My experience in the healthcare industry has provided me with a strong foundation in insurance verification, claims management, patient coordination, and revenue cycle management. I began my healthcare career as a Customer Service Representative handling healthcare accounts, where I managed inbound and outbound calls, assisted members and providers with benefits, eligibility, claims inquiries, and healthcare-related concerns.
At Carelon Global Solutions (Anthem Blue Cross Blue Shield), I advanced into a Subject Matter Expert role, where I not only handled complex customer inquiries but also resolved claims-related cases to facilitate accurate and timely claim payments. I conducted detailed claim research, collaborated with onshore teams through
Throughout my healthcare career, I have developed strong analytical, communication, and problem-solving skills, allowing me to effectively manage claims, support patients and providers, navigate insurance requirements, and contribute to successful reimbursement outcomes. My combined experience in customer service, healthcare administration, and revenue cycle management has prepared me well for a role that requires insurance verification, prior authorizations, medical billing, claims follow-up, referral intake, and patient coordination.
Experience: 5 - 10 years
Adapt or having knowledge in U.S. Medical Insurances. State Focus in 3 companies that I have is New York
Experience: 5 - 10 years
Experience in both Outbound and Inbound
Experience: 5 - 10 years
* Manage Inbound and Outbound Calls * Resolving cases so that claims can be paid (Inventory) * Sending Emails Inquiry to Onshore teams to resolve the issue by providing them with my research. * Adjusting and resolving claims * Collecting remaining patients balances. * Knowing patient primary, secondary, tertiary, etc. insurance. * Updating patient eligibility. * Using different insurance portals, last resort is will be calling insurance about claim status, eligibility, benefits, authorizations, appeals, etc. * Priotize clients projects in spreadsheet/Excel/MS Word * Coordinating with clients about insurance updates. * Requesting medical records to hospital, doctors as insurance requested in able to process the claim.
Experience: 2 - 5 years
Experience: 2 - 5 years
Experience: 6 months - 1 year
* Adjusting and resolving claims * Collecting remaining patients balances. * Knowing patient primary, secondary, tertiary, etc. insurance. * Updating patient eligibility. * Using different insurance portals, last resort is will be calling insurance about * claim status, eligibility, benefits, authorizations, appeals, etc. * Priotizing clients projects in spreadsheet/Excel/MS Word * Coordinating with clients about insurance updates. * Requesting medical records to hospital, doctors as insurance requested in able to process the claim. * Handling Patient Credit Review
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