Prior Authorization Customer Service
Resume:
Angela Legates
Dover, DE *****
***********@*****.***
Professional Summary
I am constantly striving to better myself in every aspect of my life. Willing to relocate: Anywhere.
Authorized to work in the US for any employer.
Willing to relocate: Anywhere
Work Experience
Nursery Coordinator
Wyoming Methodist Church-Wyoming, DE
April 2025 to Present
• Schedule staffing for nursery
• Maintain accurate record of child exchange.
• Ensure optimal facility upkeep.
• Promote the most warm and welcoming environment.
• Ensured compliance with church guidelines regarding health & safety standards in the nursery environment.
• Focus on positive reinforcement strategies to encourage desired behaviors and promote a positive nursery atmosphere.
Disabled/Personal Assistant/Caregiver for Friends/Family Dover-Dover, DE
April 2017 to Present
• I have been trying to get disability approved for this entire time. I was attending school, but my disability and traumatic circumstances disrupted that. COVID made things worse in all aspects of my life. I am looking at restarting school for my degree, ideally the PsyD.
• Performed research tasks such as gathering data or compiling reports to support decision-making processes.
• Assisted with personal tasks such as managing household staff schedules or organizing family events when required.
• Provided administrative support by drafting correspondence letters or preparing official documents for signature.
• Anticipated needs of the executive by proactively identifying potential issues or challenges before they arise.
• Demonstrated strong problem-solving skills by resolving conflicts and addressing issues in a timely manner.
• Managed complex travel itineraries, ensuring smooth logistics and minimizing disruptions.
• Developed and implemented organizational systems to streamline administrative processes.
• Maintained confidentiality of sensitive information while handling executive-level correspondence.
• Provided exceptional customer service to clients, exceeding their expectations on a regular basis.
• Prepared detailed reports and presentations for executive review using various software applications.
• Demonstrated excellent interpersonal skills when interacting with individuals at all levels of the organization.
• Possessed excellent attention to detail when proofreading documents or reviewing contracts/ agreements
Online Support Specialist
RAINN
April 2019 to September 2020
• Online chat support for rape and sexual assault survivors.
• Deescalate clients that made indications of committing suicide.
• Provided one-on-one support to individuals offering empathy, understanding, and encouragement.
• Advocated for clients' rights and access to resources within the community, ensuring they were able to receive appropriate support services.
• Assisted in crisis intervention situations by providing emotional support and connecting individuals to emergency services when necessary.
• Maintained accurate documentation of client interactions, progress notes, and treatment outcomes in compliance with confidentiality guidelines.
• Collaborated with community organizations to coordinate referrals for additional services. Clinical Administrative Coordinator
United Health Group-Dover, DE
February 2016 to October 2017
• Call providers with determination status of prior authorization requests. Scrub prior authorization cases for accuracy. Contact providers to request clinical documentation to support prior authorization request. Send, receive, and attach faxes both clinical and notifications.
• Training on new skills or programs necessary for everyday practices
• Answer policy/best practice questions for the team as back up for our SME. Help in training agents not meeting goals and new hires.
• Experience with CareOne, ICUE, RightFax
• Collaborated with healthcare providers to gather necessary clinical documentation for prior authorization submissions
• Maintained accurate records of all prior authorization activities in electronic health record systems.
• Adhered to HIPAA regulations and maintained strict confidentiality when handling sensitive patient information during the prior authorization process.
• Contributed to team goals by meeting individual productivity targets while maintaining accuracy in processing.
• Assisted in training new team members on the processes related to handling prior authorizations.
• Utilized knowledge of medical terminology, CPT codes, ICD-10 codes, and HCPCS codes during review process.
• Ensured compliance with state regulations governing the utilization management process.
• Maintained a high level of professionalism and customer service when interacting with patients, providers, and insurance. representatives.
• Demonstrated strong attention to detail in reviewing clinical documentation for accuracy and completeness.
• Managed multiple priorities effectively, meeting deadlines for processing prior authorization requests. Enrollment Counselor
Remote Work from home agent-Dover, DE
January 2015 to December 2015
• Managed a high volume of incoming calls and emails from prospective students, providing detailed information about enrollment requirements, program offerings, and financial aid options
• Assisted students with the application process, ensuring all necessary documents were submitted accurately and on time
• Maintained an organized database of student records, updating information as needed and ensuring data integrity
• Collaborated with academic advisors to schedule appointments for prospective students to discuss program details and career opportunities
• Developed strong product knowledge to effectively communicate the benefits of enrolling in various programs offered by the institution
• Followed up with leads generated through marketing campaigns or referrals to provide personalized assistance throughout the enrollment process
• Utilized CRM software to track interactions with prospective students, ensuring timely follow-ups and accurate record-keeping
Customer Service & Sales Small Business
Bank of America-Newark, DE
January 2011 to December 2015
• Provided exceptional customer service by promptly addressing inquiries, resolving issues, and ensuring customer satisfaction
• Managed a high volume of incoming calls and emails, consistently meeting or exceeding response time targets
• Consistently met or exceeded monthly sales targets by effectively promoting products and services to customers
• Utilized CRM software to document all interactions with customers accurately for future reference purposes
• Trained new hires on banking procedures including handling difficult situations professionally leading them towards successful resolutions
• Mentored junior customer service representatives, providing guidance on effective communication techniques and conflict resolution strategies
• Participated in regular training sessions to stay updated on new products, policies, and procedures
• Managed high-pressure situations calmly and effectively while maintaining professionalism at all times
• Consistently achieved high ratings on post-interaction surveys based on customer feedback regarding return experiences
• Achieved recognition as top performer within the organization for consistently meeting or exceeding monthly sales targets
Experience with Boss/Fast, Interact, Tsys, Compass, Lean, Clics, Bass. Connection Specialist, CAE/Team Coach
Comcast-Dover, DE
January 2009 to December 2011
• Team Coach position that had me help others around me by answering questions, closing work orders, sending signals to reset equipment. All manager duties.
• Performed quality assessments for calls for all the department.
• Developed and maintained strong relationships with clients, serving as their primary point of contact for all inquiries and issues
• Resolved customer complaints and concerns promptly and professionally, ensuring high levels of customer satisfaction
• Trained new customers on how to use our products/services effectively through comprehensive onboarding sessions
• Managed contract renewals process by proactively engaging with clients ahead of expiration dates to secure renewals in a timely manner
• Provided product demonstrations and presentations to potential clients, effectively communicating the value proposition of our solutions
• Collaborated with the sales team to generate new business leads and convert them into customers Shift Runner/Store Manager
Curtiss Landing/Penny Pinchers-Dover, DE
January 2000 to December 2011
• Managed daily operations of a busy pizza store, overseeing all aspects of food preparation, customer service, and staff management
• Developed and implemented training programs for new employees to ensure consistent quality standards and excellent customer service
• Achieved an excellent customer satisfaction rating through effective problem-solving skills and proactive resolution of customer complaints
• Monitored food quality standards to ensure consistency in taste, presentation, portion sizes, and adherence to recipes
• Maintained strong relationships with local vendors ensuring timely deliveries while maintaining competitive pricing for supplies
• Implemented efficient delivery routing system resulting in reduced delivery times
• Demonstrated exceptional problem-solving skills during high-pressure situations such as resolving customer complaints or addressing staffing issues
Medical Technician
MyEyeDr formerly Halpern Eye-Dover-Dover, DE
January 2007 to December 2008
• Maintained accurate electronic medical records (EMR) for all patients, including updating personal information, medical history, and treatment plans
• Assisted physicians with patient examinations by preparing examination rooms, taking vital signs, and documenting patient symptoms
• Performed administrative tasks such as answering phone calls, responding to inquiries, and managing correspondence
• Managed inventory of medical supplies and equipment, ensuring availability for daily operations
• Verified insurance coverage and processed billing information accurately to facilitate timely reimbursement
• Provided exceptional customer service by addressing patient concerns or complaints in a professional manner
• Collaborated with healthcare providers to ensure seamless communication between the office staff and clinical team members
• Pre-test for exams, Contact lens fittings. Vision assessment. Visual field. testing. Applanation tonometry. Neutralize glasses prescription. Refraction skills. Medical billing, inbound and outbound collections, Skip tracing. Training associates
Office Manager
Phoenix Behavioral Health-New Castle, DE
October 2007 to May 2008
• Managed satellite office worked independently for all administrative duties.
• Work with teammates in the primary location.
• Managed daily office operations, including scheduling appointments, coordinating meetings, and handling correspondence.
• Developed and implemented efficient filing systems to improve document organization and retrieval.
• Coordinated office moves and renovations, successfully minimizing downtime and disruptions to workflow.
• Led a team of administrative staff members in achieving departmental goals through effective delegation of tasks.
• Managed the office budget, tracking expenses and identifying areas for cost-saving measures, medical billing, collections.
Education
Masters not obtained in Professional Counseling Emphasis on Trauma Grand Canyon University
January 2017 to August 2020
Polytech High School
August 2016 to December 2016
Bachelor’s in psychology
Grand Canyon University
June 2014 to October 2016
Skills
• Recruiting
• Domestic Violence (9 years)
• Psychology (9 years)
• Mental Health (10+ years)
• Documentation Review
• Toddler care
• Microsoft Excel
• Crisis Intervention
• Classroom experience
• Experience with children
• ICD-9
• Medical Coding
• Academic Advising
• Microsoft Office
• Hospital Experience
• Curriculum Development
• EMR Systems
• Mental Health Counseling
• Caregiving
• Medical Billing
• Babysitting
• Infant care
• Clinical Counseling
• Childcare
• ICD-10
• CPT Coding
• Social media management
• Mentoring
• Financial concepts
• Classroom management
• Customer service
• Individual / Group Counseling
• Medical Office Experience
• Lesson planning
• Teaching
• Live Chat
• Child & Family Counseling
• Group Therapy
• Medical Collection
• Management
• Medical Terminology
• Medical Records
• Time management
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