Insurance Verification & Healthcare Operations Specialist | Cleaner Claims, Fewer Denials, HIPAA-Trained
Hi, I'm John. I help healthcare businesses, clinics, and surgical centers stop losing time and money to claim denials, missed authorizations, and messy documentation.
For the past 5+ years, I've handled full insurance verification for four Ambulatory Surgical Centers at once, covering eligibility, copay, deductibles, OOP max, authorization requirements, and reimbursement rates for CPT/diagnosis codes. I don't just check boxes; I call insurers directly when benefits are unclear, catch demographic errors before they turn into denials, and keep every case audit-ready.
I've also managed appeals and grievance cases for a Medicare Part D plan, work that earned me a promotion to Team Lead for consistently handling complex, high-stakes cases with accuracy. And I've supported patient-facing coordination, booking and managing therapy appointments while matching patients to the right providers.
I'm proficient across a range of clinical and administrative software systems, including Availity, Raintree Systems, HST Pathways, SIS Complete Tool, and eBridge, and I pick up new platforms quickly.
Here's what you get when you work with me:
-Insurance verification done right the first time (eligibility, benefits, authorizations, reimbursement rates)
-Fewer claim denials and pushbacks through proactive follow-up
-Grievance and case resolution handled with care and compliance
-Strong proficiency in clinical and administrative software systems
-HIPAA-trained, detail-obsessed, and reliable under deadline pressure
If you need someone to own your insurance verification or case management process so you can focus on patient care, let's talk.
Verified
