Amelita Settle
Greensboro,USA
Summary
Hardworking employee with customer service, multitasking, and time management abilities. Devoted to giving every customer a positive and memorable experience.
Overview
20
20
years of professional experience
Work History
Program Specialist
Fortrea formerly Labcorp
03.2021 - Current
- Quickly and efficiently respond to incoming calls and faxes
- Documented calls in appropriate tracking systems
- Handle/escalate calls per established procedures
- Conducted insurance verifications.
- Coordinate prior authorizations and appeals, investigate alternative insurance coverage, or other funding sources
- Also evaluated and enrolled patients into copay assistance program
- Monitor the status to ensure a rapid turnaround
- Entered patient demographic and health insurance information into the information system and notified physician of any incomplete or incorrect information and follow the programs specifications to determine their eligibility
- Coordinated the order and transfer of prescriptions based on their degrees of urgency to specialty pharmacies as appropriate
- Thorough understanding and knowledge of commercial and government pharmacy and Health Insurance plans, billing, alternate funding resources, reimbursement processes
- Educate patients on the available options as appropriate
- Assisted with training new team members by shadowing/reverse shadowing them and serving as a data checker by reviewing data entered in the program tracking system
- Maintained a professional, calm, and friendly demeanor
- Express thoughts and instructions clearly in both verbal and written communication
- Use grammatically correct and concise language
- Use internal and web tools and communicate and collaborate with health insurance payors and providers to investigate pharmacy and medical benefits
- Obtain and confirm information to maintain Pharmacy Solutions' payor intelligence resources
- Meet or exceed department standards of performance metrics
- Take responsibility and accountability for daily tasks providing periodic progress reports on goals and metrics
- Work cross-functionally for process and productivity improvement and to troubleshoot and resolve situations, taking ownership as needed
- Understand and comply with all adherences to federal, state, and local pharmacy laws, HIPAA policies and guidelines, SOP's and procedures OF Pharmacy Solutions and Company
- - Identifies potential Adverse Event situations for reporting to Pharmacovigilance ensuring Company meets FDA regulations
- Demonstrated ability to lead and participate within a team, manage multiple priorities, and meet associated timelines while maintaining accuracy
- Skilled with the use of the Microsoft Office suite and the ability to use and effectively learn and navigate other computer systems.
Customer Service Representative II
AT&T Mobility
- Maintain up-to-date knowledge about AT&T products and services.
- Respond to customer queries about AT&T services, equipment, promotions, roaming, and billings. Also, set up and maintaining customers' accounts.
- Enhance customer retention and satisfaction by providing outstanding customer service and first-call resolution, as well as help to increase sales.
- Understand customer needs and recommend appropriate products and rate plans.
- Presented and developed innovative ways to sell AT&T products and services to customers.
- Handle customer requests for payments, activations, upgrades, and other services.
- Address and resolve customer concerns promptly.
Healthcare Billing Specialist
Lacorp
- Researched missing or incorrect information, translated, and analyzed routine front-end billing issues.
- Updates demographic data to ensure prompt payment from customers.
- Verification of insurance information.
- Resolve systems issues from daily reports to determine appropriate resolution action.
- Examine patient's encounter forms to verify diagnosis codes and reconcile codes against services rendered, and key them into the system accurately and timely.
- Communication through phone calls with clients/patients to resolve billing defects.
- Meet daily and weekly goals in a fast-paced, production environment.
- Ensure billing transactions are processed in a timely, customer manner.
Education
Some College (No Degree) - Medical Office Management
Gtcc Middle College High School
Jamestown, NCSkills
- Communication
- Organizational skills
- Attention to detail
- Excellent customer service
- Interpersonal skills
- Problem solving
- Computer literacy
- Staff Development
Websites
References
References available upon request.
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Timeline
Program Specialist
Fortrea formerly Labcorp
03.2021 - Current
Customer Service Representative II
AT&T Mobility
Healthcare Billing Specialist
Lacorp
Some College (No Degree) - Medical Office Management
Gtcc Middle College High School