Tyeesia Perry
Raleigh
Summary
Dynamic Insurance Verification Specialist with proven expertise at Select Rehabilitation in optimizing patient eligibility verification and resolving insurance discrepancies. Skilled in EMR documentation and compliance standards, I excel in fostering team collaboration and enhancing patient communication, ensuring seamless revenue cycle management and improved service delivery.
Overview
4
4
years of professional experience
Work History
Insurance Verification Specialist
Select Rehabilitation
Raleigh
06.2022 - Current
- Reviewed medical records to ensure accuracy of required information needed for pre-authorization requests.
- Responded promptly to customer inquiries regarding their benefits and eligibility status.
- Provided timely follow up with payers regarding payment status of claims.
- Maintained confidentiality of patient information in accordance with HIPAA regulations.
- Developed a working knowledge of insurance plans, including Medicare and Medicaid regulations and requirements.
- Collaborated with internal staff members such as Billing Specialists, Medical Coders to resolve any discrepancies in patients' insurance information.
- Performed daily audits of submitted claims to ensure compliance with industry standards and regulations.
- Maintained accurate documentation on all pre-authorization requests, denials and appeals.
- Analyzed complex health plan contracts to determine benefit coverage levels for services rendered.
- Verified patient eligibility for insurance coverage by contacting insurance carriers and obtaining the necessary authorization numbers.
- Identified discrepancies in patient's insurance coverage or benefits, ensuring accuracy of data entered into system.
- Updated patient and insurance data and input changes into company computer system.
- Instructed clients on amounts covered under benefits plans in easy-to-understand terminology.
- Verified that patients had proper insurance coverage prior to procedures or appointment scheduling.
- Collaborated with healthcare providers to communicate insurance coverage and authorization details.
- Implemented process improvements to enhance efficiency and accuracy of insurance verification.
- Liaised with insurance companies to obtain pre-authorizations for procedures and medications.
- Retained strong medical terminology understanding in effort to better comprehend procedures.
- Assisted in training new staff on insurance verification procedures and best practices.
- Utilized electronic medical records (EMR) systems for documenting verification processes.
- Developed and maintained professional relationships with insurance representatives.
- Verified patient insurance coverage, benefits, and eligibility for services across multiple insurance platforms.
Patient Account Representative
CSI Companies (United Healthcare)
Raleigh
10.2023 - 01.2024
- Ensured compliance with company policies concerning the privacy of confidential health information.
- Researched discrepancies in patient accounts to determine appropriate resolution.
- Initiated collection activities on delinquent accounts while adhering to HIPAA guidelines and regulations.
- Processed payments from patients and maintained accurate records of all transactions.
- Conducted follow-up calls with patients to ensure that accounts were up to date and properly documented.
- Interacted with other departments within the organization such as finance, accounting, IT, and Human Resources when necessary.
- Worked closely with insurance companies to obtain authorization for services rendered.
- Communicated frequently with healthcare providers regarding payment status updates on their claims submitted.
- Analyzed claims denials from third party payers and identified potential solutions for reimbursement.
- Reconciled payments received against outstanding invoices ensuring proper posting of credits and debits.
Claim Benefit Specialist
CVS Healthcare
Raleigh
12.2022 - 12.2023
- Reviewed and processed applications for benefits eligibility.
- Reconciled invoices against payment records to verify accuracy of billing cycles.
- Verified customers' information to ensure accuracy of claims data.
- Monitored claim status updates from providers and communicated relevant updates to customers.
- Maintained records of claims processing activities and updated databases accordingly.
- Analyzed trends in customer complaints to determine areas needing improvement in service delivery.
- Assisted in the development, implementation and maintenance of various benefit programs.
- Investigated discrepancies between billings submitted by providers and payments received from insurers.
- Tracked customer feedback on new products or services introduced by the organization.
- Provided guidance on claim procedures and policies for customers.
- Ensured compliance with all applicable regulations governing employee benefits plans.
- Performed quality assurance checks on completed claims forms prior to submission for payment authorization.
- Monitored reports to identify claims issues and worked with adjusters to resolve problems.
Provider Enrollment & Credentialing Specialist
Aston Carter (Duke University Health System)
Rale
10.2021 - 11.2022
- Processed re-credentialing applications for existing providers according to contractual requirements.
- Maintained detailed records of provider data in the credentialing database system.
- Assisted in developing and implementing departmental procedures related to provider enrollment and maintenance activities.
- Interacted regularly with representatives from health plans and commercial payers regarding credentialing matters.
- Coordinated with internal departments such as medical staff services or risk management to resolve any issues identified during the verification process.
- Collaborated with internal teams regarding provider contracts and agreements.
- Prepared correspondence for various departments concerning credentialing updates or requests for additional information.
- Provided support in responding to inquiries from external parties regarding credentialing information.
- Researched discrepancies between submitted provider data and verified sources when necessary.
- Ensured timely completion of credentialing processes by providing guidance to providers on required documentation.
- Reviewed and processed credentialing applications to ensure accuracy, completeness, and compliance with all accreditation standards.
- Maintained informational resources, tracking and documenting requests for updates, certification and credentialing.
- Prepared and submitted detailed reports on credentialing progress to management.
- Processed documents and status-change requests, conducting followup assessment regarding enrollment inquiries.
Education
Bachelor of Arts - Interdisciplinary Studies
Fayetteville State University
Fayetteville, NC05-2020
Cerification - Medical Billing
Wilkes Community College
Wilkesboro, NCCertificate - Medical Coding
Absolute Medical Coding Institute
Raleigh, NCSkills
- Insurance verification
- Patient eligibility verification
- Claims analysis
- EMR documentation
- Revenue cycle management
- Data entry accuracy
- Insurance discrepancies resolution
- Compliance standards
- Financial liability estimation
- Team collaboration
- Communication and interpersonal skills
- Prior authorization processing
- Medical billing
- Insurance claim validation
- Process evaluation
- Policy interpretation
- HIPAA compliance
- Claims processing
- Database management
- Customer relationship management
- Data entry proficiency
- Accuracy and precision
- Adaptability
- Database administration
Timeline
Patient Account Representative
CSI Companies (United Healthcare)
10.2023 - 01.2024
Claim Benefit Specialist
CVS Healthcare
12.2022 - 12.2023
Insurance Verification Specialist
Select Rehabilitation
06.2022 - Current
Provider Enrollment & Credentialing Specialist
Aston Carter (Duke University Health System)
10.2021 - 11.2022
Bachelor of Arts - Interdisciplinary Studies
Fayetteville State University
Cerification - Medical Billing
Wilkes Community College
Certificate - Medical Coding
Absolute Medical Coding Institute
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