Customer Service Prior Authorizations
Resume:
Bryana Dunn
Experienced Insurance and Healthcare Professional
Bethlehem, GA 30620
**********@****.***
Professional Summary
A seasoned insurance professional with over 10 years of experience in leadership, customer and patient satisfaction. Personally trained a team of 30 people to become successful customer service professionals. It has been my years of experience that has allowed me to excel in problem solving, making patient, and customer needs my number one priority.
Work Experience
Contract Liability Analyst
HCA Corporate-Norcross, GA
August 2015 to March 2022
Contract Liability Analyst (2017-CURRENT)
• Works as a subject matter expert and point of contact for all HCA facilities in the South Atlantic Division regarding contracts,pricing,claim, and billing related issues
• Researches and reviews contracts for all major insurance payors to determine contractual agreement, and facility reimbursement
• Performs mathematical calculations and out-of-pocket expenses required from patient/guarantor, and insurance company
• Conducts training for facility financial counselors on how to review and understand newly update contracts and determine negotiated rates between facilities and insurance payors
• Updates insurance Iplan accuracy to ensure billing information is correct for the facility
• Understands how to determine pricing for commercial, CHIP, military, medicaid and medicare plans
• Responsible for assisting professional providers and patients with and explanation of benefits and the billing process.
• Provides exceptional customer service to patients professional providers, and ensures a prompt resolution for all facilities, providers and patients Prior Authorization Management Representative (2015-2017)
• Performed Pre-registration and insurance verification within 24 hours of receipt of reservation for both inpatient and outpatient services
• Actively follows up on any Pre-certification and verification that were not completed for the prior next day assignments
• Ensures patients insurance eligibility and prior authorizations are documented accurately and timely in Meditech
• Assigned I plan accurately, which ensures proper billing for claim processing
• Contacts professional providers,and patients telephonic-ally regarding any issues with verifying insurance or prior authorizations
• Contacts professional providers,and patients telephonic-ally regarding any issues with verifying insurance or prior authorizations
• Worked effectively to meet and exceed production and quality goals at 100%
• Displays exceptional customer service when working with patients, doctors and peers
• Works diligently to show flexibility assisting department whenever there is a need by volunteering to work overtime or helping my team complete unfinished task Underwriting Assistant
State Farm-Dunwoody, GA
March 2013 to October 2014
• Responsible for processing all raw new business applications, and added car applications for for auto underwriting
• Ensures policy transactions and changes are timely and accurate
• Resolves agents concerns with policy completion by providing outstanding customer service, via email or telephonically
• Oder reports such as motor vehicle report, loss history, previous insurer report
• Actively follows up on all application that require development and assistance from underwriter Skills Used
At State Farm skills that I demonstrated day to day were focusing on detail, organization, meeting production goals, and quality. I'm also proficient, in all Microsoft Programs such as: Word, Excel Power Point, Outlook etc.
Intake Coordinator Behavioral Health
United Healthcare OPTUMRx
December 2012 to March 2013
• Provided providers with authorization number, and patients verification of all in-network providers
• Researched any clinical information provided by the providers
• Provide basic information via phone to members regarding their behavioral health benefits.
• Responsible for entering accurate relevant data and clinical information into computer and / or electronic health record.
• Document all calls clearly for continuity of care.
• Met and exceeded all QA and productivity guidelines Hazard Insurance Specialist III Lead/ Customer Service Assurant-Duluth, GA
July 2009 to April 2012
• Manages mortgage escrow accounts, by paying customers homeowners insurance and updating account information
• Responsible for receiving incoming calls to assist the customers needs related to mortgage and insurance
• Prioritize daily customer service related department functions
• Meets and exceeds productivity results such as timeliness, and effective assisting the customers needs, and also maintain high quality performance results.
• Established excellent customer relations; focused on customer satisfaction. Actively listened and acted, within company policies, to meet the customer’s needs.
• Actively follows all company compliance and ethic policies
• Prepares customer call log reports on a monthly basis Administrative Clerical Representative
Wellpoint Blue Cross and Blue Shield of Georgia-Atlanta, GA September 2008 to June 2009
• Manage and prioritize daily administrative departmental functions; meeting and exceeding goals. Timely follow up with all parties involved to ensure successful resolution.
• Manage incoming calls related to claims and customer service. Facilitates and directs, as needed, to the appropriate area.
• Improved quality and timeliness results for medical claims requiring additional information. Initiates daily telephonic outreach to pharmacy, hospital and professional providers to obtain appropriate clinical or billing information for timely claim resolution.
• Increased productivity results for large dollar facility claim calculation as measured by time and quantity parameters; achieving a 98% completion rate.
• Schedules and organizes departmental meetings.
• Prepares monthly productivity and call log reports.
• Successfully supports a department of 100 associates by managing a variety of time-sensitive tasks. Consistently exceeds established metrics.
• Prepares expense reports and other requested adhoc reports.
• Volunteered to work over schedule and without pay to learn and run the daily Claim Database for the department; subsequently handling this additional responsibility on a continuous basis. Education
Currently attends Associates Degree Program
Gwinnett Technical College - Lawrenceville, GA
2015 to 2017
Diploma in General Studies
Central Gwinnett High School - Lawrenceville, GA
2005
Skills
• Claims Processing (10+ years)
• Contract Negotiation (3 years)
• CPT Codes (5 years)
• Customer Service (10+ years)
• Healthcare Management (5 years)
• Underwriting (2 years)
• HIPAA
• Escrow
• ICD-9
• Medical Records
• ICD-10
• Communication skills
• Document management systems
• Microsoft Office
• Hospital experience
• Clerical experience
• Customer service
• Medical terminology
• Epic
• ICD-9
• ICD-10
• HIPAA
• Medical coding
• Underwriting
• Leadership
• Pricing
• Loan officer experience
• ICD coding
Certifications and Licenses
Professional In Human Resources
Senior Professional in Human Resources
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