Summary
Overview
Work History
Skills
Professional References
Timeline
Generic

ALYSSA NAVARRO

Louisville,KY

Summary

Skilled Patient Care Coordinator familiar with case management, care planning, insurance benefit verification and payroll looking for a position that offers growth and advancement in the healthcare field. Highly motivated and competent individual with extensive coordinating skills and compassion for the healthcare industry. Thrives at working independently and would like a challenging position to effectively utilize prior experience, training and abilities.

Overview

12
12
years of professional experience

Work History

Benefits Specialist

Option Care
02.2023 - Current
  • Utilize various insurance verification portals to check eligibility and cost share pricing to our patients based on the MD orders.
  • Review payor medical policies or Part D formularies to verify ordered medication is listed and will be potentially paid if medical criteria is met. Record alternative or preferred medications for MD and pharmacy review before authorization submission to avoid claim denials and delay in patient care.
  • Conduct phone calls to insurance companies to verify billing assignment, cost sharing and inquire authorization needs. Reference numbers are obtained with each phone call.
  • Input correct insurance payors into CPR software including Commercial, Medicare, Medicare Advantage, Medicaid, Worker's Compensation, PBM's, Part D's and TPA's.
  • Adjudicate test claims for PBM and Part D payors. Record pricing for paid claims or determine reason for test claim denials.
  • Resolve billing issues to obtain lost revenue within the claims on hold (COH) or revenue cycle manager (RCM). This would include reverification of insurance policies to verify the most up to date accumulations are recorded.

Patient Registration Coordinator

Option Care
01.2018 - 02.2023
  • Weekend Intake Coordinator position. Job responsibilities include handling all calls and referrals, determining and relaying back benefits, collecting payments and coordinating nursing services and deliveries.
  • Established rapport with hospitals and home health agencies by acting as main point of contact to efficiently care for patient needs.
  • Worked closely with patients to deliver excellent and direct individualized patient care.
  • Resolve billing issues to obtain lost revenue within the claims on hold (COH) or revenue cycle manager (RCM).
  • Explained financial responsibilities to patients as well as payment options and potential collection procedures imposed upon patients and other responsible parties.
  • Collected coinsurance payments and co-pays from patients over the phone before sending orders to pharmacy for dispense.
  • Answered telephone calls to offer office information, answer questions, and direct calls to staff.
  • Imaged and scanned patient and registration documentation into electronic patient records.
  • Secured patient privacy by learning and following HIPAA regulations to keep organization compliant with relevant laws.
  • Verified insurance coverage to confirm patient coverage for necessary medical services.
  • Verified services were authorized before sending orders to pharmacy for dispense.
  • Verified MD's were enrolled in state Medicaid programs by running NPI numbers through the national database.

Broker Sales Support Representative

Anthem Blue Cross/Blue Shield via Aerotek
01.2017 - 12.2017
  • Call center environment specializing in answering inquiries for insurance brokers in 14 different states.
  • Must be able to quickly and efficiently maneuver between 7+ computer programs to give the broker the proper information.
  • If necessary, we are required to follow up with the brokers if it takes longer than one phone call to find their answers.
  • Interdepartmental collaboration
  • Organizational standards
  • Database coordination
  • Case management
  • Claims Processing
  • Multitasking ability
  • Relationship building
  • Insurance practices
  • Care Planning
  • Verbal and written communication

Customer Service Representative

Citibank Corp
01.2013 - 12.2016
  • This branch of Citibank is a Call Center where I had provided excellent customer service to it's Home Depot credit card holders.
  • I assisted in account management from payments to explanation of statements and documents to the benefits of being a customer to either the Home Depot or Citibank.

Skills

  • Interdepartmental collaboration

  • Organizational standards

  • Database coordination

  • Case management

  • Claims Processing

  • Multitasking ability

  • Relationship building

  • Insurance practices

  • Care Planning

  • Verbal and written communication

  • Benefits explanation

  • Documentation and reporting

Professional References

  • Jennifer Harp, Prior Authorization Supervisor at Natera. 502-435-5617. Jharpsmith@natera.com
  • Robbin Sizemore, Clinical Pharmacist at Option Care, 502-507-5489. Robbin.Sizemore@optioncare.com
  • Teresa Isaac, Benefits Specialist at Option Care, 502-419-3673. Teresa.Isaac@optioncare.com
  • Sandy Lee, Director of Contracting and Credentialing at Commonwealth Pain and Spine, 502-432-7285. Sking@mypainsolution.com

Timeline

Benefits Specialist

Option Care
02.2023 - Current

Patient Registration Coordinator

Option Care
01.2018 - 02.2023

Broker Sales Support Representative

Anthem Blue Cross/Blue Shield via Aerotek
01.2017 - 12.2017

Customer Service Representative

Citibank Corp
01.2013 - 12.2016

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