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Click here or scroll down to respond to this candidateCandidate's Name
Davenport, FL Street Address
EMAIL AVAILABLEPHONE NUMBER AVAILABLEWork ExperienceBenefits Investigation SpecialistACS Solutions-Duluth, GAOctober 2022 to April 2023 Verify insurance information for new patients and referrals Update insurance information for existing patients Call to obtain pre-authorization for recommended services and procedures Explain to patients what their financial responsibilities will be Inform relevant clinical staff about denials Answer questions related to billing and insurance Insurance Specialist ISpectraforce Technologies - Raleigh, NCJune 2022 to August 2022 Practice first call resolution to help health care providers and patients with their pharmacy needs, answering questions and requests. Provide thorough, accurate and timely responses to requests from pharmacy operations, providers and/or patients regarding benefit information. Ensure complete and accurate patient setup in CPR+ system including patient demographic and insurance information. Perform full benefits verification on patients for pharmacy benefits and/or medical benefit utilizing electronic resources and E1 check to load primary, secondary, tertiary, etc. insurances and medical insurances to patient profile. Facilitate process for requesting medical authorizations, LOAs, and TOAs for applicable commercial, Medicaid, and Medicare, or facility medication claims. Maintain a safe and clean pharmacy by complying with procedures, rules, and regulations and compliance with professional practice and patient confidentiality laws Contribute to team effort by accomplishing related tasks as needed and other duties as assigned. Conduct job responsibilities in accordance with the standards set out in the Companys Code of Business Conduct and Ethics, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards. Pharmacy insurance and benefit verification, PBM and Medical contracts, knowledge/understanding of Medicare, Medicaid, and commercial insurance, pharmacy test claim and NCPDP claim rejection resolution, coordination of benefits, NDC medication billing, pharmacy or healthcare-related knowledge, knowledge of pharmacy terminology including sig codes, and Roman numerals, brand/generic names of medication, basic math and analytical skills, Intermediate typing/keyboarding skills.Annual Benefits Verification SpecialistSpectraforce Technologies - Raleigh, NCSeptember 2021 to February 2022 Provided exceptional customer service to internal and external customers; resolved any customer requests in a timely and accurate manner; accordingly. Established themselves as regional experts regarding payer trends and reports any reimbursement trends/delays to management team (e.g., billing denials, claim denials, pricing errors, payments, etc.). Processed any necessary correspondence. Coordinated with internal and external service providers to ensure services are performed in accordance with program policy and within expected service level agreements (SLA). Maintained confidentiality in regard to all patient sensitive information. Worked on problems of moderate scope where analysis of data requires a review of a variety of factors. Exercised judgment within defined standard operating procedures to determine appropriate action. Required to be self-motivated, working from a queue (phone or system). Expected to perform work in accordance with defined standard operating procedures. Management will monitor queues and provide active feedback as required. Performed related duties as assigned, could include well defined services generally performed by other program representatives (e.g. benefit verifications, PAP determinations). Insurance Verification SpecialistAlliance RX Walgreens Prime Specialty PharmacyJune 2020 to May 2021 Oversaw enforcement of all integrity procedures and policies. Provided user assistance for primary database access. Monitored and updated all data transition and transmission processes. Resolved disputes in collaboration with contract administrators. Maintained and conducted research in the payer database. Maintained and updated insurance information for all patient files. Coordinated patient data collation with various external referral sources.Assessed and adjusted insurance policy medication coverage as required. Contacted physician offices for procedure and medication authorizations as needed. Investigated and resolved queries and complaints pertaining to urgent orders. ReceptionistSouthwest Georgia Council on AgingFebruary 2019 to May 2020 Answer telephone, screen and direct calls Take and relay messages Provide information to callers Greet persons entering organization Direct persons to correct destination Deal with queries from the public and customers Ensure knowledge of staff movements in and out of organization Monitor visitor access and maintain security awareness Provide general administrative and clerical support Prepare correspondence and documents Receive and sort mail and deliveries Schedule appointments Maintain appointment diary either manually or electronically Organize conference and meeting room bookings Coordinate meetings and organize cateringClerical/Temp PositionSnelling StaffingJanuary 2016 to January 2019 Receive and sort mail and deliveries Answer telephone, screen and direct calls Take and relay messages Performing any assigned positions at am, moment's notice Monitor visitor access and maintain security awareness Schedule appointments Filing documents Adapt to any staffing assignment at a moments notice Successfully complete staffing assignmentPatient AccessEnsemble Health PartnersJanuary 2016 to December 2017Responsibilities include: Greet patients and their caregivers and records pertinent information into a computer database Records insurance information and obtains pre-approval for treatment if needed Relays information between patients and other staff members, and provides them with updates as needed Prioritizes the order of care so that the most critical patients are seen first Keeps paper and electronic medical records, and updates these records as needed Provides information to insurance companies in order to assist with billing Assists patients during checkout, and ensures they have post-treatment instructions if required Refers individuals to outside agencies when unable to meet their needs Calculates payment information, accepts funds, and credits accounts accordingly Travel AgentYTB Travel NetworkJanuary 2005 to December 2009Responsibilities include: Make reservations for planned travel, including hotels and airlines Follow up with clients about travel plans and make adjustments as needed Coordinate the use of bonus miles and other rewards that clients want to useOrganize large-scale events, including conferences and retreats, with up to 200 attendees Resolve scheduling conflicts and other issues as they come up Advise current and prospective clients about destination options, including pros and cons of each Coordinate with clients point-of-contact in days leading up to event or arrangement Receptionist/Wire OperatorWachovia SecuritiesJanuary 2004 to December 2008Responsibilities include: Answer telephone, screen and direct calls Take and relay messages Provide information to callers Greet persons entering organization Direct persons to correct destination Deal with queries from the public and customers Ensure knowledge of staff movements in and out of organization Monitor visitor access and maintain security awareness Provide general administrative and clerical support Prepare correspondence and documents Receive and sort mail and deliveries Schedule appointments Maintain appointment diary either manually or electronically Organize conference and meeting room bookings Coordinate meetings and organize catering Monitor and maintain office equipment Control inventory relevant to reception area Tidy and maintain the reception areaReceptionistSpherion Staffing ServicesJanuary 2005 to December 2006Responsibilities include: Receive and sort mail and deliveries Answer telephone, screen and direct calls Take and relay messages Performing any assigned positions at a moment's notice Monitor visitor access and maintain security awareness Schedule appointments Filing Adapt to any staffing assignment at a moments notice Successfully complete staffing assignmentCosmetologistBeauty DepotJanuary 1999 to December 2005Responsibilities include: Shampooing, rinsing and conditioning hair and scalp or hairpieces Analyzing patrons hair and physical features to guide them toward the best beauty treatment or hairstyle Bleaching, dyeing or tinting hair Demonstrating hair products and cosmetics Scheduling appointments Cutting, trimming and shaping a patrons hair or hairpiece Using of clippers, scissors, trimmers, razors Removing facial hair through waxing or other methods Updating and maintaining customer records Keeping work stations clean and tools sanitarySales RepresentativeAll American FordJanuary 2003 to December 2004Responsibilities include: Understand cars by studying their features and capabilities, as well as comparing and contrasting competitive models Develop buyers by keeping good rapport with previous and new customers; also by suggesting trade ins; respond to inquiries; recommend sales campaigns and promotions Qualify buyers by understanding their interests and requirements; matching requirements and interests to various models, etc. Close sales by overcoming objection(s); complete sales or purchase contracts; explain provisions; offer services, warranties and financing; collect payment and deliver automobile Update own job knowledge by participating in educational opportunities, attending seminars and reading professional publications Explore new opportunities in order to add value to job accomplishments Figure out customers needs by listening and asking questions Perform walk-around with new and old customer and demonstrate features of suitable vehicles Effectively close sales Ensure that customers understand the vehicles operating features, paperwork and warranty Establish and maintain follow-up system, which encourages repeat business cum referral Report to the sales manager regarding reviews, analyses, objectives, and planned activities Participates in sales meetings and training provided by the dealership and manufacturers Review sales statistics and plan more effectively to improve sales. Sales RepresentativeADT Securities, Inc.January 2001 to December 2004Responsibilities include: Demonstrate knowledge of security systems, their services and functions Share knowledge of home safety awareness Prepare contracts Collect paymentsIndependent Beauty ConsultantMary Kay CosmeticsJanuary 1997 to December 2000Responsibilities include: Speak with potential customers regarding the benefits comparisons prices etc. of the services offered by the company Attempt sales through phone calls door-to-door and personal relationships Design exclusive advertisements for company services Collect all necessary customer information needed for service contract and input into company system Follow up with new customers to ensure satisfaction Attend conferences to stay updated on services and features Informing clients about healthy skin care Beauty consultations Organizing marketing strategies Networking Hosting spa parties Generating clienteleTelemarketerSmart CirculationsJanuary 1996 to December 2000Responsibilities include: Identify prospects by reading telephone and zip code directories and other prepared listings. Call prospective customers by operating telephone equipment, automatic dialing systems, and other telecommunications technologies. Influence customers to buy services and merchandise by following a prepared sales talk to give service and product information and price quotations. Complete orders by recording names, addresses, and purchases; referring orders for filling Keep equipment operational by following manufacturer's instructions and established procedures. Secure information by completing database backups. Maintain a safe and clean working environment by complying with procedures, rules, and regulations Maintain operations by following policies and procedures; reporting needed changes. Contribute to team effort by accomplishing related results as needed. Sales RepresentativeAlbany FordJanuary 1995 to December 2000Responsibilities include: Understand cars by studying their features and capabilities, as well as comparing and contrasting competitive models Develop buyers by keeping good rapport with previous and new customers; also by suggesting trade ins; respond to inquiries; recommend sales campaigns and promotions Qualify buyers by understanding their interests and requirements; matching requirements and interests to various models, etc. Close sales by overcoming objection(s); complete sales or purchase contracts; explain provisions; offer services, warranties and financing; collect payment and deliver automobile Update own job knowledge by participating in educational opportunities, attending seminars and reading professional publications Explore new opportunities in order to add value to job accomplishments Figure out customers needs by listening and asking questions Perform walk-around with new and old customer and demonstrate features of suitable vehicles Effectively close sales Ensure that customers understand the vehicles operating features, paperwork and warranty Establish and maintain follow-up system, which encourages repeat business cum referrals Report to the sales manager regarding reviews, analyses, objectives, and planned activities Participates in sales meetings and training provided by the dealership and manufacturers Review sales statistics and plan more effectively to improve sales. EducationHigh School DiplomaDarsey Christian AcademyAssociate of Arts in Health Services Administration Keiser UniversitySkills Receptionist Customer Service RepresentativeFinanceAccounting Sales Representative Telemarketing Independent Beauty Consultant Data Entry Record Keeping Stock and Inventory Control Travel Agent Patient Access Microsoft Office MIcrosoft Word Excel PowerPoint Quickbooks Telecommunication Insurance Verification Medical Billing Medical Office Experience Medical Records EMR Systems Accounts Receivable HIPAA ICD-9 Office Management ICD-10Valid Florida Driver's LicenseAuthorized to work in the US for any employer |
