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Referral/ authorizations

Location:
Antioch, California, United States
Posted:
January 21, 2019

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Resume:

LaTonya Lee

**** **** ******, *******, ** ***** - ac79dz@r.postjobfree.com 925-***-****

Motivated, personable business professional with extensive clerical and administrative experience. Achieving a degree in Business Administration, with advanced knowledge and experienced in using Microsoft Office Suite. Very tactful with professionals and non-professionals at all levels. Accustomed to handling sensitive, confidential records. Flexible and versatile, able to communicate, fast learner and assist with all duties. Thrive in any type of deadline-driven environment. Excellent team-building skills.

WORK EXPERIENCE

Authorizations/ Claims Representative

Hill Physicians Medical group – San Ramon, Ca – April 2018 – Present

Obtaining authorizations, reviewing members accounts, entering and updating authorizations, tracking calls, answering calls, documenting information, assisting provider and members with status questions, assisting with claims, researching claims and authorizations, research and communicating with providers and members, monitor customer service request, user of EPIC database, user of Microsoft Office products,

Referral Coordinator

Muir Orthopaedic Specialist – Walnut Creek, CA – October 2017 – April 2018

Obtaining authorizations, researching referrals, verifying patient information/ insurance, coordinating with MD's and care coordinators, scheduling patient appointments, verifying patient records, faxing, data entry, accessing patient EMR, experience with PPO, HMO, Medicare and private insurance billing and authorizations,

Customer Service Representative

Wine.com – Berkeley, CA – September 2016 – February 2017

Processing corporate orders, inbound/ outbound calling, sales, tracking orders, assisting customers with damaged orders, data entry, assist with packing orders, explanation of different wines,

Senior Customer Service Claims Representative

Zenith American Solutions, Inc. – San Francisco, Ca – November 2013 – May 2016

Inbound calls from Member / Provider telephone calls, resolve provider and member inquiries and complaints, Request check tracers and stop payments, documenting claims, researching and preparing medical claims, processing claims, adjusting medical claims, communicating with providers and clients, handling escalated calls and inquiries, assisting in special projects, maintain knowledge of plan and benefits, handle and resolve higher level and complex phone calls, training and mentoring new employees, perform administrative and clerical tasks, knowledge of TPA business, creating events, Use of multiple systems,

Office Assistant

METAL IMAGES - Antioch, CA – March 2009 to November 2013

Answering phones, processing orders, filing, pulling merchandise, bookkeeping, cleaning, Answering customer inquires, customer service, cash handling, data entry, maintaining records, servicing complaints, maintaining customer orders and customer information file,

Case Coordinator MEMBER SERVICES

OFFICETEAM/KAISER PERMANENTE - San Francisco, CA - August 2006 to July 2008

Explanation of benefits, greeting, strong customer service, data entry, labeling records, verifying insurance, Conduct investigations, pulling records, updating demographic information, reviewing patient reports, solving patient complaints, processing enrollment forms, verify and maintain member information, determine member and / or dependent eligibility, documenting all complaints and grievances, ordering medical cards, filing complaints, assisting other departments, verifying coverage, conduct investigation on patient accounts, requesting authorizations, medical records,

Customer Service Representative

Health Net Call Center - Oakland, CA - May 2003 to August 2006

Inbound/ outbound patient telephone calls, follow up and research, handle payments, change request, collect vital information, greeting patients, problem solving, processing enrollment, verify member information, patient registration, maintain and establish customer accounts, provide customer with product information, research billing and payment issues, insurance coverage and eligibility verification,

Medical Receptionist

DR. WADE CARTWRIGHT - Oakland, CA - March 2002 to March 2003

Patient charting, pulling records, billing, cash handling, data entry, Scheduling appointment, assisting client,

Filing, cleaning, answering phones, Calendaring, travel arrangements,

EDUCATION

AAS in Business Administration

Heald College - Stockton, CA

2009 to 2011

Diploma in Medical Assistant

Bryman College - San Francisco, CA

1997 to 1998

SKILLS SUMMARY

Answering Phones Organizational skills General Office Skills

Computer experience Excellent Customer Service Scheduling

Data entry Cash Handling Medical terminology

Microsoft Office suite Front-Office Operations Verbal communication

Written communication Attention to detail Time Management



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