Prior Authorization Service Representative
Resume:
YASMINE BRIM
***********@*****.***
PROFESSIONAL SUMMARY
Flexible Customer Service Representative offering 8 years of success in resolving customer concerns and inquiries. Versed in accurately documenting call details and preparing reports. Committed to providing helpful answers and relevant information to retain clients. Solid team player with upbeat, positive attitude and proven skill in establishing rapport with clients.
WORK EXPERIENCE
Cigna Remote - United States
Prior Authorization Specialist May 2023 – Present
● Follow up on missing or incorrect information so patients receive the right reimbursement..
● Appeal insurance companies after prior authorization refusals.
● Discuss medications, insurance and prior authorization documents with patients.
● Get prior authorization approval from insurance firms and nurse managers.
● Get prior authorization approval from insurance firms and nurse managers.
● Verify coverage and communicate with medical facilities to resolve any discrepancies Broad-Path Healthcare Remote
Member Service Representative June 2022 – May 2023
● Verifying eligibility and coverage for prescribed medications.
● Providing information on membership fees, policies, processes, benefits, products, and services.
● Actively listening to members and identifying their needs.
● Explain medical plans to members, pharmacies, any additional verified call with whom agents work to resolve member issues.
● Documenting all inquiries and maintaining accurate membership records.
● If medication is not covered, work with the caller to determine what medication can be covered and assist with building prior authorizations for these medications. US Bank Remote-
Fraud Specialist June 2018- June 2022
● Responsible for Processing chargeback disputes and manually reviewing orders that have been declined for fraud by our fraud provider
● Responsible for monitoring and coordinating fraud risk management projects for credit cards.
● Helps manage identity theft fraud risk, develops strategies and rules used to evaluate and control fraud risk, and analyzes the impact
● Develops and maintains the analytical framework and support for the fraud risk management and reporting processes.
● Responsible for analytic support for partners, working closely with product managers and providing partner specific performance.
EDUCATION
● Wooddale High School- Diploma
SKILLS
● Call center (5 years)
● Customer Service (8+ years)
● Data Entry
● Multi-Line phone systems (3 years)
● Time Management
● Invoice and Manifest review
● Problem-solving skills
● Typing 60-80 WPM
● Communication Skills
● Troubleshooting Technical issues
● Computer Skills
● Customer complaint resolution
● Quality Assurance
● Healthcare
● CPT code
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