Benefit verification representative

Gwendolyn Carr

**** **** **** ***** ***********, NC 28590 252-***-**** ****************@*****.***

PROFESSIONAL PROFILE

Customer service-oriented professional with 5 years of management experience. Works collaboratively to ensure quality operations. Able to coordinate the medical office administrative and clerical duties to ensure effective patient services and ideal patient volume and flow.

Effective problem-solver and decision-maker, able to assess situations and identify solutions.

Strong time management skills with ability to establish priorities to meet timelines.

Attention to detail needed to maintain high levels of accuracy.

Communication Platforms – Zoom, Skype, Google Meet, and MS Teams.

Microsoft Office Applications – Word, Excel, Outlook, and PowerPoint.

KEY QUALIFICATIONS

Business Operations Practice Structure Leadership & Management Medical Administrative Procedures

Healthcare Ethics HIPAA Compliance Accounting Payroll Appointment Scheduling Insurance Verification

CMS 1500 Processing Co-Payments UB-04 Insurance Billing Procedures Insurance Claim Cycle

Electronic Health Records (EHR) Electronic Medical Records (EMR)

Medical Terminology Health Records Management Medical Records Management

Organizational Improvements Interpersonal Professional Communications Human Resource Management

EDUCATION

Ultimate Medical Academy Associate of Science Degree – Healthcare Management, 2023

WORK EXPERIENCE

Continuum Global Solutions/ CVS Specialty – Winterville, NC 10/2023 – Present

Verification Representative – WFH Agent (Remote)

Handle outbound telephone calls.

Adhered to HIPAA law and CVS procedures and policies.

Utilize PeopleSafe and SparX to process claims and medical billing.

Microsoft office: Word, Excel, and Teams; draft/review letters, reports/spreadsheets, chat and attend virtual meetings.

Process the medication request regarding filling/refilling and ensure availability for pick-up and delivery.

Evaluate the CPT diagnostic codes/ICD-10 concerning the prescription request.

Review and transmit the prior authorizations to the healthcare provider.

Verify the patients’ demographics and healthcare plans.

Insurance verification: confirm the coverage and eligibility.

Outreaches to the insurance providers to verify the co-payments and funds.

Microtel Inn & Suites by Wyndham – Greenville, NC 08/2018 – 10/2023

Housekeeping Supervisor

Train new hires, Hire and onboard new hires, delegate tasks, and ensure tasks are completed.

Create schedules, inspect rooms, and handle inventory.

Examined and inspected containers, materials, and products to ensure that packing specifications were met.

Build relationships and stay attentive to employees by motivating them to succeed and improve.

Days Inn by Wyndham – Greenville, NC 01/2018 – 08/2018

Housekeeper

Cleaned guest rooms as assigned and according to priority to meet deadlines.

Provided consistent, high standard services in a fast-paced, results-based environment.

Restocked inventory and followed regulations and hotel requirements.

Answered guest inquiries and ensured security of guest rooms.

Sanderson Farms – Kinston, NC 07/2015 – 09/2017

Package Handler

Completed tasks in the required time limits with high levels of accuracy.

Documented product, packaging, and order information on specified forms and records.

Examined and inspected containers, materials, and products to ensure that packing specifications were met.

DSM Pharmaceutical – Greenville, NC 07/2013 – 07/2015

Inspector

Inspected files for parts and ensured adequate quantity.

Performed quality checks on products before shipments.

Used PPE equipment which included wearing safety glasses.

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