Amy Anthony
Aurora,CO
Summary
Medical claims professional with a proven success in building relationships with medical providers and injury attorneys through effective communication and outstanding work ethic. Effective at managing time and multi tasking through a heavy work load. Analytical problem solver with a can do, positive attitude.
Overview
9
9
years of professional experience
Work History
Team Lead/Lead Medical Claims Advocate
Continuum Health Solutions
Centennial, CO
06.2017 - Current
- Manage auto claim medical benefits for a team of six hospital providers by sending billing and records to the medical auto adjuster and following up to intersect any possible delays in a timely manner.
- Document updates in each provider's EHR and fulfill EOB and status update requests from the providers.
- Confirm that the hippa release is on file prior to sending records to the medical auto claim. Requesting the hippa release from auto adjuster if one is not on file prior to fulfilling their medial records request.
- Negotiate reduction agreements with attorneys at settlement that would allow patient funding for personal compensation while assuring that the medical bills are paid maximally.
- Train new hires on auto claims management and how to navigate multiple EHR's such as Epic, Cerner and Meditech.
Customer Service Representative/Team Lead
Aetna
6235 S. Main St. Aurora, CO
08.2016 - 03.2017
- Resolve issues by researching prescription medication rejections for both medicare and commercial Aetna plans
- Perform various plan benefit overrides to allow members to have access to their medication according to Aetna policies
- Assist team members with any questions and challenges they may have regarding a medication rejection
- Monitor the use of each team member's time and assure they were in the correct aux for taking calls
Customer Service Representative
Optum Health
10700 Briarwood Ave. Centennial, CO 80122
09.2015 - 03.2016
- Advise United Health Care customers of their insurance premium amount and total balance due
- Accept United Health Care insurance premium payments over the phone using KeyBank software
- Set up monthly EFT payments
- Attentively work with customers on billing discrepancies. Solve and correct billing discrepancies by comparing invoices with received payments.
Building Salesman/Estimator
Armstrong Steel Buildings
Greenwood Village, CO
09.2012 - 07.2015
- Utilized Salesforce to call an average of 75 internet inquiries per day
- Effectively addressed customer questions and provided information on the many benefits of investing in a high quality Armstrong Steel building as opposed to cheaper competitor steel buildings
- Promoted to Estimator and worked directly with salesmen to design and quote proposals for a custom steel building according to customer needs
Education
Associate of Science -
Northeastern Oklahoma A&M College
Miami, OK1992
Skills
- Relationship building
- Compassion
- Caseload management
- Insurance understanding
- Verbal and written communication
- Insurance verifying
- Negotiating
Community Service
5/95-4/05 Foster Parent for State of Oklahoma
6//07-3/13 Foster Parent for State of Colorado
Timeline
Team Lead/Lead Medical Claims Advocate
Continuum Health Solutions
06.2017 - Current
Customer Service Representative/Team Lead
Aetna
08.2016 - 03.2017
Customer Service Representative
Optum Health
09.2015 - 03.2016
Building Salesman/Estimator
Armstrong Steel Buildings
09.2012 - 07.2015
Associate of Science -
Northeastern Oklahoma A&M College
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