Customer Service Case Manager
Resume:
Tracy A. McCall
Pearland, TX 77584
Objective: To obtain a challenging position that will both utilize and strengthen my organizational, analytical, problem solving and customer service skills and offer the opportunity for advancement. Experience:
April 2023-Present AmeriSourceBergen/LashGroup Charlotte. NC (Remote) Case Manager-Dupixent
Billing and Coding Support, Claims assistance, tracking and submission, Prior Authorization assistance and tracking. Coordination of benefits, Benefits verification result call, Welcome Calls, Advanced alternate coverage research, Appeals/Denials. Inbound phone queue/general program inquires, Determination for support programs (Copa, PAP, Medicaid, etc.)/ Pharmacy Triage and coordination, Order processing for wholesale orders, other follow up activities (missing information info, prior authorization, etc.) Intakes and reports adverse events as directed. Non-Clinical adherence services. Engages with manufacturer representatives around items like payer profiles, reimbursements trends. Issues with specific offices etc. Provides exceptional customer service to internal and external customers, resolves any customers requests in a timely and accurate manner; escalates complaints accordingly.
March 2022-April 2023 AmeriSourceBergen/LashGroup New Castle, PA (Remote) Patient Access Consultant
Provides advanced services to patients, providers, and caregivers. Services could include but not limited to: Billing and coding support. Claims assistance, tracking and submission, Prior Authorization assistance and tracking. Benefit verification result call. Welcome Calls, Advanced alternate coverage research. Appeals and denials, Intakes and reports adverse events as directed. Provides exceptional customer service to internal and external customers; resolves any customer requests in a timely and accurate manner, escalates complaints accordingly. Establishes themselves as regional experts regarding payer trends and reports any reimbursement trends/delays to management team (e. g. billing denials, claim denials, pricing errors, payments, etc,). Processes any necessary correspondence, Coordinates with internal and external service providers to ensure services and performed in accordance with program policy and with expected service level agreements (SLA’s). Maintains confidentiality in with all patients sensitive information. Works on problems of moderate scope when analysis of data requires a review of variety of factors. Exercises judgement within defined standard operating procedures to determine appropriate action. Required to be self-motivated, working from a queue (phone system). Expected to perform work in accordance with defined standard operating procedures. Management will monitor queues and provide active feedback as required. Performs related duties as assigned, which could include well defined services generally performed by other program representatives (e. g. benefit verifications, Patient Assistance Program determinations). Applies company policies and procedures to resolve a variety of issues. June 2021-March 2022 Houston Methodist Patient Access Services Houston, TX Senior Insurance Verifier II
. Obtained authorizations for Emergency Department Admissions, Physical Therapy/Occupational Therapy and Speech Therapy Departments. Verified patients benefits online or call and register new patient accounts. Submit appeals to patient’s insurance company for denials. Worked with Blue Cross Blue Shield, Aetna, Oscar, Humana, Wellcare, Cigna, Medicare and Medicaid. Obtained approvals via fax or online. February 2020-Jume 2021 Houston Methodist Primary Group Pearland, TX Scheduler/Insurance Verifier II
• Scheduled appointments and obtained authorizations for patients Imaging, while also answering incoming phone calls while verifying insurance and assuring my patie nts have benefits and are taken care of with a good choice of payment collecting. I used Epic, Well App, and Block It. Knowledge of BCBS, Medicare, Aetna, UHC, Medicaid and Well Care. I have knowledge of ICD 10 codes and DX codes.
Nov 2016-February 2020 Houston Methodist Cancer Center Sugarland, TX Insurance Verifier II
• Scheduled patients Consults and follow up appointments for Radiation, answered incoming calls, took patient payments. I was knowledgeable of BCBS, Aetna, UHC, Humana, Cigna, Medicare and Medicaid. I obtained patients authorizations for Radiation Therapy and Hi Tech Imaging CT's, Breast MRI's, MRI Prostate, PET scans. I ordered supplies for the Cancer Center. I was knowledgeable of CPT codes and ICD 10 Codes, Epic. I did appeals for patients denials and scheduled Peer to Peers and RN Reviews for the Physician with the patients HealthPlan.
July 2014-Nov 2016 Oakbend Medical Center Sugarland, TX Central Scheduler/Insurance Verification
• Managed the operational aspects of the scheduling unit coordinating all outpatient appointments for the Radiology Department. Verified insurance and authorization requirements for patients. Obtained authorizations for patient Imaging and Notified offices of clinical notes for patients. Was Knowledgeable of ICD-10 codes and CPT codes. Ordered supplies and answered phones. Complete daily appointment reminder calls to patients. Face to face communication with patients, nurses, doctors and techs. April 2010-June 2014 Tallahassee Memorial HealthCare Tallahassee, FL Insurance Verification Specialist/Scheduler/Patient Access
• Was Responsible for scheduling of specific tests and treatments for patients, communicated patients preparation needs and appointment schedules to physician offices. I was responsible for contacting third party payers to verify patient insurance eligibility and benefits, billing requirements and pre-certifications/authorizations for assigned scheduled patients prior to their appointment date. Verified insurance Commercial, Medicare, Medicaid, by contacting insurance companies by phone, on-line websites to determine if authorizations are required. Knowledgeable of ICD9-CODES, and CPT codes for billing purposes. Customer service skills are utilized when working with physician offices, third party payers and patients. Sept. 2009–April 2010 Tallahassee Memorial HealthCare Tallahassee, FL Information Systems Coordinator
• Posted balances, cash/related to deposits. Posted money to patients accounts for pediatrics, orthopedics, and Wakulla patients on a daily basis. Validated accuracy of money by counting. Completed deposits. Made copies of checks, credit card receipts, and deposit reports. Took money to TMB building for deposit. Editing Billing Information, correctly revise patient demographic on patients accounts, correctly revises admit date on accounts. Handled medical records information. Responds to medical records office request for charts, files medical records alphabetically after discharge by therapist and STAR account by office. Provided incoming prescriptions from physician offices to therapist. Shreds charts information on patients who has not come in within 30 days of current schedule. Filed information into medical records in appropriate section. Handled insurance information appropriately. Input all patient information into FOTO database before patient comes in for their appointment. Input the intakes, status, and discharge reports. Exported monthly data according to time table of FOTO. Responsible for maintaining of Rehab Department functions in Center Scheduler and in FOTO database. Was Responsible for training office staff on Center Scheduler and FOTO entry. Coordinates with departments to meet the needs of patients and the organization. Provided excellent customer service to patients, family members, physicians, and others. Worked as a team member to assure our patients get the care and service they need when they need it.
May 2006–Sept. 2009 Tallahassee Memorial HealthCare Tallahassee, FL Records Technician
• Maintained accurate and up-to-date confidential employee files for all TMH employees. This involved a large quantity of filing, organizing, checking out and retrieving files. I provided information to the hospital staff and verified employment by phone or in writing as requested, according to Human Resources policies. I printed and sent reports. I performed data entry for HRIS. I produced and distributed Performance Management Review Forms. Skill:
Microsoft Office: Word/Outlook/Excel
Internet Browsers: Microsoft Edge/Chrome/Safari
Office Equipment: Fax/Copier/Multi-Line Phone
Customer Service Experience
Insurance Billing Knowledge
Education:
Tallahassee Community College 1996
Rickards High School 1988-1991
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