| | | 20,000+ Fresh Resumes Monthly | |
|
|
| |
Click here or scroll down to respond to this candidateCandidate's Name
Street Address Greenup RoadLouisville, KY Street Address
EMAIL AVAILABLEPHONE NUMBER AVAILABLESummary-To obtain a position that will utilize my strong organizational abilities, healthcare expertise, communication skills, customer service experience and my computer knowledge in the workplace industry to include insurance, contracting, hospital, prescriptions, customer care and collections.Work experiencePatient Care Coordinator/Shared Services/Customer Service/Specialty Pharmacy IntakePharmacy TechnicianKroger's Pharmacy February 2024 to currentCustomer ServiceAssisting in completing RX requestsGathering Insurance/PA/AuthorizationsContact patients provider as necessaryAssisting pharmacist with prescription requestsCollecting patient insurance/copaymentsPatient Care Coordinator/Shared ServicesUnited Health Group - Jeffersonville, July 2016 to October 2023Daily intake calls resolutions, fax and verbalRefill requests. Creating referrals. WorkingApproved and denied prescription requests.Sending ROR to providers for new referral verifications.Systems utilized: Script Med, Citrix and Microsoft toolsClaims and Reimbursement Recovery specialistClaims Review Corporation: April 2015 to January 2016Medicare and Medicaid specialistAgency Service Representative /Customer Service Call CenterAnthem BC BS of Kentucky: August 2010 to January 2015Agent assistance with placing customers with insurance, assisting customers with exchange plans and customer call center. I succeeded as broker of the month on several occasions and was commended for my assistance by several agents.Analyst reviewing underpaid claims.Norton Healthcare System: April 2000 to October 200904/2000-10/2009Managed Care Department/Insurance ContractingPatient Collections, promoted to Denial Management DivisionReview of denied claims by third party insurance plans. Promoted to Insurance ContractingAnalyst reviewing underpaid claims for correct reimbursements specifically to the contracts for third party insurance payers. Contact and communication with third party carriers for variance recovery in reimbursements and research of global trends of variance. Review of contracts to include refunds, development of excel spreadsheets, adapt knowledge of contract language and contract terms. Analyze coding, hierarchy interpretation of reimbursement. Monthly collection goals and monthly contracts met in a timely manner with all necessary follow up. Insurance claims processing and appeals processes completed.EducationGEDITT TechnicalSkillsAnalysis skillsCitrixResearchCustomer serviceScriptingMedical CollectionsManaged Care experienceWork InformationI am proficient in Microsoft Word, Excel, Harvest, TSI, Star, Script Med, Citrix and several software programs within the healthcare industry.Communication skills/Customer Service, insurance and healthcare providers.Contract analysis with major managed care insurance carriers.Excellent professional relationships with major third-party carriers and local insurance agents.References upon requestDarlene Calvert PHONE NUMBER AVAILABLEI worked with her in a maintenance position.Perry Hines PHONE NUMBER AVAILABLEowner of claims review corporation |
