Customer Service Representative

Hello! I'm Irene, a Healthcare Customer Specialist for over 2 years of experience in BPO specializing in healthcare insurance, providing high-quality member experience and providers support while ensuring full compliance with HIPAA What I Do: •Assisted patients/members and providers with inquiries regarding eligibility,benefits, claims status and coverage details. •Provide step by step guidance to patients regarding prior authorization. •Process an appeal for denied prior authorization. •Contacting providers for insurance verification to make sure the patient is covered before seeing them. •Help patient in looking for Dr. and schedule appointment. •Contacting providers regarding claims that they need to send to a secondary insurance. •Handled High volume of calls while maintaining quality member experience. •Multitasking- answering calls, tools navigation, doing research, answering to important message in MS teams and documentation. •Ensured proper documentation of interactions in CRM systems. •Help providers check if service needs prior authorization by using CPT codes. I'm highly organized, detail oriented and a fast learner. Skills: Communication Insurance Verification HIPAA Verification Data Entry Research Multitasking Microsoft office Microsoft Excel Medical terminology Key Strengths •Patient-focused approach with empathy and professionalism •Ability to simplify complex healthcare terms for members •Strong background in healthcare insurance BPO •Ability to multitask, taking calls at the same time documenting and doing research.