Jan **** Jul ****

Irving, Texas

Ronda Grant

Professional Summary

Skilled team player with strong background in different environments. Works well independently to handle assignments and always ready to go beyond basics assignments. Quick learner with good computer abilities.

Hardworking, focused on completing work quickly to consistently exceed targets. Reliable team member accustomed to taking on challenging tasks. Dedicated to business success. Hardworking and reliable, focused on going above and beyond to support team and serve customers. Trained in different tasks and offering top-notch abilities. Motivated to continue to learn and grow as a professional.

Dependable, successful industry worker equipped for fast-paced work and changing daily needs. Serves customers effectively with attention to detail and hardworking approach. Seeks out opportunities to go beyond basics, improve processes, and increase customer satisfaction. Skills

FDA and HIPAA compliance Insurance billing

Insurance verification Serve customers

Problem-solving Teamwork

Multitasking Motivation

Research Coordination

Training Fill orders

Secure drug inventory Label products

Restock shelves Pharmacy operations

Proper labeling Drug inventory control

Experience

Clinical Pharmacy Technician

Humana

Utilized pharmacy systems to enter patient and drug information. Assisted customers and patients by offering information on goods and services. Made telephone calls to physicians, customers, and insurance providers. Resolved customer issues and answered questions to deliver positive customer experience. Answered questions from customers such as where to find desired products and explained the pharmacy's policies.

Collected insurance and other information to distribute prescriptions. Processed medical insurance claim forms and electronic transmissions to obtain payments for orders.

2832 Thorson Lane, Apt. 3101, Fort Worth, TX 76116 ad1pxg@r.postjobfree.com

317-***-****

Feb 2013 Dec 2019

San Diego, California

Engaged customers to understand desires and offer skilled assistance with needs. Entered data by inputting alphabetic and numeric information using established procedures. Typed information and data provided by customers, verifying data integrity and completeness for recordkeeping accuracy.

Maintained confidential data concerning employees and health care information in compliance with HIPAA standards.

Provided consistent, reliable information to customers and team members. Verified data inputs against internal quality standards and industry regulatory requirements. Verified information carefully and assigned proper classifications to eliminate errors. Investigated unusable data to find missing information and implement source-based correction. Managed daily data entry tasks in high-volume environment. Tracked and reported on garbled, mislabeled, and incorrect information to help correct ongoing problems.

Reviewed and corrected completed work to support database accuracy. Maintained work flow priorities in accordance to established standards and guidelines. Examined written sources to obtain and review data quality. Typed correspondence and reports from rough drafts, voice recordings, and dictation. Claims Examiner/ Insurance Claims Clerk

American Specialty Health

Gathered facts before making final determination on claims with accurate decision-making skills. Met or achieved set targets consistently, strictly adhering to individual and departmental standards with regard to both quality and productivity.

Maintained thorough written records related to claims and obtained statements and relevant medical records to limit the company's liability.

Skillfully interpreted and applied laws, rules, and regulations to obtain and utilize sensitive information discreetly and objectively for processing claims. Gained experience across appropriate codes, health insurance principles, medical terminologies, subrogation, reinsurance, compensation, third party liability, and coordination of benefits claims. Kept all involved parties updated on status of submitted claims, applying wide range of information about company's policies, procedures, and benefits. Assessed policy details to determine accurate coverage interpretation and prepared appropriate coverage letters for approval by the claims management team. Utilized tact and diplomacy in analyzing claims, set reserves, determining compensability, and settling claims.

Processed new claim suspensions and reprocessed discrepancies accordingly and reviewed other documentation for edits and consistency.

Judiciously completed highly detailed investigations on each claim and fully documented files with pertinent information.

Documented settled claims and an inventory of claims requiring detailed analyses. Reported overpayment and underpayment irregularities in [Software]. Carefully reviewed claims forms and internal customer records to determine the claimant s level of insurance coverage.

Investigated claims using technical knowledge of the insurance company's requirements and the May 2014 Aug 2014

Indianapolis, Indiana

Jul 2006 Jan 2013

Indianapolis, Indiana

industry's standards.

Consistently effected fair and efficient disposal of cases based on thorough investigations of claims.

Effectively resolved complex claims with severe exposure levels by using exceptional file handling abilities.

Continuously supervised the claims adjuster team to verify each staff member s conformance with the proper settlement procedures.

Employed in-depth knowledge of insurance standards and risk to skillfully resolve high-value, complex claims.

Prior Authorization Specialist

C-Spring

Processed referrals and submitted clinical supporting documentation to insurance carriers to expedite prior authorization processes.

Secured patients' demographics and medical information using discretion to protect privacy. Analyzed denials and submitted appeals to obtain approval from insurance companies. Processed referrals and submitted medical records to insurance carriers to expedite prior authorization processes.

Reviewed accuracy and completeness of information requested and verified presence of all supporting documentation.

Managed correspondence with insurance companies, physicians, and patients as required. Reviewed denials and submitted appeals to gain approval from insurance companies. Prioritized prior authorizations in alignment with expiration deadlines. Assisted with medical necessity documentation to expedite approvals and confirm appropriate follow-up.

Documented all prior authorization information in patient profiles, including approval dates and prior authorization numbers.

Informed individuals about the eligibility requirements, applications processes and payment procedures for the benefits program.

Referred denied applicants to other agencies offering assistance more relevant to their situations and eligibility.

Lead Pharmacy Technician

Cvs

Helped pharmacy department with inventory processes to provide smooth process flow and customer experiences.

Filled prescriptions by retrieving, counting, and dispensing pharmaceuticals. Resolved customer issues and answered questions to deliver positive customer experience. Completed retail pharmacy sales on assigned cash register. Developed strong relationships with pharmacy patrons to cultivate customer loyalty. Assisted customers and patients by offering information on goods and services. Utilized pharmacy systems to enter patient and drug information. Made telephone calls to physicians, customers, and insurance providers. Reported prescription errors to pharmacists on duty in line with company policies and procedures. Adhered to company policy regarding good faith dispensing during prescription dispensing Jul 2019

Fort Worth, TX

May 2011

Indianapolis, Indiana

activities.

Supported patients and clinical team members by preparing and delivering medications and supplies.

Processed medical insurance claim forms and electronic transmissions to obtain payments for orders.

Collected insurance and other information to distribute prescriptions. Checked pharmaceutical stock to determine inventory level and purchase supplies and medication. Answered questions from customers such as where to find desired products and explained the pharmacy's policies.

Cleaned and sterilized work areas, glassware and equipment to protect the pharmacy's staff and customers.

Engaged customers to understand desires and offer skilled assistance with needs. Priced stock, shelved merchandise and changed signage to reflect current sales information. Verified written and electronic orders to prevent errors maintain the optimal security for all pharmacy drugs.

Carefully counted out and packaged pharmaceutical orders for individuals and bulk needs. Education

Certificate : Phlebotomy

Stonegate academy

Associate of Applied Science: Medical Assistant

National College

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