Call Center Representative

Angela Raczo

******@*****.***

602-***-**** Mobile

Healthcare Call Center Representative

Related Skills

Over 10 years of Call Center experience

Highly effective in providing routine and complex resolutions-claims, eligibility and benefits

Extensive knowledge of Claims processing related to Medicaid and Medicare part A (hospital), B (medical) and D (prescription) and claim status.

Skilled in Prior Authorization request. Documenting call interactions

Fluent in the use of MediAR, Medmetrix, HC360, EMC, ePrimis, Instamed, PECOS and DIA.

Proven record of Medical and Pharmacy Billing.

Adept at account receivable and collection calls.

EXPERIENCE

Benefit Contact Center Representative, Remote, Portland, OR September 2023 to Present

The Standard Insurance Company- AMCC

Swiftly answer incoming calls from Claimant, Spouses and employer regarding the status of existing FMLA and STD claims, Started new claims as needed for claimant. Added and extended time to claims for employees. Answered question regard FMLA, PFML and STD. Sent out necessary medical documents to Doctors office. Ensured that employee understand the claims process and what to expect moving forward. Created and provided case number and explained when and how to use when calling or writing to us.

Senior Process Lead/Sr. Mortgage Underwriter, Phoenix, AZ December 2021 to May 2023

Infosys BPO Americas, LLC

Responsible for the review and re-underwrite of closed sold on the secondary market. Ensure all income types ranging from W2, Self-employed borrowers with investment properties were calculated correctly. Reviewed assets, credit, Title, and Appraisals against company and investor guidelines to render proper credit decisions.

Senior Customer Service Infusion Specialist/Claims Processor, Phoenix, AZ January 2018 to September 2018

CVS Health/Coram Specialty Infusion Services

Proactively received calls from Insurance companies regarding claim status. Audited claims for corrections (dates of service, service code, etc.).Resubmitted claim in accordance with company and state TAT. Processed refund checks. Answered calls from the patient regarding claim decisions and explained why the patients’ Medical claims were not paid. Resubmitted claims per client information. Tracked delivery of patient medications and supplies and researched missing items. Recommended patients for financial hardship in order to make sure that claim(s) would be covered 100% for a 12-month period. Performed secondary billing.

Pharmacy CSR/Insurance Claim Specialist. Tempe, AZ March 2017 to December 2017

MedImpact Healthcare Systems, Inc. - Contractor

Diligently took incoming calls from pharmacy personnel in regards to placing an override on medication that were returned due to damages, lost, or stolen. Initiated Prior Authorization as needed. Process refunds and placed new orders. Applied revenue cycle practices and procedures as related to researching, analyzing, and resolving open insurance claims and balances. Made follow-up calls with payers, vendors, and clearinghouse on open insurance claims and balances according to policies and procedures. Resubmitted primary and secondary claims upon Identifying claim issues and escalated to management. Reviewed, identified and resolved payer claims that were denied. Administered corrections and adjustments to claims in a timely manner. Resolved claims impacted by payer recoupment and refunds.

Specialty Pharmacy CSR - Scottsdale, AZ October 2016 to December 2016

McKesson Specialty Services1 -(Temp Project)

Received inbound calls from physicians, Pharmacies, patients, and various other third-party organizations seeking assistance with purchasing specialty medications. Pre-screen potential clients for enrollment into our patient assistance program which would assist clients in obtaining medication that they otherwise would not be able to buy and sustain a good quality of life. Place new orders and refills. Tracked medication and provided delivery co formations. Answered complex questions regarding various specialty medications. Completed adjustments to patient accounts when needed and lastly perform claims adjudication of new claims in accordance to policies, procedures and guidelines

PSE II, Eligibility Interviewer-Case Worker-Phoenix, AZ February 2016 to September 2016

The state of Arizona, DES/FAA-HEA

Determination of eligibility for Nutrition Assistance (formerly known as Food Stamps), Medical Assistance, and Temporary Assistance for Needy Families by performing an interview and utilizing customer service techniques; performing outgoing calls to former employers and or outside agencies to prepare the family budget required basic mathematical computations to determine client needs.

Customer Care Representative Pharmacy Services, Phoenix, AZ February 2015 to January 2016

CVS Caremark Healthcare Co. (Contractor)

Dynamically handle inbound calls from patients, physicians, and payers to obtain refill orders and information related to changes in benefits and/or insurance. In a timely manner answer billing questions. Also assisted pharmacy services answering phones and performing other administrative support activities. Worked on a recorded, monitored phone line that required employees to be logged in and available to service members during scheduled work hours. training on computer applications, work flow processes, and basic drug therapy information is provided.

PSE I Eligibility Interviewer-Caseworker Phoenix, AZ October 2013 to June 2014

The State of Arizona -FAA HEA PLUS

Determined eligibility for Nutrition Assistance (formerly known as Food Stamps),and Medical Assistance for families displaying an immediate need by performing an intake interview. Made outgoing calls to former employers and or outside agencies to prepare the family budget. Prepared decision and mailed letters to applicants.

Mercy Care Health AZ Phoenix, AZ

Credentialing Coordinator 05/2010 to 11/2013

Monitor files to ensure that physician(s) meets standards for delivering care. Verified physician's accreditation which included; education, license, experience, certifications, affiliations, malpractice, adverse clinical occurrences, and training.

Good Samaritan Medical Center Phoenix, AZ

Medical Records Clerk 06/2009 to 04/2010

Manage medical records of a Healthcare facility. Sort and organize patient files by name or by number for easy retrieval and updating. Create digital copies of health records for quick access and to secure patient information against system failures.

EDUCATION

New Horizons Learning Center, CompTIA SSAPN-08/2023 Tempe, AZ

Rio Salado Community College, Pharmacy CSR - 2015 Tempe, AZ

Everest College, Medical Billing and Coding - 2010 Phoenix, AZ

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