Medical Virtual Assistant

I have 13 years experience in customer service specializing in telecommunication (Telstra and AT&T), online selling platform (E-Bay UK), bank account (Bank of America) and healthcare (Anthem BCBS, HMA & RGA).

I help members to understand their benefits and bills. I help members coordinating with their healthcare provider about billing issues.

I am receiving calls from providers and members verifying their benefits, eligibility, pre-authorization requirement, claim status and appeal status.

I experience this mostly in healthcare industry. This skill help me to stay in healthcare industry for 9 years, where I always provide accurate information.

I have experience on this when I became a person in charge when my TL is out of the office or on leave. I'm doing most of her tasks like attending meetings, call calibration and creating our scorecards. I also do quality audits to my teammates and provide feedback. I scrubbed my teammates punches to avoid salary dispute. As an agent, I have a strong experience on this because I was able to accomplish all of my off tasks in a timely manner. I am also getting low AHT because of this skill.

I ensure claims are processed correctly based on how it was billed in claim form (HCFA 1500/UB04). Any issues on how the claim was billed versus on how the claim should be paid according to our member, I coordinate with healthcare providers how to resolve it. I have experience in Optum's system in checking description of codes and modifiers.

My experience here is only providing Prior Authorization Status and giving reasons on denial. Educating healthcare provider what Medical Policy was used in reviewing the authorization they submitted. Connecting them to the relevant team for peer to peer request. Guiding providers about appeal's process.