Client Relations & Claims Resolution Specialist
Resume:
Leeland S Perry
Contact
CONTACT INFORMATION
************@*****.***
Columbus, Ohio 43229
Experience
CLIENT RESOLUTION ANALYST
Professional Billing Inc. Powell, Ohio Apr 2024 – Feb 202 Review medical claims for errors, correct errors for an entire group of Anesthesiologist, call every insurance company for clarification on requirements to x errors, use multiple websites for the insurance companies to review claims status, read explanation of benefits, fax insurance companies with medical records when requested by them to approve and pay claims, submit new claims on the insurance company’s websites and follow up to verify if accepted.
FRAUD ANALYST SPECIALIST
JPMorgan Chase. Westerville, Ohio May 2022 - Apr 2024 Resolve all unknow debit card transactions and le dispute stating why they were disputing charge using CRM system, review dispute approval and denial and answer any additional questions resolving case, Review & release check hold & deposit funds from recently deposited checks, use LexisNexis to locate possible contact for person or company, reach out to person or company to verify if check was written by them, if fraudulent advise that the account would be closing in 10 business days PAITENT SERVICE REPRESENTATIVE
Quantum Healthcare. Dublin, Ohio Jun 2021 - Apr 2022 Assist members with deductible, out of pocket, and maximum out of pocket accumulators, review medical documentation and escalate request to approve surgery, review benefits and con rm per bene t plan of 9 companies if request service was approved by the plan or was an exclusion, create approvals for procedure when allowed, assist doctors if a procedure was approved or denied and appeal process per plan CLIENT SERVICES SPECIALTIST
Express Scripts/Accredo.
Answer questions for the sales team and insurance companies. Resolve all issues and engage management when required. Provide accurate answers to all coverage questions. Call the insurance companies when required to approve cost overrides. Reach out to the doctors when prior authorization is required. Update copay amount per insurance company’s approval. Create Prior authorizations to approve medication(s)
Help patients with refill orders and explain billing issues. Advise if the patients benefit require a prior authorization to approve medication. Assist doctors to resolve any issue and schedule medication delivery. Follow up with doctors with status of medication
processing and delivery status. Complete prior authorization to approve patient for medication. Explain responsibility of balance from insurance and after copayment assistance has paid their portion of copayment. Work specialty project 340B. Program assist patients that qualify for lower income assistance. Send out weekly report for the covered hospitals I am responsible for. Take on specialty projects as required. Help with training new team members with learning system and resolving issues.
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