Andrea McPherson
Customer Service Representative
Atlanta,GA
Summary
Persuasive Customer Service Representative with expertise in assessing client needs, advising on options and monitoring accounts. Energetic and communicative professional with 15 years of experience. Dedicated to developing meaningful client relationships and offering best solutions.
Overview
9
9
years of professional experience
Work History
Insurance Specialist
Children's Healthcare Of Atlanta
03.2021 - 03.2022
- Provides clinical information as needed, emphasizing medical justification for procedure/service to insurance companies for completion of pre-certification process.
- Implemented a new project tracking system that decreased the project input time by 20% while working remotely
- Collaborates with the Appeals department to provide all related information to overturn claims denied.
- Monitors insurance authorization issues to identify trends and participates in process improvement initiatives.
- Provides ongoing communication to physician offices, patients/families, and others as necessary to resolve insurance authorization issues.
- Investigated and processed claims swiftly to keep customers satisfied.
- Acted as subject matter expert, answering internal and external questions and inquiries.
- Complied with HIPAA guidelines and regulations for confidential patient data.
- Manage workflow scheduling, data entry and accuracy verification for six large data projects.
- Created detailed reports for management to track performance and
Patient Coordinator
Family Practice Center
06.2019 - 03.2021
- Reviewed insurance benefits with patients
- Collected payments, set up payment arrangements and set up files to send accounts to collections
- Used professional communication and conflict resolution techniques as required
- Partnered with other healthcare professionals to create and implement individualized care plans for patients in various units.
- Acted as main point of contact for patients, doctors, and hospital staff by closely reviewing medical charts and maintaining high levels of communication.
- Communicated with patients, caregivers and families members to relay diagnoses and treatment options.
Surgery Scheduling Coordinator
Ophthalmic Plastic and Cosmetic Surgery
09.2018 - 03.2019
- Educated patients about surgeries and provided treatment plan documentation.
- Verified insurance coverage and obtained pre-authorizations and pre-certifications ahead of scheduled surgeries.
- Informed patients and caregivers on clearance procedures to maintain patient health and facilitate recovery goals.
- Managed office bookkeeping with insurance billing and patient payments.
- Follow up with insurance company on unpaid or rejected claims; resolve issue and re-submit claims.
- Assisted with medical coding and billing tasks.
- Coordinated with facilities to set up surgeries.
- Updated patient records to reflect upcoming surgeries and medical histories.
- Customize the care plan for each patient.
- Arranged pre-operative and post-operative appointments for surgical patients.
- Obtained pre-authorizations and pre-certifications ahead of scheduled surgeries.
Patient Coordinator
Woolfson Eye Institute
06.2016 - 08.2018
- Verified insurance eligibility and reviewed with patients.
- Collected payments, set up payment arrangements and set up files to send accounts to collections.
- Conducted all assignments as a professional and role model with a sense of urgency.
- Used professional communication and conflict resolution techniques as required.
- Partnered with other healthcare professionals to create and implement individualized care plans for patients in various units.
- Maintained confidentiality of patient data and condition to safeguard health information.
- Acted as main point of contact for patients, doctors, and hospital staff by closely reviewing medical charts and maintaining high levels of communication.
Front Office Manager
Plastiko's Plastic And Cosmetic Surgery
07.2013 - 06.2016
- Serve as liaison between physicians, practice manager, employees and patients, ensuring the office delivers unparalleled support and service to physicians, employees and patients.
- Review analyze and use business reports to identify missed opportunities, recommend and implement best practices and systems needed to positively impact office performance.
- Oversee daily operations of the office, ie., filing claims, managing payments, resolving patient issues, coordinating team schedules, and tracking inventory
- Ensure HIPPA and FDCPA Compliances.
- Reconciled end-of-day reports to determine accurate billing and payment processing.
- Established performance goals for employees and provided feedback on methods for reaching those milestones.
Education
Associates - Business Management
Georgia State University
Skills
- Over 10 years experience working with EHR and EMR software
- Ability to work independently in a changing environment and handle stressful situations
- Billing and Claims Procedures
- Call Center Customer Service
- Professional Relationships
- Compiling Data
- Data Processing
- Document and Records Management
- Payor Procedures
- Patient Health Information Access
- Trained in 10-Key
Timeline
Insurance Specialist
Children's Healthcare Of Atlanta
03.2021 - 03.2022
Patient Coordinator
Family Practice Center
06.2019 - 03.2021
Surgery Scheduling Coordinator
Ophthalmic Plastic and Cosmetic Surgery
09.2018 - 03.2019
Patient Coordinator
Woolfson Eye Institute
06.2016 - 08.2018
Front Office Manager
Plastiko's Plastic And Cosmetic Surgery
07.2013 - 06.2016
Associates - Business Management
Georgia State University