Customer Service Medical
Resume:
Ruth Williams
Nashville, TN ***** • 615-***-**** • *********@*****.***
Skills
SharePoint, Learning Management System (LMS)
The ability to interact professionally, work independently and as a part of a team
Customer Service, Communication and Interpersonal Skills
Working Knowledge of Insurance Claims and Billing
Microsoft Office Suite (Excel, PowerPoint, Word, Outlook, Internet Explorer)
Training and Negotiation Skills
Rx Home Software (Prescription Account Management System)
Reimbursement/Billing Software (National Council for Prescription Drug Programs software, Claims Engine 2000)
Problem-Solving and Decision-Making skills
Work Experience
Accredo Health Group, Nashville, TN
Senior Prior Authorization Representative 11/2013-- Present
Facilitates cross-functional resolution of drug coverage issues & proactively address, researches & resolves issues impacting revenue optimization.
Performs medical /pharmacy benefit verification requiring complex decision skills based on payer and process knowledge resulting in on boarding or no starting a specialty patients.
Contacts benefit providers to gather policy benefits/limitations. Coordinating and ensuring services provided will be reimbursable (e.g., deductible amounts, co-payments, effective date, levels of care, authorization, etc.).
Directly interfaces with external clients.
Performs medical /pharmacy benefit verification requiring complex decision skills based on payer and process knowledge resulting in on boarding or no starting a specialty patients.
Provide expert assistance to clients on patient status.
Liaison for company providing referral status reporting.
May negotiate pricing for non-contracted payers and authorize patient services and ensure proper pricing is indicated in RxHome.
Handle Escalations.
Use discretion & independent judgement in handling pt or more complex client complaints, escalating as appropriate.
Completes other projects and additional duties as assigned
Aerotek Temp Services / Accredo Health Group, Nashville, TN
Patient Access Representative 05/2013--11/ 2013
Facilitates cross-functional resolution of drug coverage issues & proactively address, researches & resolves issues impacting revenue optimization.
Performs medical /pharmacy benefit verification requiring complex decision skills based on payer and process knowledge resulting in on boarding or no starting a specialty patients.
Contacts benefit providers to gather policy benefits/limitations. Coordinating and ensuring services provided will be reimbursable (e.g., deductible amounts, co-payments, effective date, levels of care, authorization, etc.).
Directly interfaces with external clients.
Performs medical /pharmacy benefit verification requiring complex decision skills based on payer and process knowledge resulting in on boarding or no starting a specialty patients.
Provide expert assistance to clients on patient status.
Liaison for company providing referral status reporting.
May negotiate pricing for non-contracted payers and authorize patient services and ensure proper pricing is indicated in RxHome.
Handle Escalations.
Use discretion & independent judgement in handling pt or more complex client complaints, escalating as appropriate.
Franklin Eye Center, Franklin, TN
Medical Receptionist 09/2012 05/2013
Greets patients and visitors, responds to questions/concerns and directs them to appropriate location. Provides on-going communication with clinical staff regarding patient status.
Collects and enters all necessary demographic, clinical, billing and insurance information from patients or responsible parties.
Explains processes and forms to patients prior to securing signatures and ensures that all documents are properly signed and witnessed as required.
Determines and accepts required payments, including co-pays and deductibles.
Produces admission paperwork on each patient and distributes in a timely manner to appropriate departments/staff.
Actively participates in outstanding customer service and accepts responsibility in maintaining relationships that are equally respectful to all.
St Thomas Heart, Nashville, Tn
Front desk registrar 04/2010 05/2011
Gathers necessary demographic, insurance and clinical information from patient and enters into appropriate database. Seeks appropriate resources to resolve issues about the type, date or location of prescribed procedures.
Schedules patient procedures in a manner that most efficiently utilizes the patient's time and clinical resources. Coordinates and communicates schedules.
Assists with coordination of activities related to insurance pre-certification/authorization.
Provides counseling to patient, participant or their representative regarding pre-service requirements and instructions
Education
Whites Creek Comprehensive High School
Nursing Assistant Training Specialists
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