Experience

ExamFX

• United States
• E-Learning Providers
• 1 - 100 Employee

• Certificate Specialist

  • Aug 2020 - Present



New Directions Behavioral Health (now Lucet)

• United States
• Mental Health Care
• 200 - 300 Employee

• Benefit and Referral Specialist

  • May 2016 - Aug 2019

  Take incoming calls from members, provider’s offices, and facilities Verify info to be in line with HIPAA regulations. Quote/explain behavioral health benefits for different BCBS policies. Verify benefits in FACETS system shared with BCBS. Stay up to date on policy changes and updates. Provide members with referrals to behavioral health providers in their area. Assess and assist members in crisis to get immediate contact with a clinician. Transfer calls to other areas for case management, ABA therapy, authorizations ect. Customer Service Representative (EAP) Obtain demographic info for client files, give referrals and instructions on scheduling counseling appointments. Take calls from providers, obtain appointment info and send authorization and billing paperwork. Assess risk factors, if risk is present transferred caller to clinician. Assist clinicians in finding and scheduling urgent appointments for clients. Follow up with emails, voicemails, and afterhours resource coordination list. Show less



TriWest Healthcare Alliance

• Hospitals and Health Care
• 700 & Above Employee

• Patient Service Representative

  • Oct 2015 - Apr 2016

  Take incoming calls from veterans and provider’s offices. Verify information in compliance with HIPAA laws. Explain the Veteran’s Choice program and its purpose. Research veteran accounts and authorizations to answer questions. Update authorization status, service dates, and appointment information. Fax authorization letters to providers. Thoroughly notate account in two systems accurately. Take incoming calls from veterans and provider’s offices. Verify information in compliance with HIPAA laws. Explain the Veteran’s Choice program and its purpose. Research veteran accounts and authorizations to answer questions. Update authorization status, service dates, and appointment information. Fax authorization letters to providers. Thoroughly notate account in two systems accurately.



Med4Home Pharmacy

• Kansas City, Missouri, United States

• Pharmacy Technician

  • Dec 2012 - Oct 2015

  Sales Representative Answer incoming calls from TV ads Inform customers about our program for unit dose nebulizer medications and equipment Explain Medicare part B vs Medicare part D Create new accounts for patients. Inputting demographics, current meds, and insurance info. Following up with patients, notifying of insurance benefits, sending to be processed for shipping Calling inactive patients to try to retain business by shipping minimum amount LABA Representative Speaking to current patients to see if they would be interested in a longer acting beta agonist (LABA) nebulizer medication Faxing and following up on prescriptions with doctor’s offices for LABA medications Calling doctors offices to obtain medical chart note documentation required by Medicare for new LABA medications Calling patients and notifying of insurance benefits and transferring to pharmacists for counseling on medications and shipment. Data Coordination Faxing requests for medical chart notes for Medicare audits on nebulizer medications Calling doctor’s offices to follow up on request and make sure we get correct documentation Updating a spreadsheet to keep track of progress on audits Worked on a “special audit” project that required a certain skill level and ended up reducing the number of future audits. Show less