ANNA AVILDSEN
Bartlett,IL
Summary
Diligent Managed Care Representative with solid background in managed care operations. Adept at navigating complex healthcare systems and facilitating efficient provider-payer interactions. Demonstrated expertise in problem-solving and effective communication.
Overview
13
13
years of professional experience
Work History
Managed Care Representative
Wheation Eye Clinic
10.2023 - Current
- Coordinated patient insurance verification processes to ensure timely approvals and care delivery.
- Managed comprehensive patient records, ensuring compliance with HIPAA regulations and accuracy of data entry.
- Assisted patients in understanding their benefits and coverage options, empowering them to make informed healthcare decisions.
- Resolved escalated issues promptly and professionally, preserving positive relationships with providers and members alike.
- Determined appropriateness of payers to protect organization and minimize risk.
- Identified what insurance plans require authorization for services and worked closely with Various Medical groups to ensure we have all necessary documentation before the date of service.
- Responsible for checking prior authorization requirements for outpatient procedures and initiating authorizations for plans that do require it by contacting insurance company directly or using a online provider portal.
- Strong understanding of reading clinical documentation and knowledge of ICD-10 and CPT codes needed for various services.
Patient Representative
WOODFIELD PEDIATRICS
04.2022 - Current
- Developed strong relationships with patients by demonstrating empathy and understanding of their needs.
- Utilized knowledge of medical terminology to ensure accurate data entry into the system.
- Assisted patients with scheduling appointments, registration, insurance verification, referrals, authorizations, and other inquiries.
- Maintained patient confidentiality while handling sensitive information.
- Processed payments accurately and efficiently according to established policies and procedures.
- Demonstrated problem-solving skills when addressing customer complaints or resolving conflicts.
- Ensured compliance with organizational policies regarding patient care standards and services delivery processes.
Guest Service Associate
TARGET
11.2012 - 05.2023
- Processed returns and exchanges efficiently while ensuring accuracy of paperwork related to transactions.
- Utilized problem-solving skills to resolve conflicts between customers or staff members in a diplomatic way.
- Greeted customers in a friendly and professional manner, providing them with product information and assistance.
- Collaborated with team members to provide exceptional customer service at all times.
- Performed cashier duties accurately, including processing payments and issuing receipts.
- Provided timely resolution of customer issues and escalated complex problems when necessary.
- Demonstrated excellent communication skills to effectively respond to customer inquiries, complaints and requests for service.
Education
Associate In Science (A.S.) - Health Information Technology
Rasmussen College
Aurora, IL11.2019
Skills
- Medical Terminology
- Patient Data Privacy
- Proficient in EPIC
- Time Management
- Reviewing Patient Information
- Critical thinking
- Prior authorization processing
- Insurance coverage verification
- Task prioritization
- Documentation skills
- Organizational skills
Timeline
Managed Care Representative
Wheation Eye Clinic
10.2023 - Current
Patient Representative
WOODFIELD PEDIATRICS
04.2022 - Current
Guest Service Associate
TARGET
11.2012 - 05.2023
Associate In Science (A.S.) - Health Information Technology
Rasmussen College