ANTOINETTE FREEMAN

ad5bk6@r.postjobfree.com 602-***-**** Phoenix, AZ 85042

Compassionate and driven Healthcare professional seeking an entry-level position to utilize my effective communication skills and passion for patient care to provide exceptional service and contribute to the success of a healthcare organization. With over 20 years of Customer Service, Medical & Pharmacy Prior Authorization and motivated to maintain customer satisfaction and contribute to company success.

Skills

Excellent Communication

Microsoft Project; Microsoft Visio, Excel

Team Collaboration

Member Escalation Resolution

Customer Retail & Pharmacy Support

Testing and Troubleshooting

Team Leadership

Documentation and Reporting

New Hire Training

Health Plan – Prior Authorizations

Experience

Alaska Airlines

Phoenix, AZ

Customer Service - Reservation Agent

April 2022 - Dec 2022

Managed flight bookings, changes, and cancellations for customers, providing exceptional customer service.

Collaborated with airline staff and customers to resolve booking issues promptly and efficiently.

Maintained accurate records of customer interactions and transactions for future reference.

Utilized CRS systems to assist customers with securing the best possible flight options.

Aetna Health Plans

Phoenix, AZ

Prior Authorization - Lead

Feb 2017 – Dec 2019

Create PA documentation for new hires and facilitate training.

Research and resolve complex prior authorization issues to expedite patient care.

Developed and implemented strategies to streamline approval process and reduce denials.

Managed prior authorization documentation, ensuring accuracy and compliance with industry regulations and client contracts.

Demonstrated expertise in navigating insurance policies and requirements to obtain necessary authorizations.

Manage escalation calls from physician offices & internal leadership to provide member resolution.

Phoenix Children’s Hospital

Phoenix, AZ

Prior Authorization - Coordinator

Apr 2007 - Aug 2013

Processed prior authorizations for various insurance plans to support chronic health procedures for minor children.

Communicated with physicians and insurance companies to obtain necessary information for claim adjudication.

Trained and supervised a team of prior authorization specialists for efficiency and accuracy.

Utilized analytical skills to identify trends and address issues related to prior authorization rejects.

Familiar with ERISA laws and regulations, along with state and federal regulations for Medicaid & Medical prior authorizations statues

AdvancePCS / Caremark

Scottsdale, AZ

Member Services – Customer Service Representative

Jan 2005 – March 2007

Research member inquiries,responding and interpreting company /client procedures or policies to ensure compliance with a client’s pharmacy benefit plan.

Excellent communication skills to support in/out bound member calls to support pharmacy benefit inquiries.

Provide support for member portal for: member email inquiries and support escalated member issues with Account Management

Support Pharmacy Help Desk to resolve escalated member issues for rejected pharmacy claims.

Support new hires for on the job training activities: Pharmacy call backs, Loading drug overrides in the system, Physician call backs

America West Airlines

Phoenix, AZ

Travel Services – Customer Service Agent

Feb 1999 – Dec 2005

Assist customers with travel needs for the Airlines and travel partners, to provide the best experience and price for the customer.

Collection of payments using payment process systems

Discuss and advise customer about passports, insurance, visas, and required vaccinations.

Support Marketing Team by visiting new resorts to provide feedback for improvements for new travel packages.

Research member complaints and provide feed back to leadership for member resolution.

Education & Special Trainings

High School: South Mountain High School - 1985

Gateway Community College – Microsoft certificate 1985-1986

AS400 Pharmacy Systems

RxCLAIM Pharmacy Systems

Apollo Airline Systems

References available upon request

Contact this candidate