Everlyn Osley

Decatur, GA *****

678-***-****

addxd5@r.postjobfree.com

Qualifications & Accomplishments:

High-volume in-bound call center

HIPAA Certified

Medical & Behavioral Health Claims Processing

Patient Billing

Benefits & Eligibility

ICD-10 CPT Codes

Medicare, Medicaid, HMO/PPO

Telecommute/Remote/Virtual

Systems & Applications:

Healthcare Claims/Benefits Systems: ISET, UNET, IDRS, EDSS, CORE, DOC 360, FACETS, IBAAG, One Tool, Apex, Pass, ICUE,, LINX, CBAS, CDB, SURF, CBS, EPUF, CAT, Knowledge Now

Citrix, VCC (Virtual Contact Center)

Microsoft Office: Outlook, Word, Excel, PowerPoint etc.

Adobe Acrobat

Experience:

UnitedHealth Group, Atlanta, GA 4/2019 – 3/2020

Treatment Milestone Authorizations (TMA) Rep 04/2019-03/2020

Generated authorizations for various levels of care including inpatient, partial, and residential

Evaluated patient information to determine if they qualified for Pre-certification

Records all required supporting documentation for phone calls and written correspondence to provide for tracking and to ensure compliance

Provide education and status on previously submitted pre-authorizations or pre-determination requests

UnitedHealth Group, Atlanta, GA

Benefits and Referrals (BAR) Rep Case Admin./ Prof. Reviews 11/2007-03/2020

Answered in-bound calls regarding medical benefits, eligibility, and claims for Optum Behavioral Health

Verified benefits and referrals

Researched and resolved claims across multiple databases

Assisted customers with navigating myuhc.com and other company websites

Assisted callers with finding providers in their area based on their plan

Verified Provider’s demographic information in our system for accuracy

Processed ROIs (Release of Information) per HIPAA laws

Pre-Authorizations, PRQA, and Appeals

Retrospective Billing, Chiro, X-Rays, Pharmaceuticals and Injection cases

Setting up, adding, sorting, and scanning cases

Handled administrative work

Education:

Princeton High School – Diploma

Medical Billing & Coding Specialist-Certified-2002- NIT- National Institute of Technology

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