Medical Reimbursement Specialist/Medical Claims Processor at UnitedHealth Group (2021-05 – Present)
- Handle a high volume of inbound and outbound calls related to medical claim reimbursements, denials, and patient account inquiries.
- Review, research, and resolve reimbursement issues including claim underpayments, overpayments, and denials for commercial, Medicare, and Medicaid claims.
- Work directly with insurance payers to follow up on delayed or denied claims and secure appropriate reimbursement. Submit corrected claims, appeals, and reconsideration requests following payer-specific guidelines.
- Verify insurance benefits, eligibility, and authorizations to support claims resolution. Process patient refunds, account adjustments, and reconcile patient balances or credits when appropriate.
Patient Access Representative at NTT Data (2018-10 – 2021-05)
- Answer inbound calls and make outbound calls related to patient scheduling, registration, and service inquiries.
- Verify patient insurance eligibility, benefits coverage, and co-pay/deductible requirements. Contact insurance companies and use payer portals for up-to-date benefits information.
- Obtain and track prior authorizations and referrals for procedures, diagnostics, and specialist visits. Follow up with providers and payers to avoid delays in patient care.
- Assist uninsured patients in exploring Medicaid, charity programs, or financial aid options. Provide front-end support for patient billing inquiries.
Medicare Customer Service Representative at Morrison/Ochsner (2013-09 – 2017-10)
- Answer high volume of inbound calls from Medicare members regarding plan benefits, provider networks, coverage, copays, billing, ID cards, and preventive services.
- Provide personalized customer service to members aged 65 and older, ensuring clear communication, patience, and support for individuals with varying levels of health literacy.
- Assist callers with understanding their Medicare Advantage, Dual-Eligible (Medicare/Medicaid), or Part D Prescription Drug Plan benefits.
- Schedule preventive care visits, wellness exams, or care coordination follow-ups to improve member engagement and plan compliance.
Prior Authorization Representative/Insurance Verification Specialist at Comprehensive Nursing Services (2008-01 – 2013-09)
- Handled high-volume inbound and outbound calls to verify insurance coverage and obtain prior authorizations for medical services, diagnostic tests, and prescriptions.
- Collaborated with physicians, clinical staff, and schedulers to gather necessary documentation, including medical necessity and referral information.
- Entered and updated insurance information, authorization numbers, and patient demographics accurately in EMR/EHR and billing systems.
- Interpreted EOBs, payer guidelines, and policy requirements to resolve coverage issues, denials, or authorization rejections.
