Summary
Overview
Work History
Education
Skills
Timeline
Generic

Nicole Thornton

Harrells,NC

Summary

An employee with the ability to multi-task, work independently and adhere to guidelines. The only person in my department to be cross trained in outpatient surgery & radiology insurance verification, initiate inpatient authorization requests, pre-registration & estimates, as well as ED registration.

Overview

13
13
years of professional experience

Work History

Insurance Verification/Pre-registration/Financial Support Rep

UNC Health Johnston
10.2020 - Current
  • Began working in pre-registration contacting patients scheduled for outpatient testing by phone to verify demographic information, create and provide estimate and provide appointment information
  • After four months my supervisor offered to move me into the Insurance verification role for outpatient surgery where I was also trained on inpatient notification/authorization requests
  • In this outpatient role I verify the patient’s insurance coverage, network status, benefits and authorization status
  • If an authorization is required, I ensure all the information is correct
  • For inpatients I verify coverage, check patient class to notify of an observation or inpatient stay using Availity, P/Link, Blue-E or via phone providing diagnosis and provider information from the chart, notify the UR department for clinicals via P/Link
  • The Financial Support Representative is part of a multidisciplinary team charged with the responsibility of providing accurate and professional financial clearance to patients scheduled for services at Johnston Health (i.e
  • Inpatient Surgery, Same Day Surgery, Outpatient Diagnostic and Imaging procedures and services)
  • The Financial Support Representatives mitigate the financial risk to Johnston by performing an accurate financial clearance review along with a comprehensive analysis of patient and payor specific benefits and patient liability
  • The Financial Support Representatives is responsible for performing all appropriate insurance verification, i.e
  • Verifying all insurance benefits and coverage, prior approvals, whether or not an authorization is required and that it is obtained at least the day prior to the patient’s arrival for surgery, any testing, Observation care, or In-patient Hospitalization
  • The representative must check with all the payors to verify that an authorization has been started and is completed prior to service
  • If not, the representative must contact the provider’s office to obtain the status of the authorization
  • If the authorization is not obtained timely, the representative escalates this to management (Patient Access Manager, PFS Director, Chief Financial Officer and Chief Medical Officer) and informs the provider that the surgery may have to be rescheduled.

Registrar/Scheduler/Phone Operator

Sampson Regional Medical Ctr
Clinton, NC
04.2018 - 10.2020
  • Answer multi-line phone scheduling outpatient and special procedures with the physician office and with the patient
  • Verify medical necessity and any lab work needed prior to appointment
  • Ensure the procedures within time-frame of necessity
  • Verify insurance coverage using Accureg and Meditech
  • Obtain authorization for each patient scheduled either online or by calling insurance company, performing peer to peer or appeals whenever necessary
  • Create an estimate and call patient to pre-register going over demographic information, appointment details, instructions and estimate
  • Cross trained to answer phone calls at the operator switchboard.

Preschool Teacher

Grace UMC Preschool
Clinton, NC
06.2012 - 04.2018
  • Caring for children in age range of 6 weeks to 3 years old
  • Plan daily activities for children
  • Adhere to state guidelines and regulations
  • Interact with parents and family members
  • Checking to ensure the person is listed as a contact
  • Complete daily paperwork
  • Ensure children are cared for in a safe learning environment.

Registrar

Sampson Regional Medical Ctr
Clinton, NC
10.2009 - 06.2012
  • Collect patient demographic, insurance and limited medical information from patients presenting for service in the ED and outpatient at SRMC
  • Obtain signatures for consent and authorization; producing registration documents and distributing as required per hospital policy
  • Collect self-pay balance, deductible and co-payment according to hospital credit policy
  • Provide assistance to patients; their families and visitors in getting to their destination within the hospital
  • Operate computer; answer telephone and verify medical license of non-medical staff providers who order diagnostic test.

Education

A.A.S - Commercial Graphics

Lenoir Community College
1996

Skills

  • Investigate insurance authorization requirements
  • Determine coverage
  • Scheduling
  • Time management
  • Meet deadlines

Timeline

Insurance Verification/Pre-registration/Financial Support Rep

UNC Health Johnston
10.2020 - Current

Registrar/Scheduler/Phone Operator

Sampson Regional Medical Ctr
04.2018 - 10.2020

Preschool Teacher

Grace UMC Preschool
06.2012 - 04.2018

Registrar

Sampson Regional Medical Ctr
10.2009 - 06.2012

A.A.S - Commercial Graphics

Lenoir Community College

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