Strategic OPS Team

• Dec 2021 - Present

Claims Call Center Rep

• Feb 2020 - Dec 2021

Handles inbound phone calls from Providers, VA, and other customers. Reviews claims and responds to billing questions. Provides updates on claim status, including notification that claims are in process, pending for more information, and denied. Works in a detailed, fast-paced, and repetitive production environment. Interacts with customers in a professional, formal manner where the focus is on completing the task pleasantly and with high quality and accuracy. Handles inbound phone calls from Providers, VA, and other customers. Reviews claims and responds to billing questions. Provides updates on claim status, including notification that claims are in process, pending for more information, and denied. Works in a detailed, fast-paced, and repetitive production environment. Interacts with customers in a professional, formal manner where the focus is on completing the task pleasantly and with high quality and accuracy.

Diagnostic Scheduler

• Sep 2018 - Oct 2019

Scheduling patient treatments or diagnostic procedures; receiving physician orders, insurance verification, gathering pre-authorizations and pre-certifications. Maintains records and produces statistical reports as required. Scheduling patient treatments or diagnostic procedures; receiving physician orders, insurance verification, gathering pre-authorizations and pre-certifications. Maintains records and produces statistical reports as required.

Pharmacy Service Associate

• Oct 2016 - Sep 2018

1. Collection of structured clinical data for prior authorization and non-formulary exception requests following the guidance provided in our online prior authorization tools and/or corresponding forms.2. Initial screening of requests based on guidance given by online prior authorization tools.3. Approves prior authorization requests if the data collected meets the approval specifications.4. Refers prior authorization requests that do not meet the approval specifications to a Pharmacist for clinical review.5. Independently responds to contacts ranging from routine to moderate complexity. May seek assistance with health care professional services issues of substantial complexity.6. Performs research to respond to inquiries and interprets policy provisions to determine most effective response using established departmental procedures, HIPAA regulations, and corporate policies.

Referral Coordinator

• Aug 2015 - Sep 2016

Maintain ongoing tracking and appropriate documentation of referrals to specialists-Assemble records and per referral guidelines provide appropriate clinical information to specialists-Contact insurance companies to ensure that prior authorization requirements are met-Review details and expectations about the referral with patients-Answering phone calls and scheduling patients-Verification of insurance coverage for medical, vision and behavioral health services Maintain ongoing tracking and appropriate documentation of referrals to specialists-Assemble records and per referral guidelines provide appropriate clinical information to specialists-Contact insurance companies to ensure that prior authorization requirements are met-Review details and expectations about the referral with patients-Answering phone calls and scheduling patients-Verification of insurance coverage for medical, vision and behavioral health services

Prior Authorizations

• Oct 2014 - Aug 2015

Responsible for verifying and obtaining authorizations as required by insurance companiesdependent upon the plan coverage for all patients. Responsible for verifying and obtaining authorizations as required by insurance companiesdependent upon the plan coverage for all patients.

Billing Specialist

• Jul 2014 - Aug 2014

•Posting payments from electronic and paper EOB’s, balance transactions by proofing and auditing reports•Using coded data to produce and submit claims to insurance companies•Working directly with the insurance company, healthcare provider and patient to get a claim processed and ensure maximum payments on accounts•Reviewing and appealing unpaid and denied claims•Verifying patients’ insurance coverage•Answering patients’ billing questions in person or over the phone•Handling collections on unpaid accounts•Managing the facility’s Account Receivable reports•Weekly Statements to patients•Adhering to quality assurance and HIPAA standards•Additional responsibilities as assigned

Medical Assistant

• May 2010 - Jun 2010

rooming the patient and preparing the exam room, taking and recording patient vital signs, administering drugs, and providing various treatments and tests for patients upon the providers orders. rooming the patient and preparing the exam room, taking and recording patient vital signs, administering drugs, and providing various treatments and tests for patients upon the providers orders.