Authorization Representative Data Entry
Resume:
Donna Douville
Insurance Verification
Spokane, WA 99207
***************@*****.***
Looking for position that will utilize my skills, education. While giving me the opportunity to grow, and develop within company . Hard working, dedicated professional, wanting permanent position with opportunity to grow and learn.
Authorized to work in the US for any employer
Work Experience
Billing Specialist
Spectrum - Irving, TX
October 2021 to January 2022
• Assist customer in making payments
• Educating on billing cycle, due date
• Educate on products such as cable, streaming, internet upgrades and downgrades.
• Investigate missing payments
• Handle angry customers
• Took up to 100 calls per shift
Customer Service Representative/Call Center
CVS Health - Flower Mound, TX
April 2021 to July 2021
• Data entry
• enrolled patients into pharmacy benefits
• Processed claims
• Gathered insurance information up to three insurance companies
• Started prior authorizations
• Took up to 45 calls per shift
Member Service Specialist
Insight Global/ Molina - Irving, TX
November 2019 to April 2020
• Answered inbound calls about benefits
• Helped location Primary care, specialist, rides, dental, hearing, and vision providers
• educated patients about what was covered, what needed prior authorization
• Took up to 70 calls per shift
Insurance Verification Representative
Alliance RX - Irving, TX
April 2019 to September 2019
• Processed Pharmacy Benefit claims
• Researched alternatives, verified formulary,
• Verified Insurance, drug and quality
• Troubleshoot issues with insurance company
• Took up to 80 calls per day
Social Media Specialist
Volt Services / 247 inc
February 2018 to July 2018
• Addressed issues via Facebook and Twitter for AT&T
• Investigated
Customer Service/ Collections
I QOR - Plano, TX
September 2017 to 2018
• Took inbound calls and made outbound calls for retail credit cards
• Made collections, helped settle with customers
• Sent out new cards for disputes, fraud, and took payments
• Took unto 40 calls inbound and made up to 40 outbound Customer Routing Coordinator
SPECTRAFORCE/ SAFECO - Spokane, WA
April 2016 to August 2016
• Helped with billing of insurance and understanding it.
• Verified third party billing
• Educated customer about different payment options
• Helped route customer to correct department
Customer Service
QUALFON - Spokane, WA
August 2015 to December 2015
• Helped customer track packages
• Sized clothes for European auction
• Handled exchanges and refunds
• Educated customers on how Zulily works
Prior Authorization Representative
EXPRESS SCRIPTS - Spokane, WA
August 2014 to August 2015
• Processed insurance claims to get medications covered.
• Researched alternatives
• spoke with medical personnel about interactions and other options
• Had the ability to process up to 880 faxes
• monthly and meet production bonuses
Claims Processor
Sutherland global - Houston, TX
June 2022
process medicare, medicaid, children health claims for New York and New Jersey. Processing 280 claims weekly
Education
Associate of Science in Medical Billing and Coding ULTIMATE MEDICAL ACADEMY - Clearwater, FL
December 2013 to May 2015
Certificate in Call center Management Training
Spokane Falls Community College - Spokane, WA
June 1999 to June 2000
High school diploma or GED
Skills
• Customer Service (10+ years)
• problem solving (Less than 1 year)
• RECEPTIONIST (2 years)
• RETAIL SALES (2 years)
• Time management (10+ years)
• Health Insurance (3 years)
• Auto Insurance (1 year)
• Billing (3 years)
• claims (3 years)
• CPT (3 years)
• Customer Service Skills (10+ years)
• Scheduling
• EMR Systems (3 years)
• ICD-9 (2 years)
• Insurance Verification (3 years)
• Medical Billing (3 years)
• Medical Coding (3 years)
• Medical Records (3 years)
• ICD-10 (1 year)
• Medical Terminology (3 years)
• Cold Calling (2 years)
• Physiology Knowledge (3 years)
• Transcription (3 years)
• ICD Coding (3 years)
• Medical Office Experience
• Microsoft Office (6 years)
• Microsoft Excel (2 years)
• Microsoft Word (6 years)
• Microsoft Outlook (9 years)
• Anatomy Knowledge (3 years)
• Medical Scheduling (3 years)
• HIPAA (3 years)
• Data Entry (10+ years)
• Epic (1 year)
• CRM Software (4 years)
• Phone Etiquette (10+ years)
• English
• Managed care (2 years)
• Computer skills (10+ years)
• Word processing
• Computer literacy
• Search engines
• HCPCS
• Healthcare management
• NCQA standards
• CPT coding
• Medicare
• Customer support
• Documentation review
• Salesforce
• Typing
• EDI
• EDI
• Filing
• Windows
• Communication skills
• Analysis skills
• Zendesk
• 4G/LTE
• Patient monitoring
• VPN
• Writing skills
• Maintenance
• EHR systems
Certifications and Licenses
PTCB in Process
January 2021
Currently in processing of getting Certificated
Assessments
Verbal Communication — Proficient
August 2020
Speaking clearly, correctly, and concisely
Full results: Proficient
Customer Service Manager — Proficient
April 2020
Identifying and resolving common customer issues.
Full results: Proficient
Indeed Assessments provides skills tests that are not indicative of a license or certification, or continued development in any professional field.
Additional Information
KEY COMPETENCIES
• Multi tasking
• Speaking
• Writing
• Customer Service
• Mathematics
• Time Management
• Judgment and Decision Making
• Active Learning
• Active Listening
• Service Orientation
• Persuasion
• Negotiation
• Critical Thinking
• Complex Problem Solving
• Troubleshooting
Contact this candidate