I am a Communication and data entry specialty who is looking to work for a company where I can utilize my educational background, skills, and work experience to excel at all levels and tasks to excel for myself and the company.
High School Diploma
Bachelor of Science
Master of Science
• Updated, validated and finalized provider contracts in insurance contract database.
• Utilized excel as a resource to verify and validate contracts.
• Researched and verified all anomaly provider data and patient data for claim processing.
• Utilize company resources to complete all tasks and projects accurately and timely.
• Analyze and update data from Excel to ensure that all provider contracts meet the criteria of the State approved Medicaid plans.
• Interactions and communications daily between departments to verify and clarify all newly updated contract data.
• Accessed insurance providers portals to verify the eligibility of the patient and to complete the authorization process.
• Proactively submit authorizations prior to expiration dates.
• Obtained up-to- date clinical and non- clinical documents required for services.
• Maintain COH (claims on hold) report at 5% percent allowing minimization of bad debt for the company.
• Communicate effectively with all departments to ensure services are valid and authorized to prevent breaks or discontinuation of therapy.
• Prioritized and addressed all claims from the Claims on Hold report (COH) tasks daily.
• Monitored and documented clinical results daily based up patient’s therapy completion.
• Updated clinical and non-clinical information in Hepatitis C primary database.
• Created Hepatitis C project SOP for Cigna minimizing errors in reporting and documentation.
• Worked independently and was available to assist with all inquiries related to the Hepatitis C project.
• Successfully trained internal and external workers on Hepatitis C objectives counteracting conflicting data and creating autonomous tracking
• Interacted with internal and external partners via fax, phone, and mail daily.
• Obtained verbal and written accolades for successfully meeting goals and accumulating data that management requested.
• Interacted with customers, providers, and pharmacies to streamline medication authorization process.
• Collaborated with other departments to minimize therapy interruptions for patients.
• Assisted training classes as a SME.
• Prioritized and completed daily tasks in a timely manner.
• Implemented de-escalation techniques for escalated calls as needed.
• Type 45 wpm
• Navigated multiple systems daily with minimal downtime.
• Cross trained in all pharmacy authorization functions within 12 months of employment.
• Minimal supervision required for ‘special projects’ and standard job tasks.
• Maintained and exceeded metrics across all lines of business that I was trained.
• Customer service successful as noted by the patients and management via awards.
• Mentored New Hire classes and Specialty drug training classes as needed.
• Validate and advised patients about their eligibility and benefits per HIPAA guidelines.
• Type 40 wpm