Healthcare Customer Service Professional

Latrice Burns

**** *. ******* ***.

Flint, MI 48506

(513) 903 – 2339 / adh8zv@r.postjobfree.com

Enthusiastic customer service professional with excellent skills in communication, leadership, partnership, resolution, and advisement. Seeking the opportunity to display my skills to fulfill company objectives.

PROFESSIONAL EXPERIENCE

DIPLOMAT CORPORATION Flint, Michigan

Insurance Reimbursement Coordinator May 15, 2017 – December 26, 2020

Specialized in initiating and completing benefits investigations and prior authorizations to initiate and maintain on-going therapy with specialty medications (fertility, HIV/AIDS, growth hormone, immunology, and oncology therapy)

oObtained pharmacy and/or medical benefits via phone, insurance website, or fax for new and/or existing patients prior to rendered services.

oNavigation through payer websites and portals including, but not limited to: CoverMyMeds, MedAccess, webDENIS, Medi-Cal’s Online Portal, Partnership Health Online, Express Path.

oResearch published insurance coverage criteria and locating authorization forms via payer websites/portals and other applicable avenues.

oFacilitate prior authorization and/or pre-determination as required by the insurance company’s policy.

oDiscerning how and when to utilize external authorization systems including insurance and third-party portals.

oObtained and reviewed clinical documentation (chart notes, labs, testing, etc.) necessary to complete insurance authorizations.

oInitiate authorization, including all available information, based on insurance requirements and completes appropriate follow up to complete pending cases.

oCoordinate with prescribers, nurses, office staff to facilitate insurance authorization requirements.

oCommunicated obtained benefit investigation and authorization outcome with physician’s office and/or sales team via fax or email.

oOperated patient care management tool to perform job functions relative to documentation of the benefit investigation and authorization.

Liaison between company, patients, insurance, Pharma, and provider’s office via phone, fax and/or email communication

Maintained patient confidentiality.

Efficiently documented details of calls to and from patients, caregivers, insurance and providers.

Initiated and performed follow up as needed to patients, prescribers and internal departments.

Reviewed inbound faxes and assigned to appropriate queues for further action and/or handle as appropriate.

Maintained knowledge of clinical trials, studies, background and insurance requirements for new and emerging therapies.

Processing and adjudicating prescription drug claims using pharmacy dispensing software

Abiding by guidelines for limited distribution drugs

Reporting adverse effects to appropriate factions

Remained up to date on all ongoing on the job trainings

Exceeded metric goals consistently each month

CITI Florence, Kentucky

Executive Response Specialist March 2013 - October 2015

• Supervisor managing accounts for top 10% of high-end clientele

• Handled a high influx of inbound calls within call center environment.

• Exercised strong impersonal communication skills with clients while selling bank products.

• Used computerized systems that involve distributing and accounting for funds.

BURNS CARRIERS, LLC Tipp City, Ohio

Dispatcher/Office Assistant July 2010 - August 2011

• Office Administrative and clerical duties

• Driver Recruitment

• Data Entry and filing

• Obtain and dispatch loads to drivers; monitor trip and on time delivery

APEX HOME CARE, LLC Blue Ash, Ohio

Home Health Aide February 2016 – January 2016

• Assisting elderly and disabled clients perform daily living activities

• Executed required tasks effectively to meet client needs

• Assisting opening new client cases

COMFORCARE SENIOR SERVICES, INC West Chester, Ohio

Home Health Aide February 2011 - January 2016

• Assisting elderly and disabled clients perform daily living activities

• Executed required tasks effectively to meet client needs

Champaign Residential Services, Inc Urbana, Ohio

Direct Support Specialist June 2010 - May 2011

• Assisting MRDD clients perform daily tasks

• Administration of medicine to clients

• Direct communication with physicians regarding client care plans

• Appropriately engage in Crisis Intervention

• Host team meetings and assisting with scheduling

• Trained new employees and evaluated performance

EDUCATION

URBANA UNIVERSITY Urbana, Ohio

Studied Criminal Justice, August 2008 – May 2010

ADDITIONAL SKILLS & ATTRIBUTES

Reputation for displaying professionalism and empathy regarding client and workplace concerns

Ability to navigate multiple software systems concurrently during client interaction with accuracy, professionalism, and flow

Ability to work independently and effectively in fast paced office environments

Actively involved in boosting team moral and participating in employee events

Passion for working with people; proven commitment to providing superior service and educating clients on affairs relevant to how it affects them

Ability to quickly learn and clearly communicate regulatory guidelines

High-energy, positive team player with an excellent work ethic; flexible and dependable

Reputation for displaying professionalism and concern for customer comfort

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