Centralized Biller Resume Hartford, CT - Hire IT People

EXPERIENCE:

Confidential, Hartford, CT

Centralized Biller

Responsibilities:

Verified patients’ insurance status for multiple worksites and contacted them if ineligible for follow - up
Processed client insurance updates into billing system, including write-offs and identifier errors.
Validated monthly billing for commercial medical insurance and bimonthly billing for Confidential
Completed demographic data entry cleanup of missing patient information

Confidential

Insurance Verification Coordinator

Responsibilities:

Verified benefits for all customer funding sources for durable medical equipment.
Communicated directly with insurance carriers on the customer’s behalf for prior authorizations.
Worked closely with Funding Coordinators regarding additional information or clarification as needed.

Confidential, Rocky Hill, CT

Quality Assurance Coordinator

Responsibilities:

Received completed IME and Peer review reports to verify content for quality assurance and accuracy
Contacted transcriptionists and physicians’ offices reviewing report details and clarifications
Maintained frequent contact with clients for accurate referral status
Entered client referrals into company tracking system

Confidential, Old Lyme, CT

Intake Specialist

Responsibilities:

Reviewed and evaluated new behavioral health referrals for assignment to credentialed clinicians
Maintained insurance pre-authorizations between clinicians and commercial insurances
Processed discharges and recalls with regional client services director to reconcile facility census cleanup and prioritized critical issue resolution using Carelogic and Salesforce
Provided exemplary customer service to behavioral health professionals and facilities
Established close rapport with social services staff in assisted living and skilled nursing facilities for Tennessee and Indiana regions, and support other regions with coverage and load balancing

Confidential, Hartford, CT

Clinician Support Assistant

Responsibilities:

Prepared physician orders from region queues for Intake Specialists at Confidential
Assigned patient referral documents to electronic medical records
Contacted assisted living and skilled nursing facilities for missing referral documents

Confidential, Glastonbury, CT/Bloomfield, CT

Large Customer - Short Term Disability/FML Claims Specialist

Responsibilities:

Processed short term disability claims for payment in company databases and delivery systems
Reviewed medical records to obtain details for accurate and timely claim decisions
Completed decision letters and any additional letters for claimants and their attending physicians
Interacted with claimants in an empathetic manner in a fast-paced environment to assist with recovery and return to work if possible and worked closely with health care providers for claimant’s condition to make full and fair claim decisions.

Confidential

Vendor Program Coordinator

Responsibilities:

Developed a close rapport with external medical vendors and their customer service teams
Acted as Independent Physician Consultant (IPC) liaison for the Confidential offices
Coordinated Dragon Naturally Speaking software installation and training for IPC’s
Acted as subject matter expert for Dragon Naturally Speaking and liaison for IPC’s
Awarded multiple MetLife Circle of Excellence awards for exceptional customer service
Acquired experience in short term disability and FMLA case management
Built and performed claim maintenance in company specific databases and delivery systems
Made initial claim termination decisions based on customer specific plan provisions
Assigned claims to short term disability case managers after eligibility reviews completed

Confidential

Correspondent

Responsibilities:

Created and updated documentation for the Clinical Vendor Program
Scheduled IME/FCE exams with medical vendors for Glastonbury claims and clinical teams,
Excelled in customer service with internal and external customers, established relationships with legal and management teams that followed beyond the Correspondent I role.