1. Janice Riffer
Jdrifferl318@gmail.com • 507 Emerson Street, Vandergrift PA 15690• 724-882-9622
Possessing an effective combination of strong interpersonal and communication skills and extensive
insurance knowledge. I am able to quickly adapt to challenging situations while still developing and
maintaining a positive relationship with internal and external customers. Strengths in multitasking and
working independently as well as a strong team player.
Work Experience
ZOLL I 121 Gamma Drive, Pgh, PA 15238
Appeals Coordinator March 2014- current
• Identify authorization denial appeal procedure and information
• Initiate re-consideration and Appeal process
• Obtain medical records from hospitals and /or doctor offices
• Communicate with Territory Managers on P2P requests, Letters of Medical Necessity,
and/or any additional clinical information needed.
• Review all clinical received, and review for additional diagnosis to be included in the
appeal process.
• Obtain and understand medical policies.
• Create Claims to process for billing
• Compiling and completing appeal letters, comparing Medicare and Insurance policies
and guidelines
• Tracking a l l cases in appeal process and outcome
Intake Specialist- July 2012-March 2014
• Setting up new patient accounts
• Verifying insurance on all new patients
• Utilizing internet resources with insurance verification
• Following medical criteria to book revenue with new accounts
• Initiate prior authorizations and follow up until complete
• Resolving Faxes
• Dispensing all new orders
• Resolving all exceptions

2. •••
CVS Caremark 105 Mall Blvd. Pittsburgh, PA 15146
NPE Insurance Verifier/ New Patient Enrollment- Nov 2009 – July 2012
• Setting up new patient accounts
• Verifying all insurance including major medical and prescription plans
• Obtain prior authorizations for medication ordered.
• Utilize websites for insurance verification and prior authorization requests
• Update all information in the operating systems to process new orders
• Process and download claims for patient orders.
• Patient contact to update and collect method of payment prior to shipping new orders.
• Assist patients in enrolling for copay assistant programs for high copays and
deductibles.
• Trouble shoot with insurance companies on rejected claims and denied authorizations.
• Prioritize medication orders with overnight shipments.
CVS Caremark Patient Account Services/ Collections-
• Calling patients for collection efforts
• Writing up accounts for collection and bad debts
April 2009-Nov 2009
• Insurance Verification on claims processed incorrectly
• Completing posting vouchers, payment transfers and refunds
• Process credit card payments and payment plans
• Working with patients to help them understand their benefits.
• Completing all special projects.
Kiski Area School District I Vandergrift PA 15690
Administration/ Secretary July 2008 toApril 2009
• Substitute for all administration and secretarial positions
• Prepare correspondence and documents
• Answering phones and scheduling appointments
• Maintaining filing systems
• General secretarial and office administrative work as assigned.
UPMC- UPP I Pittsburgh, PA
Surgery Scheduler- Gyne/Oncology 2004-2008
• Review physician orders for surgery scheduled and pre-op requirements
• Review with patients all surgical requirements and schedule pre-op testing.
• Schedule surgery in system, physician's calendars and with operation room.
• Complete surgical packet with patient

3. Janice Riffcr
•••
• Verify insurance and initiate prior authorization as needed for procedure
• Trouble shoot any insurance issues prior to surgery
• Complete all necessary paperwork for surgery, admitting and prior authorization,
• Initiated new forms for surgery procedure
• Completing any continuing education classes.
Blackburn’s Physician Pharmacy I Tarentum PA
Manager of New Patient Accounts of Med/Surgical Supplies/ Customer Service
1999-2004
Owner and Operator of Floral Shop
1989-1998
Giant Eagle Markets
1977-1989
Skills
• LifeVest Network
• Soft Aid,
• PRC
• RT
• All insurance website portals
• Microsoft Word/ Excel
References
Available Upon Request