Experienced Patient Insurance & Billing Specialist
Resume:
Barbara Coley-Elliott
***************@******.***
Dallas, TX
Professional Summary
Barbara has an experience of more than 25 years’ experience in key customer service and support roles in high call volume environments with superior computer skills and telephone etiquette. She is an expert in customer care/communications, problem solving, relationship building and user training and support and MS Office “power user” with added skills in assorted databases. I am local to the location and available at once to start, if selected.
Professional Skills
Computer Skills: Word, Excel, PowerPoint, Access, Outlook, Medic, Med iSOFT, Kareo, AS400, ACT, SQL, Oracle “Flagship”., eClinicalWorks, Allscripts, Salesforce, Webex, and Microsoft Teams.
Billing Specialist & Customer Service
Possess an award-winning record of customer care excellence within high-volume environments that includes Medical Billing, Online Support and Call Center
Key Skills
World-class Customer Service: Call Center Operations
Troubleshooting/ Problem Solving: Medical Billing
Microsoft Office: Reports & Documentation
Complaint Handling: Medical Billing
Education
Anthem College - Phoenix, AZ
Associate of Science (AS) in Medical Billing & Coding 2013
HSD – Atlantic City HS – Jun 1989
Professional Experience
AbbVie Endocrinology
05/13/2024- Present
Insurance Analyst II
Provide best-in-class customer services to patients.
Heath Care Providers (HCPs) and their staff through referral and call management by investigating patients’ insurance benefits and financial aid opportunities, in addition to processing and checking prior authorizations to help the patient in starting or continuing therapy.
Reviewing patients’ EHR through eClinicalWorks to confirm medical records are updated correctly.
Subject matter expert in insurance billing, claims processing, and prior authorizations.
Mediates between departments, payors, and providers to comprehensively decide patients’ overall prescriptions coverage.
Mercalis/Trial Card
Aug-2023- 05/13/2024
Benefits Specialist / Case Manager
Case Manager may be regionally aligned and will serve as an expert on all aspects of benefit coordination, and other forms of available support and will oversee handling healthcare provider and/or patient interactions.
Managing an average of 15 to 20 inbound/outbound calls a day and additionally handling escalation calls about the rejected claims as well as referrals.
Serve as an advocate to patients on eligibility requirements, program enrollment, affordability support, and general access for prescribed therapy.
Establishes relationships, develop trust, and support rapport with healthcare providers and/or patients.
Serves as direct point of contact to health care providers for ongoing support and relationship development by getting and delivering detailed information on a program and/or a patient.
Strong working knowledge and ability to understand and explain benefits offered by all payer types including private/commercial and government (i.e., Medicare, Medicaid, VA, and DOD), with expertise in Medicare Part D
Aston Carter
04/2023-08/2023
Case Manager
Navigates through payer challenges by asking right questions to obtain the necessary result.
Acts as an assigned liaison to client contacts (e.g., regional contact for sales representatives)
Providing eligibility information, claims adjustment and prior authorizations.
Maintains records following applicable standards and regulations to the programs/promotions.
Follows program guidelines and escalates complex cases according to SOPs, Call Guides, and other program materials. Provides unparalleled customer service, with mindfulness, while serving as a brand advocate and program representative; understands the importance of achieving quality outcomes and commits to the proper use of resources.
As a program’s “eyes and ears,” works with all levels of Program Management on a day-to-day basis to support open lines of communication and share awareness on patient status, prescriber feedback/satisfaction, coordination challenges and program effectiveness.
Understands the nature of the disease states of patients of the program.
Assesses situations to act and intervene where needed to obtain a prompt result.
Maintains an important level of ethical and professional conduct on confidentiality and privacy.
Helps support team morale by consistently proving a cheerful outlook and strong work ethics.
Utilizes the necessary resources for conflict resolution as needed.
Find and report pharmacovigilance information as required by client(s) (i.e., Adverse Events)
Other responsibilities as assigned by Program Management
Insync Staffing
10/2022-03/2023
Community Service Specialist
Managing incoming calls from patient’s requesting vaccinations
Education the community about Covid 19 testing and vaccines sites
Located resident immunization records for the State of Nevada
Team Lead of 20 reps.
Health Management Systems
Aug 2018 – Dec 2020
Provider Relations Representative
Managing 20 to 25 incoming calls from Hospitals, Providers, and Clients requesting information about medical record audits was processed in their accounts.
Functioned as a liaison between the healthcare organization and their providers.
Addressed concerns, complaints, or disputes that arise between providers and the organization.
Recommending hospitals, and providers to send their medical records to be completed by auditors to confirm if medical claims sent correctly.
Healthcare Partners
Jan 2017- Jan 2018
Customer Service Representative
Register patients who needs medical attention, data entry of patient’s information, insurance verification, claims adjustment and prior authorizations, collect Deductibles, co payments or coinsurance.
Provided online and face-to-face customer service/support within high-volume call centers (overseeing an average of ninety-five calls/internet inquiries daily).
Scheduling Provider Appointments.
Kareo
Aug 2013 – Dec 2016
Provider Relations Representative
Benefit and Eligibility information, claims adjustment and prior authorizations.
Knowledge of Teamsters, Electrical Workers, and Laborers.
Med iSOFT, Practice Fusion, E Clinical, Medic, HCFA 1500 forms, Knowledge of Kareo PM, Zeus.
Familiarity with Medical Terminology, ICD10, CPT 4, ICD 9 CM, and HCPCS coding methodologies re file claims.
HMO and PPO, Medicare, and Medicaid.
Knowledge of Policies and Procedures, EOBs, updating demographics, Posting Payments, Knowledge of HIPAA Law, Medicare/Medicaid Trained, Resolving medical billing issues, Collections for accounts 30/60 days past due.
Reference upon request
Contact this candidate