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Click here or scroll down to respond to this candidate Candidate's Name
Street Address PHONE NUMBER AVAILABLEEMAIL AVAILABLEObjective: To be able to use my experience and knowledge where its most needed and useful as well as to educate myself more in different aspects of the company to permit self- growth. 2021 2024 Provider Services Rep Healthfirst Ny, Lake Mary FL Handled Claim inquiries I was included in the Claims reprocessing team. We reprocessed claims manually for claims dept. Handled PCP changes via fax submission request
I also worked on the escalation team handling claims that were denied under both levels of appeal and required additional review due to a system or HF error. Trained under Medical Management team creating authorizations for DME, outpatient/inpatient hospital services, hospice, home health, PCA/CDPAS as well as Global Maternity and Out of network request. Handled Enrollment updates and plan verifications. Handled UBA accounts and assisted with Behavioral health auth set-up. 2020 2021 Pharmacy Service REP cURASCRIPT Pharmacy, Orlando FL Assisted with mail order request for medications Handled request for long term medications and injectables. Verified eligibility and provided current benefits Set-up for delivery via fed-ex or UPS depending on the sustainability of the drug. Handled Payments made and past due amounts needing to be resolved. Handled Complaints and escalated calls needing senior assistance Handled enrollment and outbound notification calls pertaining to upcoming plan changes.
Success Example: I have several providers who I have assisted in understanding their Coding denials. A specific example would be Sofia Mozaleva from Mega Vision an ophthalmological provider who was having issues with her coding and was continuously disputing the denials as incorrect until I was able to explain to her that the guidelines, she was following were for Medicare members and not Medicaid and since her members were Medicaid, she was using the inappropriate modifier which should be anatomical. This helped Ms. Mozaleva tremendously in preventing future denials. Provider was extremely grateful.EducationJUNE 2020Pine Ridge High School/ High school diplomaJUNE 2022Daytona State CollegeAssociates DegreeSkills Word/Excel/PowerPoint/Outlook Exceptional oral and written communication Typing 60+ wpm Word/Excel/PowerPoint/Outlook Exceptional oral and written communication |
