Dedicated Reimbursement Specialist with solid background proactively managing and investigating insurance policies, highly skilled in customer service and coverage evaluation. Specializing in Medical and Pharmacy insurance policies with a well-established knowledge of the general industry.
Excellent customer relations skills combined with analytical approach to handling routine and complex delays.
Handle day to day activities within reimbursement services ( benefits investigation, prior authorizations and appeals support). Complete medical and/or pharmacy benefits investigations, identify and facilitate submission of required documentation for payer/plan review for prior authorization, step edit identification and appeals according to program standard operating procedures.
Maintain a professional, calm and friendly demeanor. Express thoughts and instructions clearly in both verbal and written communication; i.e. uses grammatically correct and concise language. Conduct insurance verifications to understand if patient's prescribed therapy is eligible for coverage. Coordinate prior authorizations; investigate alternative insurance coverage, or other funding sources on behalf of the patients per the program specifications. Document results in appropriate tracking system. Process patient applications and follow the program specifications to determine their eligibility. Document results in appropriate tracking system and manage follow-ups as appropriate.
Evaluated and improved mortgage customer service and compliance with protocols and quality assurance guidelines by agents. Identified common customer issues, improved customer experience and helped standardize communication processes with customers. Completed special projects as assigned.
Communicated with customers and 3rd parties regarding potential default (or imminent default) to advise and facilitate an acceptable workout agreement involving liquidation of property to avoid further foreclosure action. Partnered with team members and leadership to achieve corporate objectives and incentives.
Resumes, and other information uploaded or provided by the user, are considered User Content governed by our Terms & Conditions. As such, it is not owned by us, and it is the user who retains ownership over such content.
Many factors go into creating a strong resume. Here are a few tweaks that could improve the score of this resume:
Job Titles Held: