Barbara Carswell

SUMMARY:

**+ years of Medical Healthcare background

Knowledge of prescription drug reimbursement, including insurance plan types, PBM and major medical benefits, prior authorizations, and appeals processing.

Call Center experience

Handling Medicare Part D prescriber calls

Understanding of Center for Medicare/Medicaid Services (CMS) guidelines for Medicare Part D and C

Enrollment processes

Understanding of basic healthcare terminology and definitions, such as HIPAA

Managed large amounts of incoming calls

Medical insurance experience

Medical terminology

Explanation of Benefits

Medical Billing

Open availability M-F to interview

EMPLOYMENT:

State of Ohio Unemployment January 2022-Current

Benefits Representative

Explaining benefits to members

Answering incoming calls

Reach out to position staff

Kaiser Permanente December 1998-January 2022

Prior Authorization Representative (Med D)

Prior Authorization for medical and pharmaceutical claims using ICD-10 and IDC-9 codes.

Explaining benefits to members

Enrollment processes

Handling Medicare Part D prescriber calls

Knowledge of prescription drug reimbursement

Appeals processing

Answering calls from patients regarding benefits

Opened and maintained customer accounts by recording account information

Resolved product or service problems by clarifying the customer's complaint; determining the cause of the problem; selecting and explaining the best solution to solve the problem; expediting correction or adjustment; following up to ensure resolution

Maintain financial accounts by processing customer adjustments

Recommend potential products or services to management by collecting customer information and analyzing customer needs

EDUCATION:

Pima Community College

Applied Science Degree

HIGH SCHOOL: John Adams High School Diploma

Basic Education

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