Insurance Verifier

The following is an example of a qualified / professional Insurance Verifier resume sample(s). These resume examples uses an integration resume layout. The Resume initiates with the applicants qualification profile, outlining key-qualifications for Insurance job field.

Then, the candidate has an outline of their full work experience (employment history) in sequential order with employment dates on file.

Next is the Educational background, listed in descending order (most recent first). It then moves onto the Professional Background, highlighting skills separated into professional & personal skills.

And lastly, Certifications/Licenses that the candidate it involved with. Then a final part displays any other additional information that the candidate want it to be listed.

Resume Example for Insurance Verifier

Intake Authorization Rep

Plano, TX

Authorized to work in the US for any employer

Work Experience

Insurance Verifier

Walgreens Specialty

Frisco, TX

March 2017 to Present

.Responsible for performing the appropriate procedures to verify patient eligibility, coordinate benefits, run test claims and determine patient coverage/responsibility for services and testing and implementation of new plan business.  
.Utilizes all available resources to obtain and enter insurance coverage information for ordered services into patient’s file.  
.Verifies patient insurance coverage of medications, administration supplies and related pharmacy services.  
.Facilitates and completes the Prior Authorization process with insurance companies and practitioner offices.

Insurance Verifier

Medical Practice Solutions

Richardson, TX

November 2016 to January 2017

Calling patients to collect demographics for medical records . 
• Collecting insurance policy IDs and verifying benefits and checking price estimates for procedures scheduled 
• Notifying patients of estimated charges based on claims processed to date 
• Explaining patients deductibles and out of pocket expenses as necessary 
• Contacting MD offices if precertification is required 
• Documenting all contact with patients, doctors, and insurance companies 
• Contacting physicians when pre-certification  or further information is required for testing or surgeries scheduled

Intake Authorization Rep

US Renal Care Central Billing Office

Plano, TX

September 2015 to March 2016

• Temporary position with Dynamic Global Staffing 
• Review Research and resolve claim issues that are intake specific 
• Complete Cancel/Regenerations as requested by intake staff and the CBO Management Team on a daily basis. 
• knowledge of CPT and ICD-9 codes, HCFA 1500 and UB04 forms 
• Run and Work Patient reports from the billing systems 
• Run and Work Emdeon exception reports to indentify and correct insurance inaccuracies in the billing system. 
• Provide Patient reports for the clinics and doctors regarding current patient insurance coverage 
• Verify Insurance benefits and obtain authorizations if required 
• Enter all Demographics into our billing system

Workers Comp Referral Coordinator

Concentra Referral Department

Plano, TX

March 2015 to September 2015

• First point of escalation for all case related issues requiring guidance 
• Responsible for daily completion of assigned patient referrals, while meeting production requirements. 
• Reviews, processes and supports diagnostic, specialty and physical therapy referral requests by Concentra sites as defined by the market. 
• Obtains authorization for referrals and schedules appointments accordingly. 
• Ensures that appropriate networks and Concentra Advanced Specialists are used when applicable. 
• Provides all necessary information (medical records, transcripts, etc.) to payer. 
• Communicates with stakeholders – payer, employer, and patient – as appropriate and as per Service Package indications. 
• Records all appropriate information via OA/CR module of OccuSource per Policy & Procedure 
• Builds relationships with provider and payer community. Participates in quality assurance programs including case review and ongoing training sessions 
• Handles inbound and outbound calls according to the service guidelines of the department.

Specialty Pharmacy- Benefit Verification Coordinator

Amerisource Bergen

Frisco, TX

October 2011 to June 2014

• Received Inbound / outbound calls from patients concerning benefits or order status. 
• Provided intake services and setup for all new patients. 
• Completed workers compensation claims for authorization(If needed) 
• Coordinated the patient’s care with physician offices, nurses, Pharmacists and patients. 
• Performed insurance verification, both Major Medical and Pharmacy Benefits. 
• Obtained pre-certifications and pre-authorizations on behalf of doctors, nurses, and other healthcare professionals when required. 
• Performed insurance verification, both Major Medical and Pharmacy Benefits. 
• Obtained pre-certifications and pre-authorizations on behalf of doctors, nurses, and other healthcare professionals when required. 
• Maintained current documentation related to the patients drug therapies and pharmacy care plan. 
• Handled claims for both medical and pharmacy coverage. 
• Facilitated filing of appeals and grievances.

Insurance Verification Specialist

Caremark Specialty Pharmacy (Medix Staffing)

Irving, TX

April 2010 to October 2011

• Upon receipt of referral, we contacted insurance companies on behalf of the physician’s office to verify patients medical and/or pharmacy benefits(PBM) prior to shipment. 
• Interfaced appropriately with insurance administrators, physician’s offices, patients and internal personnel. 
• Facilitated filing of appeals and grievances. 
• Billed claims to determine proper copay and benefit information when applicable. 
• Placed outbound calls to participant and or Dr’s offices. 
• Prepared orders and coordinates deliveries. 
• Collected and entered insurance and benefit data. 
• Assisted with administrative and operations duties as needed. 
• Completed Referrals/Authorization research and also obtained the authorization if needed.

Member Services Representative

Medco Health Solutions

Irving, TX

June 2009 to April 2010

• Provided leadership, support and education to customers regarding their drug prescriptions and Medical benefits by inbound and outbound phone calls. 
• Verified patients order status and completed refill request prior to shipping. 
• Processed test claims for accurate benefit information. 
• Effectively communicates, written and verbally, clients policies, procedures, and applicable benefits to members and/or providers who have misinterpreted, were unaware of, or are questioning our client’s policy or decision. 
• Researched and interpreted claims, including all aspects of COB, NF, Worker’s compensation and claim recovery. 
• Met departmental standards for quality, productivity and teamwork. 
• Referrals/Authorizations research.

Benefits Representative

Wellpoint Pharmacy Management

Plano, TX

April 2006 to April 2009

• Serviced coordination for inbound and outbound calls to patients regarding drug prescription refills, PBM benefits and pre-authorization status. 
• Assisted Other co -workers with supervisor calls and general work related issues. 
• Responded to inbound calls from pharmacies that needed assistance with billing pharmacy claims. 
• Assisted Other co -workers with supervisor calls and general work related issues. 
• Completed Referrals/Authorizations research. 
• Researched claims according to established policies and procedures.