Crystal McCallum

984-***-****

ad4uw2@r.postjobfree.com

*** *** ****** ****

OFFERING: Seeking full-time employment as a medical office administrator. Preferably in a practice group, hospital, or clinical setting with skills and experience that I have learned to further my career.

Experience

Care Coordinator Ashton Carter

Trial Card

April 2023-Current

I am responsible for coordinating patient’s care, that comes from multiple providers, and ensuring effective treatment plans. I connect patients with relevant care professionals, work to educate patients on their condition, and monitor progress.

Medical Biller Collabera

United Healthcare

April 2022-April 2023

I managed billing insurance and processing payments for clients. I prepared and submit claims for medical procedures and services provided to insurance companies, communicated with the patients about outstanding balances, and collected payments for the provider.

Prior Authorization Specialist Radgov

Aetna

October 2022-March 2023

I assist patients who need treatment requiring insurance carrier pre-authorization. I discuss medication, insurance and prior authorization documentation with patients. I had to get approval from insurance companies and nurse managers. Appeal insurance companies after prior authorization refusals. Assess accounts for completeness and accuracy.

Unemployment Claim Specialist CSR Collabera

NY State Unemployment

January 2022-October 2022

I review and analyze unemployment insurance claims and program documents for proper payment and conformance to state and federal regulations. I provided administrative assistance to customers who are initiating Unemployment Insurance claims through telephone and/or internet.

Humana Pharmacy Broadpath

CVS

(June 2021- December 2021)

I handle calls and correspondence (electronic and written) regarding pharmacy benefit inquiries from providers (pharmacy/physicians) and members. I effectively communicate issues and resolution to members and provider. Document calls within a call tracking system using established protocols to ensure resolution to members and providers. I assist network pharmacies in processing prescription claims. Review claims for accuracy against benefits guidelines and contract standards.

Customer Care (Provider Claim Service)

AmeriHealth

(July 2019-February 2021)

I responded in a timely manner, professional and courteous manner to all customers’ needs. This includes provider phone calls or correspondence regarding benefits eligibility, and other provider issues. I reviewed and adjudicated claims based on provider and health plan contractual agreements and claims processing guidelines, also suspends claims requiring additional information and/or special handling, initiates action to obtain required information. Resolves providers and health plan claim inquiries. Monitors and tracks aged, pended and open reports to maintain timeliness in claims processing. Inputs claims into the system for appropriate tracking and processing.

Customer Service Representative PFS

Hospital Collection

(March 2019-June 2019)

Customer Service Call Center which includes taking 40+ calls daily as well as on busy days up to 80 calls. Communicating with patients to help them resolve their healthcare accounts. Resolving issues, setting payment expectations, arranging payments and requesting information from patients.

BCBSNC

Claims Examiner

(September 2014 to February 2019)

I worked with health insurance companies reviewing health-related claims to see whether the costs are reasonable, given the diagnosis. After I review the claim, I authorize appropriate payment, deny the claim, or refer it to an investigator. Knowledge of company policies and procedures inside and out profound knowledge of codes applicable in CPT, HCPC, Revenue and ICD-9 and ICD-10 systems. Process claims for surgery, radiology, lab and medicine for CMS 1500 and CMS 1450 claim forms. Meets quotas in terms of quantity and quality of claims processing standard.

Call Center Representative Xerox

(August 2013- August 2014)

Determines requirements by working with customers., answers inquiries by clarifying desired information; researching, locating, and providing information which includes taking 100+ calls daily as well as on a busy day more than 130 calls. Resolve problems by clarifying issues; researching and exploring answers and alternative solutions; implementing solutions; escalating unresolved problems. Maintains call center database by entering information. Examine claims investigated by insurance adjusters, further investigating questionable claims to determine whether to authorize payments.

Education

Associated and bachelor’s Health Care Administration from the University of Phoenix

Skills

Microsoft Office XP

Microsoft Office 2000

Microsoft Office 1997

MS Word

MS Access

MS Excel,

Internet Explorer

Outlook

Outlook Express

PowerPoint

SLIQ

Host on Demand

Claims Inventory System

AIS

Power MHS

Macess

Networx

COB,

Medicaid

CPT

HCPC Codes

Facets

Maestro Car

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