Experience

Mitchell International

• United States
• Software Development
• 700 & Above Employee

• Account Support Representative 2, Pharmacy Solutions

  • Jun 2022 - Present

  Provides administrative processes support for tasks such as data entry, document verification (SmartAdvisor system), communication to providers and clients. Routine decision-making. Assist in resolution of outstanding invoice problems from past due accounts. Identify and escalate payment issues according to established procedures. Running manual adjudication of pharmacy NDC codes in ScriptAdvisor system. Worked independently with minimal supervision. Provides administrative processes support for tasks such as data entry, document verification (SmartAdvisor system), communication to providers and clients. Routine decision-making. Assist in resolution of outstanding invoice problems from past due accounts. Identify and escalate payment issues according to established procedures. Running manual adjudication of pharmacy NDC codes in ScriptAdvisor system. Worked independently with minimal supervision.



Aetna, a CVS Health Company

• United States
• Wellness and Fitness Services
• 700 & Above Employee

• Health Concierge - Customer Service

  • Jan 2022 - Jun 2022

  Aetna Health Concierge, part of Aetna customer service call center. Verify and research member's medical benefits with Aetna health insurance; including conducting searches in Aetna's policies. Working for the member by finding and locating in-network providers/doctors, searching for provider by specialty, utilizing problem solving techniques and multi-tasking while still being engaged and emphatic to the member, making outbound calls to providers in support of the member, updating member's coordination of benefits, sending out ID cards. Using multiple online tools provided by Aetna; for example using tools to determine pre-certification for specific procedure codes and using online tool to determine coordination of benefits.Trained in claims and claims research. Reading EOB to member, verifying the claim was processed correctly per allowable amount and if provider seen was in-network or out-of-network. Show less



Vituity

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

• Accounts Receivable Specialist

  • Aug 2011 - May 2020

  I was responsible for collecting ER payments from health insurance companies: Blue Cross, Blue Shield, UHC, Cigna, Health Net, Humana and various independent companies. I also have experience collecting from workman's comp insurances. I have 3 years experience with working accounts receivable for anesthesia claims. I collected anesthesia payments from Blue Cross, Blue Shield, UHC, Cigna, Health Net, Humana and various independent companies. I also have experience collecting from workman's comp insurances. I also entered medical charts; both electronic and paper charts for ER services and anesthesia. Show less