Experience

The Maxis Group

• United States
• IT Services and IT Consulting
• 1 - 100 Employee

• Healthcare - Care Review Processor

  • Sep 2022 - Feb 2023

  ● Provide computer entries of authorization requests/provider inquiries by phone ● Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA). ● Verify member eligibility and benefits, Determine provider contracting status and appropriateness, ● Contact physician offices according to Department guidelines to request the missing information from authorization requests or for additional information as requested by the Medical Director. ●… Show more ● Provide computer entries of authorization requests/provider inquiries by phone ● Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA). ● Verify member eligibility and benefits, Determine provider contracting status and appropriateness, ● Contact physician offices according to Department guidelines to request the missing information from authorization requests or for additional information as requested by the Medical Director. ● Assign billing codes (ICD-9/ICD-10 and/or CPT/HCPC codes), work within the Care Access and Monitoring (CAM) team to provide clerical and data entry support for members that require hospitalization and/or utilization review for other healthcare services Show less ● Provide computer entries of authorization requests/provider inquiries by phone ● Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA). ● Verify member eligibility and benefits, Determine provider contracting status and appropriateness, ● Contact physician offices according to Department guidelines to request the missing information from authorization requests or for additional information as requested by the Medical Director. ●… Show more ● Provide computer entries of authorization requests/provider inquiries by phone ● Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA). ● Verify member eligibility and benefits, Determine provider contracting status and appropriateness, ● Contact physician offices according to Department guidelines to request the missing information from authorization requests or for additional information as requested by the Medical Director. ● Assign billing codes (ICD-9/ICD-10 and/or CPT/HCPC codes), work within the Care Access and Monitoring (CAM) team to provide clerical and data entry support for members that require hospitalization and/or utilization review for other healthcare services Show less



Convey Health Solutions

• United States
• Hospitals and Health Care
• 700 & Above Employee

• Customer Service Representative/Call Center Agent

  • Sep 2020 - Jul 2022

  ● Answer calls by utilizing the company's call management system and other software. ● Managed large amounts of inbound and outbound calls in a timely manner. ● Assisted with Prior Authorization requests ● Handles patient and insurance inquiries associated with specific patient accounts ● Identified customers' needs, clarified information, researched every issue, and provided solutions. ● Maintained strong company product and service knowledge to better assist customers with… Show more ● Answer calls by utilizing the company's call management system and other software. ● Managed large amounts of inbound and outbound calls in a timely manner. ● Assisted with Prior Authorization requests ● Handles patient and insurance inquiries associated with specific patient accounts ● Identified customers' needs, clarified information, researched every issue, and provided solutions. ● Maintained strong company product and service knowledge to better assist customers with concerns, questions, and general education. Show less ● Answer calls by utilizing the company's call management system and other software. ● Managed large amounts of inbound and outbound calls in a timely manner. ● Assisted with Prior Authorization requests ● Handles patient and insurance inquiries associated with specific patient accounts ● Identified customers' needs, clarified information, researched every issue, and provided solutions. ● Maintained strong company product and service knowledge to better assist customers with… Show more ● Answer calls by utilizing the company's call management system and other software. ● Managed large amounts of inbound and outbound calls in a timely manner. ● Assisted with Prior Authorization requests ● Handles patient and insurance inquiries associated with specific patient accounts ● Identified customers' needs, clarified information, researched every issue, and provided solutions. ● Maintained strong company product and service knowledge to better assist customers with concerns, questions, and general education. Show less



Creative Solutions In Home Health

• United States
• Wellness and Fitness Services
• 1 - 100 Employee

• Certified Nursing Assistant

  • Apr 2016 - Jan 2020

  ● Monitored patient stability by checking vital signs and weight, and recording intake information. ● Follow individualized care plans for 70+ residents by working closely with the nursing staff. ● Documented actions by completing forms, reports, logs, and records. ● Basic knowledge of anatomy, physiology, and medical terminology ● Adhere to HIPAA, PCI, and Change Healthcare Policies and Procedures ● Monitored patient stability by checking vital signs and weight, and recording intake information. ● Follow individualized care plans for 70+ residents by working closely with the nursing staff. ● Documented actions by completing forms, reports, logs, and records. ● Basic knowledge of anatomy, physiology, and medical terminology ● Adhere to HIPAA, PCI, and Change Healthcare Policies and Procedures