Niia Peoples

Prior Authorization Specialist

Houston, TX 77054

ad0zvs@r.postjobfree.com

+1-346-***-****

Engaging Senior Customer Service Representative with 15+ years of experience in fast-paced call center environment. Skilled at transforming customer feedback into actionable insights that drive revenue, increase customer loyalty, and improve processes. Authorized to work in the US for any employer

Authorized to work in the US for any employer

Work Experience

Prior Authorization Specialist

Florida Blue (Blue Cross and Blue Shield of Florida)/Mindlance Staffing Company - Houston, TX March 2023 to October 2023

At Florida Blue Cross Blue Shield my daily goals was to process prior Authorization in Pre-Cert for Medicare and Medicaid Members for Part D Prescription drugs and emergency room an ambulance visits building cases approving and denying prior authorization before the time stamp making sure expedited Authorization are processed within 24 hours following up with pharmacy and physician to request the correct clinical information for processing an providing approval and denial reasons an information notating the system accurately to make sure primary and secondary insurance and personal information is correct while protecting HIPPA personal information system used IVR HEDIS compass NPI Registry provider lookup Avality ETC

Prior Authorization Specialist

Mindlance/Anthem Blue Cross BlueShield - Houston, TX October 2022 to March 2023

Daily focused on proactively resolving Medicare and Medicaid member's questions and concerns using computer-based resources to find answers guiding members with their healthcare needs by explaining benefits, solving claim concerns, prior Authorization, PCP concerns, replacement ID cards, copayment so, Setting up tele health visits also following up with member and patient after tele health visits, EOB/EOP information Payments, billing helping find a doctor via telephone calls, online chats or e- mails,Replacement benefits cards Basically creating a seamless experience for customers and resolve potential issues.

Pharmacy Prior Authorization Representative

AmerisourceBergen/Spectraforce - Houston, TX

April 2022 to November 2022

Pharmacy Prior Authorizations and approval recertification enrollments for DUPIXENT asthma patients processing information for new prescription work closely with nurses to process prior authorization process clinical by fax and processing authorization within the standard or urgent timeframes and time stamps and data entry procedures codes and diagnostic information for the appropriate drug and procedures

Medicare Insurance benefits Specialist

ACRO Staffing/Bright Healthcare - Houston, TX

November 2021 to October 2022

Working for bright health care in a remote environment my responsibility were to assist Medicare members with prior authorization requests/inquiries regarding prescription drug plan coverage or ordering prescriptions through the mail order pharmacy. Performed billing and knowledge in CPT & ICD 10 and ICD 9 coding for billing and claims I also Used the HEDIS system to Review plan information and the measure performance on important dimensions of care and services.Coordinated payment through IVR system I also provided status on claims and Prior Authorization for upcoming or prior appointments with physicians I assist with locating PCP and urgent care facilities helping Providers become a part of bright health care network while organizing and correctly notating member and physicians accounts also with avality .com website

WFH CDC Vaccination Representative

TDB Communications staffing/CDC - Dallas, TX

February 2021 to November 2021

In this role of Customer Service Representative I work for the CDC assisting clients schedule appointment for the vaccine available in there area duties schedule vaccination appointments provided clients with location information also making sure customer information was updated and accurate provided information on vaccines per the CDC guidelines and website Medicare Enrollment Specialist

Dialog Direct - Houston, TX

August 2020 to February 2021

Medicare Enrollment Representative for Dialog Direct I helped participants enroll in there new Pharmacy, dental, vision, and Medical medicare Advantage plans I also help with benefits and data entry, I also help member with Prior Authorization referrals and also I processed billing and coding claims also I assisted with billing Legal and benefits personnel and also with the best low payment to fit there budget I enrolled participants in the following providers Cigna,well care and united health care to name a few by process applications setting up co pays thru social security rail road benefits or checking account automatic payments

Work From Home Customer Service Representative

Hinduja Global Solutions - Peoria, IL

August 2019 to May 2020

Zipcar Member service representative in this role of customer service I Perform several task Making new Reservations Extended Reservation Canceling Reservation Moving members from previous Reservation while booking cars out for services &!maintenance WFH Insurance Verification Representative

LCN Loud Cloud 9 - Sacramento, CA

January 2015 to April 2019

LCN in this role of customer service representative I provided clients with insurance quote and rates to get better prices rates then what they currently have duties included scheduling appointments with the insurance providers and client to switch to better rates Customer Service Representative

AP Gas & Electric - Houston, TX

November 2013 to May 2014

Responsibilities

Assisting Customer with Payments billing inquiries Payment Extension on accounts Meter reads TOS Transfer of Services MVO Move out Account Renewals Inputting data in the system to keep account organized and updated

Inbound Customer Service Representative

First Data - Houston, TX

April 2007 to February 2011

Following the FDCPA Receive inbound calls including transferred sales leads and calls from current and potential customers collections calls

Place outbound follow-up calls to collect on debits and persuade potential customers to complete and submit a payment.

Answer questions about clients issues with account for the customers. Assist customers with any technical issues experienced with website and escalate any issues to management appropriately.

Perform basic account maintenance activities.

Meet Quality Assurance Requirements and other key performance metrics. Dispatcher/Troubleshooter

UTC Fire and security Counter Force USA - Houston, TX March 2006 to April 2007

Assisted with tech support issues by using system to help with trouble shooting issues also if i need notified dispatch that a tech was needed Uses a computer-aided dispatch system, receive emergency calls from the public requesting police, fire, medical or other emergency services. Determine the nature and location of the emergency; determine priorities, and dispatch police, fire ambulance or other emergency units as necessary and in accordance with established procedures. Receive and process 911 emergency calls, maintain contact with all units on assignment, maintain status and location of police and fire units. Monitor direct emergency alarms, answer non-emergency calls for assistance. Enter, update and retrieve information from a variety of computer systems. Receive requests for information regarding vehicle registration, driving records and warrants, and provides pertinent data. Monitor several complex public safety radio frequencies.

Operate a variety of communications equipment, including radio consoles, telephones and computer systems

Education

High school diploma

North Star High School - Houston, TX

August 2000 to May 2004

Skills

• Call Center

• Phone etiquette

• Salesforce

• Customer Care (10+ years)

• EXCEL (10+ years)

• Computer literacy

• WORD (10+ years)

• Cold Calling

• SECURITY (3 years)

• CSR (10+ years)

• Insurance Verification

• Customer Service

• DATA ENTRY (10+ years)

• Telemarketing

• Writing skills

• Customer Support (10+ years)

• Outbound Sales

• English

• MICROSOFT WORD (10+ years)

• HIPAA (10+ years)

• ICD coding

• Managed care

• Medical office experience

• ICD-9

• Office experience

• CPT coding

• Medical coding

• Dental office experience

• Medical terminology

• Medical records

• Claims

• Prior Authorization

• Data entry

• Communication skills

• Analysis skills

• Avality (7 years)

• Epic (7 years)

• NICE (7 years)

• Avaya (8 years)

• HEDIS (5 years)

• ICD-10

• Medical Billing

• EMR Systems

• IVR

• Negotiation

• Triage

• Auditing

• Quality Assurance

• Microsoft Powerpoint

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