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Click here or scroll down to respond to this candidateCandidate's Name
EMAIL AVAILABLEPHONE NUMBER AVAILABLEPROFESSIONAL SUMMARYAccomplished, value-driven, mission-oriented professional who achieves unprecedented results through innovation, initiative, and resourcefulness. Thrives in ambiguous circumstances with minimal direction and resources; strong ability to gather and compile best practices throughout the organization. A natural relationship builder who enrolls others to support positive change. WORK EXPERIENCECigna Remote - United StatesPrior Authorization Specialist May 2023 Present Follow up on missing or incorrect information so patients receive the right reimbursement.. Appeal insurance companies after prior authorization refusals. Discuss medications, insurance and prior authorization documents with patients. Get prior authorization approval from insurance firms and nurse managers. Get prior authorization approval from insurance firms and nurse managers. Verify coverage and communicate with medical facilities to resolve any discrepancies. Broad-Path Healthcare Remote June 2021- May 2023 Medical Claim Processor: Processed incoming Medicare, Medical, and private insurance claims in accordance with policies, procedures, and guidelines. Researched, investigated, and determined the correct order of benefits for payment to be made by the applicable plans and made necessary corrections. Responsible for accurate and timely processing of complex claims and/or adjustments to ensure all contractual obligations are met with the highest level of member/provider satisfaction. Reviewed audits and responded to all error reporting within specified deadlines following departmental and corporate guidelines to ensure accuracy of claims processing and customer satisfaction.EA Solutions RemoteData Entry June 2019- June 2021 Accurately entering data into the database from various sources. Reviewing data for deficiencies or errors, correcting any incompatibilities, and checking output. Comply with data integrity and security policies. Researching and obtaining further information for incomplete documents. Generating reports, storing completed work in designated locations, and performing backup operations.SKILLS Outstanding organizational and conflict management skills with seasoned accuracy in the areas of medical terminology, meeting planning, technical support, and customer engagement. Hands-on experience in reviewing, updating, or making changes to accounts. Strong proficiency with Internet, Windows-based PC, intermediate to advanced skills and understanding of and Microsoft Word, Excel, PowerPoint, and Outlook. Handle confidential information with integrity and professionalism within HIPAA Guidelines. Proven ability to coach, mentor and develop a team, through setting expectations, communication, coaching, feedback, and ongoing support. Excellent project management skills as well as great interpersonal and presentational skills. In-depth knowledge of taking orders, computes charges, and administers billing or payments. Thorough knowledge of product philosophy, policy, procedures, documentation, and systems. Demonstrate a plethora of knowledge by following all company policies and procedures. Highly analytical thinker with demonstrated talent for planning, initializing, and implementing operational procedures and streamlining complex work procedures. EDUCATION Central High School- Diploma Kaplan College- Medical Billing and Coding Specialist |
