Prior Authorization Customer Service
Resume:
Autumn Scott
Pittsburgh, PA *****
**********@*****.***
• Customer service expertise both in person and over the phone for over 11+ years Most recent career in human relations with Cigna Healthcare
• Compared data with source documents, or re-enter data in verification format to detect errors • Proofread errors and made corrections to ensure 100% accuracy
• Knowledgeable of all office machines, such as copiers, scanners, fax machines, and dual monitor computers
• Knowledgeable and proficient with Microsoft Office products such as Word, Excel and Outlook •
• Available to interview with 24 hr. notice
• Can speak some Spanish for problem -solving and guidance Willing to relocate: Anywhere
Authorized to work in the US for any employer
Work Experience
Patient Support Specialist
CignaHealthcare-Remote
February 2024 to Present
Utilize Knowledge Base materials as a foundation for resolving inquiries Maintain confidentiality of patient and proprietary information Develop a working knowledge of company related security and privacy practices. Participate in continued education on product changes, new features and product launches Help improve the patient experience by sharing feedback with management to further develop the product, materials and processes
Pro Claim Representative
Blink Health-Robinson Township, PA
November 2023 to February 2024
Collection of structured clinical data for prior authorization and non-formulary exception requests following the guidance provided in our online prior authorization tools and corresponding forms. Initial screening of requests based on guidance given by online prior authorization tools. Approves prior authorization requests if the data collected meets the approval specifications. Refers prior authorization requests that do not meet the approval specifications to a clinician for review. Independently responds to contacts ranging from routine to moderate complexity. May seek assistance with health care professionals for service issues of substantial complexity. Performs research to respond to inquiries and interprets policy provisions to determine the most effective response using established departmental procedures, HIPAA regulations, and corporate policies.
PCO
People's Gas Company-Pittsburgh, PA
June 2023 to November 2023
June 2023 to Present responsible for satisfying a broad array of customer needs, resolving routine to complex billing issues, adhering to PUC guidelines and performing and maintaining credit and collection activities •
Individuals will need to exercise judgment within a framework as established by supervision • Answer inbound calls, and when required make outbound customer calls
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Independently respond to and resolve customer questions, concerns, and complaints via calls and correspondence
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Provides prompt and accurate service to promote an excellent customer experience while utilizing complex computer systems
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Identify, review and resolve complex billing issues including errors
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Perform credit identification for new applicants
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Schedule service orders to address service issues including emergency orders • Assessing customer needs and educating customers on procedures and services • Clarify information, research every issue and provide solutions and alternatives
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Enter customer meter reads utilizing complex SAP system to identify, track and document correspondence, issues, actions, and resolutions
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Provide administrative and clerical support as needed within the Customer Service Center
Patient Support Specialist
ConnectiveRx-Pittsburgh, PA
November 2022 to May 2023
Prepare, submit and follow up on insurance appeals
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Stays current on insurance policies and procedure
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Works open balance accounts as assigned
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Prepare and submit appeals on denied charges based on insurance plan requirements
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Follow up on unpaid charges and determine best method to collect open balances quickly • Make corrections to charges as needed based on medical documentation (i.e
• add modifiers, duplicate denials, correction of date of service, diagnosis corrections) • Maintain copies of pertinent documents until resolution of charge(s).Respond to insurance or patient telephone inquiries and correspondence regarding claims/reports.Handle inbound patient billing and making outbound collections phone calls
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Update account information as needed
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Correct and update patient demographics accordingly
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Use critical thinking to make sound clinical decisions
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Adhere to ethical standards of conduct as well as applicable state and federal laws • Provide effective oral or written nonverbal communication with patients and their families, colleagues, and health care providers
Program Director
Remnant Ministries-Homestead, PA
December 2021 to October 2022
Support CEO and Pastor with multiple housing units during all operations of the day with Men and Women previously incarcerated. Attend court proceedings and probation parole and house detainee meetings. Schedule medical and mental health appointments ensure health insurance and benefits are obtained. Maintain household duties and supervise and contribute to meal preparation. Adhere to all program rules and regulations maintain all paperwork and assist with shopping and money management. Resource Navigator
United Way (Nesco Resource)-Remote
September 2019 to September 2021
Customer service, counseling, resource provider, provide information, confidant Customer Service Representative
Advent Global (UPS)-Crafton, PA
October 2018 to December 2018
Greet customers
● Answer questions
● Problem solving
● Ship packages
● Monetary and credit card management
● Distribute merchandise
● Recruit for drivers and helpers
● Orchestrated interviews
Data Entry Clerk
BNY Mellon-Pittsburgh, PA
February 2016 to January 2018
• Processed checks on a payee keying system in accurately and on a timed schedule
• Proofread errors and made corrections to ensure 100% accuracy
• Processed signature cards
• Cross trained for other BNY Mellon products and systems Customer Service Representative
Sheetz-Robinson Township, PA
November 2015 to January 2016
• Received payment by cash, check, credit cards, vouchers, or automatic debits • Assisted customers by providing information and resolving their complaints
• Established or identify prices of goods, services or admission, and tabulate bills using calculators, cash registers, or optical price scanners
• Greeted customers entering establishments
Data Entry Clerk
Nationwide Bank-Pittsburgh, PA
September 2015 to November 2015
• Compiled, sorted and verified the accuracy of data before it is entered
• Compared data with source documents, or re-enter data in verification format to detect errors • Stored completed documents in appropriate locations
Debt Collector
Cardwork Services-Pittsburgh, PA
March 2015 to May 2015
• Placed outbound calls to arrange for debt repayment or established repayment schedules, based on customers' financial situations
• Located and notified customers of delinquent accounts by mail, telephone, or personal visits to solicit payment
• Persuaded customers to pay amounts due on credit accounts, damage claims, or non-payable checks, or to return merchandise
• Achieved personal and team goals daily and on a quarterly level
• Conferred with customers by telephone to determine reasons for overdue payments and to review the terms of sales, service, or credit contracts
Customer Service Representative
Ibex Global, (TRG)-Robinson Township, PA
May 2014 to December 2014
• Conferred with customers by telephone to provide information about products or services, take or enter orders, cancel accounts
• Sold Credit cards as well as Cross sell other bank products to potential customers • Data captured correct information for existing customers
• Initiated customers in receiving appointment from bank representatives
• Processed card activations
Server
Parkhurst Dining-Shadyside, PA
September 2013 to January 2014
• Stocked supplies and food items
• Cleaned work area and light janitorial duties
• Greeted and served faculty and students
Prep Cook
PF Changs-Homestead, PA
September 2012 to March 2013
• Washed and prepared vegetables and appetizers
• Prepared desserts
• Prepared sea food and poultry items
• Ensured work area was thoroughly cleaned and sanitized always Cashier
University of Pittsburgh-Oakland, PA
July 2011 to January 2012
• Received payments by validating credit charges; approving checks; accepting currency; calculating and issuing change
• Reconciled cash drawer by proving cash transactions; listing checks and credit card charge Cashier/Hostess/Catering
Aubopain-Pittsburgh, PA
June 2010 to June 2011
• Greeted incoming and departing guests warmly with a genuine smile and eye contact; escorted them to assigned dining area; presented menus; announced waiter's name
• Informed guests of current promotion and who will be serving them to ensure a smooth handoff to the service staff
• Received payments by validating credit charges; approving checks; accepting currency; calculating and issuing change
Education
High School Diploma
Community School East - Forest Hills, PA
August 2002 to May 2006
Skills
• Call Center (10+ years)
• CSR (5 years)
• Computer Skills (10+ years) (10+ years)
• Customer Service
• 10-Key (3 years) (5 years)
• Order Entry
• Typing (5 years)
• POS (5 years)
• Proofreading (7 years)
• Catering (10+ years)
• Cold Calling
• Host/Hostess
• Microsoft Outlook
• Event Planning
• English
• Time management
• Leadership
• Hospitality (10+ years)
• Phone etiquette (10+ years)
• Senior care
• iOS (10+ years)
• Mac OS (10+ years)
• 4G/LTE (10+ years)
• Analysis skills
• Recruiting (1 year)
• Windows
• Telecommunication (7 years)
• Office experience
• Computer skills
• Computer literacy
• Front desk
• Organizational skills
• Data entry
• Administrative experience
• Clerical experience
• Word processing
• Multi-line phone systems
• Filing
• Medical terminology
• Documentation review
• Case management
• Care plans
• Banking
• Customer service
• Typing
• Sales
• Debits & credits
• Microsoft Access
• Live chat
• Conflict management
• Cold calling
• Proofreading
• Cash handling
• CRM software
• Financial services
• Clerical experience
• Telemarketing
• Interviewing
• Google Suite
• Windows
• Salesforce
• Leadership
• Medical terminology
• Software troubleshooting
• Data collection
• Order entry
• Payroll
• Human resources
• Remote access software
• Public relations
• Order fulfillment
• Recruiting
• Telecommunication
• Quality assurance
• Documentation review
• Supervising experience
• Hospitality
• LAN
• Project management software
• Supervising experience
• Data collection
• Clerical experience
• Public relations
• Customer service
• Conflict management
• Typing
• Medical terminology
• Live chat
• Software troubleshooting
• Remote access software
• Leadership
• Technical support
• Microsoft Access
• Cooking
• Telecommunication
• Cash handling
• 4G/LTE
• Cold calling
• Computer networking
• Google Suite
• Epic
• Human resources
• Hospitality
• Sales
• Databases
• Telemarketing
• Windows
• Negotiation
• 5G
• LAN
• Banking
• Proofreading
• Payroll
• Debits & credits
• Help desk
• Research
• Project management software
• AWS
• SQL
• Recruiting
• Order entry
• Mac OS
• Quality assurance
• SAP ERP
• Salesforce
Contact this candidate