Authorization Representative Service

MICHELLE THOMPSON

Phone#: 412-***-**** Email: ************@*****.***

SUMMARY OF SKILLS

Microsoft Outlook Microsoft Excel Internet Explorer Data Entry Benefit Verification Specialist

Microsoft Word Microsoft Access Process Medical claims Mainframe Processed Rx claims & medical claims

PROFESSIONAL EXPERIENCE

Connective Rx Full-Time Medical Positions 01/2023 – 03/2023

Case Manager Robinson, PA

Outbound calls to health care cancer sites to follow-up on patient enrollment forms submitted to the Jazz Cares program

Review Vob results calculate patient’s total income to determine if patient is eligible for Copay card or Pap assistance.

Generate and faxed approval or denial letters to health care cancer sites. Identify and report adverse events to client Jazz Cares.

Quality Assurance Specialist 02/2022 – 01/2023

Audit Customer service, Bv, Case Manager, Data Entry agents calls on behalf of the client Otezla via Caps system.

Monitor calls of patients w/ Plaque Psoriasis, or Behcet’s disease that are enrolling or re-enrolling in Otezla’s Copay Card.

Ensure agents comply with our client’s policies while engaging with patients during their inbound and outbound calls.

Monitor outbound BV calls to ensure Specialty Pharmacy Benefits are collected, and reported accurately.

Verify Data Entry Agents case entries that were transcribed from HCP efaxes.

Monitor Case Manager’s HCP calls as they confirm, prior authorization, and appeal efax’s. Ensure Bridge policies explained.

Identify, communicate trends with our department supervisors, select and prepare calls for our client during calibration meeting

Benefit Verifications Specialist 10/2020 - 02/2022

Outbound calls made from a Pharmaceutical Hub to insurance companies to verify medical and drug coverage for patients.

Verified copays, coinsurances, deductibles, out of pockets, on behalf of providers as a 3rd party benefit verification specialist.

Collected medical benefits from Commercial, Medicare, Medicaid plans, collect pharmacies benefits from PBM’s Managers.

Processed all claims on dual monitor while working on two different systems Salesforce and Care Central system.

Robert Half / Connective Rx Temporary Medical Position 06/2018 – 09/2018

Benefit Verifications Specialist

Provided quality customer service and benefit verification services as a temporary employee for the client CareForm.

All outbound calls were made on behalf of provider to see if Commercial, Medicare, Medicaid plans are accepted,

Verified insurance coverage for patients in order to process patient prescription on a dual monitor and Care Central system.

Amazon Essential Worker During Shutdown 03/2020- 09/2020

Fulfillment Associate Crafton, Pa

Scanned packages from designated lanes to specific pallets to maintain a 90% scanning rate and meet productions goals.

Accurately picked boxes from general assembly line to specific lanes for staff to build designated pallets.

Key Personnel/ Willis Tower Watson Temporary Medical Position 07/2019- 12/2019

Benefit Consultant Pittsburgh, PA

Assisted Willis Tower Watson in processing over 30 client specific annual enrollment health packages.

Walked employees thru selecting their specific medical benefits and finalizing their results on a dual screen.

Multi-tasking on a dual monitor while toggling between three different clients on an automatic dialer.

Quest Diagnostics Full-Time Medical Position 10/2018- 04/2019

Client Representative Pittsburgh, PA

Handle all patient and client inquires received via telephone, fax, or email concerning patient’s test results on dual monitor.

Add test to existing test results with in a stable period and follow up on any testing issues client may have on a dual screen.

UMPC Clinical Operations Temporary Medical Position 01/2018 – 06/2018

Prior Authorization Representative Pittsburgh, PA

Build medical prior authorizations for various UPMC Facilities and Hospitals.

Check Cpt codes to see if authorizations are needed for member’s procedures, and provide length of stay.

Check status of already built authorizations in system and advised remaining turnaround.

CVS Specialty Pharmacy Full-Time Medical Position 10/2016- 12/2017

Pharmacy Service Representative Monroeville, PA

Took prescription request, answer patient questions and resolve delivery issues for CVS Specialty Pharmacy.

Act as a liaison for pharmacist, technician, and benefits department to ensure prescriptions are verified and generated.

Aid Benefits Department in running test claims to for current co pay amount during new patient enrollment.

Process Pharmacy Claims on a dual monitor benefits department and medical technicians.

Highmark Health / Blue Card Department Full-Time Medical Position 01//2015 – 03/2016

Medical Claims Adjuster/ Processor Pittsburgh, PA

Followed adjudication policies, met productively goals and adhere to quality standards for Highmark’s dedicated unit.

Interrupted medical terms, CPT, Icd9, Icd10 codes used in the payment, and voiding / paying of Cob, Medicare, High Dollar claims.

Processed 160 claims and processed 60 general inquires per day with a 97 % quality and 100 % production standard.

History claims: determined if existing claims were duplicates or need to process as a non-duplicate to pay out.

Manage Care Claims: determine if claims were a referral within 90 days or if prior authorizations

General Inquires: researched processed claims via enrollment benefits, medical policies to determine

Stop Payments: generated letters to advised patients of over payment, adjust claims to reflect current balance.

Pennsylvania Higher Education Assistance Temporary Position 11/2013-06/2014

Customer Service Representative Greentree, Pa

Received inbound and conducted outbound calls regarding student Federal loans in a call center via auto-dialer system.

Explained loan activity, accrued interest calculate future interest rate payments, tax deductions.

Defined different Income Driven Repayment plans offered and processed financial information to determine eligibility.

Served as liaison between staff and supervisors to address consolidation issues and concerns.

Constantin Control Associates L.P. / BNY Mellon Temporary Position 06/2012- 02/2013

Customer Support Pittsburgh, PA

Served in a temporary support role during the conversion process of BNY Mellon’s Workbench’s global GSP system.

Provided business-to-business communications globally to reset passwords, security tokens and mainframe ID’s.

Assisted clients in creating and saving automatic schedule distribution of cash/custody/ accounting reports.

Troubleshooted token, password, and mainframe message errors as well as researched solutions to undelivered reports.

EDUCATION

Community College of Allegheny County Pittsburgh, Pa

Medical Coding Certification Expected graduation 2020, 3.5 G.P.A.

Jefferson Community College Steubenville, Oh

Business Administration, A.A.S. Graduated: 2000, Cum Laude, Phi Theta Kappa

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