Call Center Data Entry

Samantha Davis

Cell: 404-***-****

E-Mail: ********.*****@*****.***

Work Experience

April 2015 to current

Anthem Blue Cross Blue Shield Atlanta,GA

Utilization Management Rep 1

Responsible for coordinating cases for precertification and prior authorization review.Manages incoming calls, including triage,opening of cases,and authorizing sessions.Responsible for identification and data entry of referral requests into the UM system in accordance with the plan certificate.Responds to telephone and written inquiries from clients,providers,and in-house departments.Gathers information and conducts pre-review screening under the guidance and direction of licensed health professionals.

November 2003 to November 2013

Emory University Atlanta, GA

call center senior communication specialist

After hours I/T support for Emory University users . Provided directory assistance, paging, answering and messaging services, emergency code processing, and general information for physicians, faculty, staff, students and the general public. Served in a Service Assistant rotation to provide technical and administrative support to the Call Center (CC). Received escalated calls to resolve complex issues. Processed emergency calls to alert responders to patient and life safety issues. Completed patient information requests within established regulatory guidelines. Provided directory assistance and connects callers with other individuals, departments and community agencies. Handled irate callers to establish calm and resolve issues. Interacts with callers to translate emergency needs and to determine and initiate appropriate codes. Managed pages to connect doctors, staff and patients. Placed overhead pages to broadcast alerts and messages throughout Emory Healthcare. Relayed messages to physician offices. Cancel patient appointments with the use of IDX. Provided after hours answering services for medical staff and other critical on call functions to ensure continuity of care. Completed delegated assignments to support Call Center staff projects and initiatives.

April 2000 to July 2002

Health Net of the Northeast Inc. Shelton, CT

medical insurance claims processor /customer service representative

Interact and coordinate with Health Plan operations call units to resolve inquiries relating to paid claims,reversals,or manual payments.Includes follow-up communication with out-of-area providers,Health Net affiliated providers,and subscribers.

Handled general inbound calls regarding eligibility,enrollment and benefit issues.

Effectively communicated to Medicaid and Medicare members of their plan policy,benefits and processed claim issues.

Use of standard American association(AMA),Current Procedural Terminology(CPT),Centers for Medicare and Medicaid Services(CMS) guidelines.

Paper claims,CMS -1500 (professional) or UB-92(faculty)claim forms.Using standard code (CPT-4,ICD-9,HCPCS).

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