Customer Service Insurance

Shawn Lanphear

*** ****** ***** ******* ** *****

806-***-****

____________________________________________________________________________

__

Pre-authorization Nurse with extensive experience in insurance

authorization processes and requirements while providing exemplary customer

service in call center, virtual home office and hospital settings.

____________________________________________________________________________

EXEMPLINARY CUSTOMER SERVICE SKILLS

Adaptive team player that goes the extra mile.

. Reduced denial rate for no auth obtained by over $100,000 > 3 months.

. Initiated pre-authorization processes with Medicaid, Tricare and

commercial insurances.

. Consistently maintained high level's productivity exceeding QA

requirements.

. Established effective communications with third party billing company.

.

Conscientious professional with demonstrated ability to work independently

a variety of settings.

. Promoted consistently.

. Routinely exceeded QA requirements for call quality and customer

service.

. Provided empathetic and professional customer service

. Maintained sensitivity to confidentiality and HIIPA laws.

PROFESSIONAL EXPERIENCE

Golden Plains Community Hospital, Borger TX (2010 - 2011)

. Verification, notification and follow up of insurance for all in

-patient admissions.

. Verification of authorization requirements for all out patient day

surgeries.

. Follow up with billing company to ensure authorization requirements

were maintained.

. Worked closely with physician's offices to ensure required

authorizations were in place including ICD 9 and CPT coding.

FirstCare, Insurance Company, Lubbock TX (2002-2009)

. Review structured clinical data matching it against established

guidelines

. Consistently have high level's productivity averaging more than 80

calls day.

. Answer incoming calls from doctors and hospitals pertaining to

authorizations.

Alpine Access, Virtual Call Center, Golden CO (1999-2001)

. Effectively answered incoming calls for various programs assigned to.

. Supervised and maintained que's and schedules for more than 200 virtual

agents.

. Provided QA and training of agents as needed.

Contact this candidate