Katrina Mauney

Verifies and updates all patient demographic and insurance information. Verifies insurance eligibility and benefits using web based portals or by phone for all patients scheduled. Calculates both professional and facility estimates of patient responsibility for procedures scheduled at the ambulatory surgery center. Calculates patient responsibility estimate of professional charges for patients scheduled at local hospital for both outpatient and inpatient procedures. Uses spreadsheet data of contracted rates for all major insurance companies and Medicare when calculating estimates. Contacts patients by phone to provide estimated amount due as well as when payment is due. Explains benefit information to patients for understanding of estimated amount due. Collects patient payments for procedures by phone and verifies receipt of payments made in office, Verifies prior authorization requirements for all patients scheduled at the ambulatory surgery center as well as outpatient and inpatient procedures scheduled at the hospital. Requests prior authorization for outpatient and inpatient procedures as required by insurance by phone or using insurance web based portals. Verifies accuracy of ICD-10 and CPT codes for requested procedures. Ensures all appropriate medical documentation is submitted to insurance for prior authorization review. Verifies documentation of clinical criteria being met for specific procedures is attached to authorization requests. Follows up on all pending authorization requests to ensure approval is received prior to procedures. Documents prior authorization information in computer system for attachment to claims. Facilitates appeals and reconsiderations for procedures where prior authorization is denied. Effectively communicates important information to physicians, staff and patients as needed.

Provided excellent customer service via inbound and outbound calls to patients. Verification of all demographic and insurance information. Verification of insurance eligibility and benefits. Collection of patient payments for upcoming procedures and past account balances. Established payment arrangements for patients based on policy. Obtained prior authorization requirements for patients scheduled at ambulatory surgery centers and in the outpatient hospital setting using insurance portals or by phone. Requested prior authorization for procedures when required. Submitted necessary medical documentation for review of prior authorizations requested. Followed up on pending authorization requests. Documented approved prior authorizations in computer system for attachment to claims. Facilitated peer to peer reviews and appeals for denied prior authorizations. Assisted in calculation of estimated patient responsibility for upcoming procedures. Communicated patients estimated amount due for procedures via phone and email.

Completed accurate check in of patients entering the emergency department either walking in or being transported by ambulance. Completed full bedside registration of demographics, insurance information and accident information for patients in the emergency department. Verified insurance eligibility and benefits for patients. Collected copayments for registered patients when possible. Ensured completion of all required consents and documents for registered patients. Uploaded ID and insurance card copies to patients accounts. Ensured all patient documents were distributed appropriately for use in patient care.

Answered high volume inbound calls from patients and referring physicians for clinic scheduling in multiple specialty clinics. Completed full registration of patients demographic nd insurance information. Verified Eligibility and benefits for all registered patients to be scheduled. Scheduled patients for clinic appointments, lab testing, radiology procedures and clinic procedures ensuring appointments followed hospital and clinical protocols. Processed high volume of external referrals electronically to appropriate scheduling areas. Made outbound calls to patients to register and schedule based on referrals received. Communicated scheduling information to referring providers. Answered calls from internal staff for scheduling requests. Contacted and scheduled appointment requests from internal providers on the CPOE list. Communicated with providers and staff for urgent scheduling requests.