification and eligibility have been established and documented 
• Verifies Pre-certifications and obtains edits if needed; verifies by phone or by managed care website 
• Responsible for Site Specific Insurance – In advance of scheduled appointments and/or same-day appointments, contacts insurance companies and documents contact to; ensures precerts are for the correct exams ordered, CPT codes match and ensures any precert obtained are for the correct facility. 
• Performs “End of Day” duties in preparation for the next day’s patients; if pre-cert not obtained for next day, notifies referring doctor’s office. 
• Scheduling and Service Center staff to ensure appointments information is the most current, esp., with regard to add-on and urgent same day appointments. 
• Attended full Epic training to be briefed on any updates made to specified insurance company policies. 
• Responsible for obtaining financial clearance and/or prior balances patients may have. 
• Collects and reviews all patient insurance benefit information, to the degree authorized by the SOP of the program. 
• Provides assistance to physician office staff and patients to complete and submit all necessary insurance forms and program applications. 
• Completes and submits all necessary insurance forms and electronic claims to process the claims in a timely manner as required by all third party payors. Researches and resolves any electronic claim denials. 
• Researches and resolves any claim denials or underpayment of claims. 
• Effectively utilizes various means for collections, including but not limited to phone, fax, mail, and online methods. 
• Provides exceptional customer service to internal and external customers; resolves any customer requests in a timely and accurate manner; escalates complaints accordingly. 
• Maintains frequent phone contact with provider representatives, third party customer service representatives, pharmacy staff, and case managers. 
• Reports any reimbursement trends/delays to supervisor (e.g. billing denials, claim denials, pricing errors, payments, etc.). 
• register patients in billing system, entering all pertinent billing and related information necessary for the accurate and timely submission of claims 
• follow up with physician practices to retrieve missing patient demographic or insurance information 
• review, prepare, and accurately bill for assigned charges on a daily basis 
• prepare and submit claims to third party insurance carriers both electronically and manually 
• research and resolve incorrect addresses to obtain updated mailing addresses and resubmit invoices 
• review EOB’s from insurance payers for issues requiring follow up and resolution, such as unpaid claims and denials 
• identify and communicate billing corrections to providers and perform follow-up to ensure corrections are processed in a timely manner within established guidelines 
• conduct timely follow-up with insurance payers, patients, and facilities to obtain corrected/updated billing information 
• monitor and process A/R to meet goals for organization 
• efficiently reduce DSO on accounts 
• answer inbound customer phone calls regarding billing related questions 
• print primary explanation of benefits to send with secondary claims 
• coordinate third party insurance carriers’ requests for medical documentation 
• perform administrative tasks including, but not limited to: assist with mailings, filing, processing refunds and document scanning

Patient Access Specialist/financial counselor

Dana Farber Cancer Instiitute

Boston, MA

June 2014 to January 2015

• Responsible for contacting insurance providers to determine the reason for the denied claim for the Dana-Farber. • 
• Checking the EOB and checking to see why the CPT code didn’t match. 
• Was provided with a daily work list with the patients name and the denial claim information name and contact information for their insurance provider. 
• Responsible for collecting and documenting patient demographic, financial, and other relevant information into the hospital information system. 
• Verify the patients insurance using automated eligibility systems (NEHEN and Emdeon). 
• Writing denials appeals and sending them to the insurance provider. 
• required to input the denial information into an excel spread sheet and create reports on the denials trends to determine where the issues arise. 
• promptly assisting patients and obtaining financial clearance prior to services at the Dana-Farber Cancer Institute and its partnering facilities. 
• assist with insurance coverage issues, providing clear and accurate financial information/options, and creating payment arrangements related to cancer care at the Dana-Farber Cancer Institute, Brigham and Women’s Hospital, and Children’s Hospital. 
• Interviews patients to obtain accurate demographic and financial information from self-pay and high risk patients. Utilize real-time automated tools for insurance verification, eligibility and benefits and/or call insurance carriers as necessary for information. 
• Communicate with insurance carriers, study team, and/or other providers to obtain required information on the patient’s behalf. Compile and submit all necessary documents and data to support request for coverage of charges for services to be performed at the Dana-Farber Cancer Institute. 
• Assist patients/families and/or physicians with appeals for services in the event a denial of authorization has occurred. Perform various account updates to patients’ accounts as needed and notify other relevant departments. 
• Document all patient account correspondence in the appropriate note field, designated forms, or databases; This includes all phone calls incoming and outgoing, referral number data, and any other account knowledge that becomes available. 
• Accurately and courteously explains policies regarding financial assistance programs and assist patients/families in the completion of applications. 
• Working knowledge of GE Centricity or other hospital/professional services billing systems. Attend relevant internal staff meetings to streamline communication of clinical and financial care. 
• registering all new patients, 
• updating demographics/insurance data on-line, 
• pre-registering patients, 
• performing referral management and financial screening functions. 
• Interacts with a multidisciplinary group of physicians, nurses, clinical and support staff. Familiarity with third party payer rules is required. 
• Must keep current on federal and state regulations pertaining to the Admitting/Registration process. 
• Process expiration paperwork according to Mass. State Law. Performs QA/QC responsibilities according to departmental standards. 
• Provides support for reception area and ADT/REG computer users.

Member/provider Services Team Lead

Tufts Health Plan Medicare Preferred

Watertown, MA

December 2012 to October 2013

• Responsible for verifying, documenting and coordinating information needed to process applications and other Eligibility Operations assignments 
• Conducts health insurance policy analysis, documentation verification, employer coordination and customer service while ensuring accurate data entry, validation and timely processing. 
• Verify, document and investigate the presence of health care coverage 
for Medicare recipients 65 or older disabled 
• Complete periodic reports. 
• Customer service to include high volume of phone work answering questions and other inquiries regarding Tufts Health Plan 
• Data entry to include accurate and timely entry of information. 
• Obtain and/or verify all items related to eligibility and enrollment into Medicare health plan(s) 
• Complete maintenance of active cases during open enrollment and premium review. 
• Answer & receive inbound, outbound calls regarding assistance in premium billing, co-pays for pharmacy or medical visits. 
• Monitor insurance claims by running appropriate reports and contacting insurance companies to resolve claims that are not paid in a timely manner. 
• Identify coding or billing problems from EOBs and work to correct the errors in a timely manager. 
• Identify problem accounts and escalate as appropriate. 
• Update patient account record to identify actions taken on the account. 
• Work with patients and guarantors to secure payment on outstanding balances. 
• Sort and file correspondence. 
• Contact payer and initiate request for payment. 
• Assign and/or validation of discrepancy reason codes. 
• Review, identify and resolve payer denials. 
• Ensure adjustments are posted timely and correctly for denied claims that need to be written off. 
• Track and follow up on requests for refunds or recoupments in accordance with payer requirements.

Eligibility Advisor I / Accounts Receivable Coordinator-Call Center

Healthcare Management systems/ Mass Health

Cambridge, MA

March 2010 to December 2012

• Responsible for verifying, documenting and coordinating information needed to process applications and other Eligibility Operations assignments 
• Conducts health insurance policy analysis, documentation verification, employer coordination and customer service while ensuring accurate data entry, validation and timely processing. 
• Verify, document and investigate the presence of health care coverage 
for Medicaid recipients and their families. 
• Assist in the identification of members that may qualify for the HIPP/Premium Assistance program. 
• Complete periodic reports. 
• Customer service to include high volume of phone work answering questions and other inquiries regarding the HIPP/Premium Assistance program. 
• Data entry to include accurate and timely entry of information. 
• Obtain and/or verify all items related to eligibility and enrollment into the HIPP/Premium Assistance program.

Internships and Volunteer Work

Tufts Health Plan Medicare Preferred

2009 to 2010

Patient Services Coordinator/medical billing 
• Extensive experience in patient care services, physician scheduling, and customer service management. 
• Proficient in front desk medical office duties, fast pace and high pressured environments. 
• Patient data entry: Entering patient’s information with a level of service and diagnosis 
• Check insurance coverage: Prepare & submit claims to insurance companies, patients and other payers 
• Follow-up on delinquent accounts: Launch appeals for payments in disputes 
• Communicate with physicians and insurance companies, Resolve billing complaints:Write appeals for denied claims 
• Entering patient’s information with a level of service and diagnosis. 
• Prepare invoices with proper codes. 
• Check insurance coverage. 
• Follow-up on delinquent accounts and create appeals for payments in disputes. 
• Prepare and submit claims to insurance companies or patient’s for payment. 
• Process claims to ICD-9 standards. 
• Reimburse patients for procedures paid for by insurance company 
• Secure pre-authorization for particular procedures 
• Use of IDX and medisoft softwares

Education

Associate in Science in Human Services

Bunker Hill Community College

Boston, MA

Skills

CPT (3 years), ICD (1 year), ICD-9 (1 year), Medicaid (2 years), Medicare (1 year)

Additional Information

Key Skills 
 
• Proficient in Microsoft Word, Excel, PowerPoint, Publisher, Outlook, Strong Internet Research. 
• Excellent communication skills – Trained in group facilitation and conflict resolution. 
• Trained in CPT-5, ICD-9, and HCPCS coding with experience insurance: Medicare, Medicaid, and third-party payers 
• Strong leadership skills – able to problem solve issues that arise in the workplace in a professional manner. 
• Manage multiple tasks at once, with strict adherence to time constraint. 
• Interview and collect all demographics regarding enrollment and intake processes

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