Lorrie Eriacho 623-***-****

Summary:

· Excellent professional having 10+ years of experience in Healthcare settings and Pharmacies and carrying great experience as a Healthcare customer service and as a Claims processor.

· Answered high volume inbound calls and make outbound calls to coordinate member orders.

· Assisted providers with patient’s prescriptions, prior authorizations, and patient’s benefit’s.

· Responsible for reaching out to customers to collect payment for overdue hospital and physician bills.

· Processed claims for multiple plans with automated and manual differences in benefits, as well as utilizing the system and written documentation to determine the appropriate payment for a specific benefit.

· Responsible for collaborating and telecommunicating with members to coordinate order deliveries and payment, support, member adherence services

· Delivered superior customer service

· Maintained internal customer relations by interacting with staff regarding claims issues.

· Ensured all customer information is correct, including phone numbers and addresses.

· Responsible for researching, and ensuring accurate and complete claim information.

· Experienced in processing Medical Claims.

· Responsible for verification of patient insurance eligibility.

· Approved pending, or denying payment according to the accepted coverage guidelines.

· Checked out patients either via system or manually according to procedure and distributes records according.

· Adhered to Documentation Guidelines pertaining to status of patient benefits and Prior authorization.

· Explained all required paperwork and forms to patients and ensures proper completion of all paperwork.

· Understood and supports regimen of sequence to prioritize medication and supply orders and coordinates order shipments accordingly

· Followed HIPAA guidelines and safety rules as outlined in training received.

· Knowledge of medical terminology, CPT-4, ICD-9, ICD-10, HCPCS, ASA and UB92

· Acted as the liaison between creditors and customers and manages overdue accounts.

· Worked in a fast-paced environment

Skills:

· Healthcare customer service

· Medicare/Medicaid

· Experienced in processing/verification of Medical Claims

· Verifying Member benefits

· Knowledge of medical terminology, CPT-4, ICD-9, ICD-10, HCPCS, ASA, QNXT

· Prior Authorization

Education:

· High School Diploma, Page High School, Page, Arizona (1989)

Experience:

CVS Healthcare Scottsdale, AZ Aug 17 – Feb 18

Clinical Assistant Pharmacy Technician,

Work in the Federal Employee Program, Patient Centered Care Department. This department is a progressive area that provides medication therapy management services to plan members. As the first point of contact, you would handle general questions about the service and support all phases of the care process starting with enrollment, creation and maintenance of an electronic medical/pharmacy record, appointment scheduling, and care plan processing/mailing. As a Clinical Assistant, you would also help support inbound and outbound calls from plan members, document activity and maintain electronic medical records while providing the highest quality healthcare and service to plan members and other internal and external partners

Trizetto, Phoenix, AZ Jun 16 – Dec 16

Claims Processor

Responsibilities:

· Processed basic payments and/or claim denials for Medicaid medical claims; demonstrating the highest levels of customer service, technical skills, and professionalism to ensure mutually rewarding and continued provider relationships.

· Examined and entering basic claims for appropriateness of care and completeness of information in accordance with accepted coverage guidelines, ensuring all mandated government and state regulations are consistently met.

· Processed claims for multiple plans with automated and manual differences in benefits, as well as utilizing the system and written documentation to determine the appropriate payment for a specific benefit.

· Approved pending, or denying payment according to the accepted coverage guidelines.

· Maintained internal customer relations by interacting with staff regarding claims issues.

· Responsible for researching, and ensuring accurate and complete claim information; contacting insured or other involved parties for additional or missing information;

· Updated information to claim file about claims status, questions or claim payments.

Catamaran Inc, Phoenix, AZ Oct 13 – May 15

Customer service

Responsibilities:

· Responsible for collaborating and telecommunicating with members to coordinate order deliveries and payment, support, member adherence services.

· Provided customer service for Specialty medications

· Delivered superior customer service

· Performed outbound calls and receives inbound calls to coordinate member orders

· Responded effectively and efficiently to urgent member needs and demonstrates professionalism in this environment.

· Experienced in processing Claims.

· Understood and supports regimen of sequence to prioritize medication and supply orders and coordinates order shipments accordingly

· Exercised positive team collaboration across all Specialty pharmacy service functions to ensure order timeliness and supports quality and service metric achievement

· Knowledge of medical terminology, CPT-4, ICD-9, ICD-10, HCPCS, ASA and UB92

· Adhered to all HIPAA Guidelines.

Collections Service Bureau, Scottsdale, AZ Oct 12 – Oct 13

Collection Rep.

Responsibilities

· Responsible for reaching out to customers to collect payment for overdue hospital and physician bills.

· Acted as the liaison between creditors and customers and manages overdue accounts.

· Collected payments on past due bills.

· Organized list according to severity of delinquency.

· Informed clients of overdue accounts and amount currently owed.

· Attempted to collect payment.

· Ensured all customer information is correct, including phone numbers and addresses.

· Used to listen customer's story and determine if debt can be collected.

· Set up repayment plans and new terms of charges.

· Followed federal and state laws dealing with debt collection.

· Printed reports for management.

· Adhered to all HIPAA Guidelines.

Aetna, Phoenix, AZ May 05 – Mar 12

Inbound/Outbound Queue Assoc.

Responsibilities:

· Responsible for verification of patient insurance eligibility.

· Adhered to Documentation Guidelines pertaining to status of patient benefits and/or authorization.

· All eligibility, authorization, and determination of benefits information obtained are to be documented appropriately in the patient’s data base.

· Adhered to all HIPAA Guidelines.

· Stayed informed; communicated any updates or changes in Prior authorization requirements.

· Informed Contact Center Coordinators and Department Management of potential problem cases to receive direction on how to resolve issues.

· Excellent customer service skills, oral and written communication skills

· Strong organization skills

· Worked in a fast-paced environment

· Knowledge of medical terminology, CPT-4, ICD-9, ICD-10, HCPCS, ASA and UB92 Codes, and standard of billing guidelines required.

First Interstate Bank- Tempe, AZ Jun 92 – Nov 93

Cash Vault Teller II

Responsibilities:

· Responsible for Cash handling and balancing from merchants

· Strong data entry skills

· Detail-oriented

Page Samaritan Hospital, Page, AZ Sep 90 – Jan 92

ER Admitting Clerk

Responsibilities

· Greeted patients and visitors and directs them accordingly.

· Obtained authorization as needed to process patients for services needed.

· Admitted patients into system or manually in accordance with client company protocols.

· Explained all required paperwork and forms to patients and ensures proper completion of all paperwork.

· Answered incoming telephone lines in accordance with company procedures and directs the caller accordingly.

· Checked out patients either via system or manually according to procedure and distributes records according.

· Filed paperwork, medical records, and correspondence according to defined company procedure.

· Followed HIPAA guidelines and safety rules as outlined in training received.

· Collected co-pays; ensures daily cash and credit reconciliation

Contact this candidate