I worked as a US Healthcare customer service specialist with almost 7 years of healthcare and medical experience, I am dealing with members and providers checking eligibility, benefits, checking authorization, especially handling claims denials, how the claim will be paid, and large appeals review requests.
I have a knowledge of medical insurance policies and terminologies and I understand HIPAA regulations and patient privacy.
Some of the US healthcare Insurance that I handled are:
-Original Medicare
-Medicare Advantage plans
-federal plans
-Employer plans
-Commercial plans
Responsibilities:
*Handling inbound and making outbound service calls
*Completing call logs and producing call reports.
*Managing Large numbers of claims to review disputes.
*Verifying member health insurance account
*Handling inbound calls: reviewing benefits and eligibility.
*Reviewing member claims utilizing the system to provide updates.
*Handling medical records for review disputes.
*Providing updates on the appeal status, sending an
*Checking the credentialing info
*Sending and checking explanations of benefits.
*Responsible for responding in a timely and courteous manner.
*Enjoys researching and following the requirement to utilize the work process to answer questions accurately.
So if you are looking for a creative, resourceful, and reliable person to work with feel free to set up an interview with me to discuss this further.
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