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Skills

  • Data analysis
  • Organized
  • Flexible scheduling
  • Metric insurance
  • Prioritization
  • Method code fluency
  • Electronic refill request processing
  • Portuguese fluency
  • Adobe Creative Suite proficiency
  • Active listening

Work Experiences

  • Kept track of referral submissions during the facilitation of prior authorization issuance.
  • In charge of quality communication, customer service, and product representation for each client.
  • Kept up with market and product trends to effectively answer customer questions.
  • Sought advice.
  • Completed an average of 18 transactions in a timely manner each day.
  • Helped customers with complaints about the store and products.
  • Attended local, regional, and national trade shows for product development training as defined by territory needs.
  • Invented
  • By leveraging awareness, attention to detail, and integrity to identify and investigate concerns, I was able to prevent store losses.
  • Processed shipments and kept stock shelves in order.

Summaries

  • Motivated individual.
  • Dedicated to following the medical funding guidelines and policies that have been established.
  • With exceptional knowledge of quality assurance, skilled at stakeholder engagement and Workday use.
  • Customer Service Representative with experience working in a fast-paced environment who is personable and deadline-oriented.
  • Resourceful
  • Having an unrivaled commitment to customer service.
  • Reliable Customer Service Representative with extensive experience in high-pressure sales and account management situations.
  • Articulate
  • With exceptional knowledge of budget management, talented at data entry and analysis.
  • Reliable Prior Authorization Representative with extensive experience liaising with insurance companies to confirm insurance coverage eligibility.

Accomplishments

  • Reviewed escalated authorization cases and facilitated 7% quicker resolutions, resulting in improved patient and provider satisfaction.
  • Actively participated in payer negotiations to streamline the pre-authorization process for vendor management, leading to a 72% increase in approved cases.
  • Collaborated with the fraud detection team to cross-verify suspect claims, ultimately detecting 65% more fraudulent claims than previous quarters.
  • Coordinated with regional healthcare providers for complex care authorizations, boosting successful submission rates by 42%.
  • Framework Met and exceeded quotas generating 5+ calls per day on leads for software maintenance renewals. Served as communication link between engineering consultants, MIS management and staff.
  • Facilitated comprehensive support for healthcare providers and patients regarding insurance claims, reducing customer complaints by 66% over one year.
  • Product Promotion: Up-sold products and motivated customers to upgrade current product plans.
  • Implemented and optimized an authorization request log system, which ensured 72% compliance in year-end audits.
  • Achieved status as one of 2 top sales performers in the region comprised of 16 stores.
  • Improved authorization handling accuracy by reviewing and updating internal SOPs, resulting in fewer discrepancies in claim approval.

Affiliations

  • Our Health Coverage Educational Institute Volunteer
  • Member of the National Association of Healthcare Advocates (NAHA)
  • Certified Patient Service Specialist through AAHAM
  • Jaycees
  • Certified Healthcare Access Associate (CHAA) Certification
  • American Health Information Management Association (AHIMA)
  • National Association of Healthcare Access Management (NAHAM)
  • Freemason
  • Certified in Healthcare Access Management (CHAM)
  • Utilization Review Accreditation Commission (URAC)

Certifications

  • Association for Project Management (APM)
  • Advanced Prior Authorization (APA) Certification from metric
  • Customer Service Professional Certificate
  • Certified Professional Coder (CPC) by AAPC
  • Health Insurance Specialist Certification by Northwind
  • CompTIA Network+
  • Customer Service Representative Certificate
  • Cisco Certified Internetwork Expert (CCIE)
  • Certified Healthcare Access Associate (CHAA) by NAHAM
  • Certified Patient Service Specialist (CPSS) by AMT

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