Anthony Peragallo
Cicero,IL
Summary
Dedicated and career focused professional with extensive experience in customer service. A creative thinker works well under pressure and stressful situations in a fast-paced environment. Adaptable and able to be efficient under minimum supervision but also a great team player, with strong strategic planning and problem-solving skills. Hardworking and passionate job seeker with strong organizational skills eager to secure entry-level Customer Service position. Ready to help team achieve company goals.
Overview
17
17
years of professional experience
Work History
Medicaid Liaison
Great Lakes Medicaid
Chicago, IL
02.2018 - 03.2020
- Managed caseload of 1300 plus cases
- Worked extensively and closely with Illinois Department of Human Services
- Prepared and reviewed hearing packets prior to hearing date
- Conducts administrative hearings in fair, impartial, courteous, and professional manner
- Reviewed all documents for any changes and updates before submitting forms for secured approvals
- Analyzed trends in claims processing issues and identify work process solutions
- Properly documented in detail outcome of hearings, continuances, withdrawals, and approvals
- Handled special reporting and case reviews for management to ensure resolution and obtain approvals
- Resolved most concerned cases to ensure its implementation was not only completed but successful.
- Developed and maintained courteous and effective working relationships
- Completed paperwork, recognizing discrepancies and promptly addressing for resolution
- Used Microsoft Word and other software tools to create documents and other communications
- Resolved problems, improved operations and provided exceptional service
- Used coordination and planning skills to achieve results according to schedule
- Actively listened to customers' requests, confirming full understanding before addressing concerns
Hearing Officer
Change Healthcare
Lombard, IL
08.2013 - 02.2018
- Worked extensively and closely with Illinois Department of Human Services
- Responded to customer inquiries by telephone or email
- Familiar with Hospital Epic System and IES at IDHS
- Conducted and oversaw administrative hearings
- Educated applicants and family representatives on claim process proceedings
- Provided written decision promptly to participant in all hearing matters
- Received and examined relevant information on issues brought before hearing
- Instructed participants in hearings concerning their rights and applicable hearing procedures
- Introduced required evidence, medical records, and financial information, to both State and Federal Agencies
- Provided oversight and coaching to teams to ensure efficiency and quality of response for first touch customer interactions.
Resolve Application Specialist
Chamberlin Edmonds
Lombard, IL
02.2010 - 08.2013
- Document and update PACE daily
- Resolved high volume of customer contacts through inbound and outbound calls, email, chat, and messaging
- Investigated case details to determine root cause of issues
- Provided feedback to leadership and team members regarding processes and trends
- Kept lines of communication open with other team members to solve problems quickly
- Assisted in training and development for new hires
- Assisted callers with claim issues or general questions regarding claim status.
- Carried out day-to-day duties accurately and efficiently
- Participated in continuous improvement by generating suggestions, engaging in problem-solving activities to support teamwork
Claims Processing Specialist
Chamberlin Edmonds
Lombard, IL
05.2009 - 02.2010
- Handled all inquiries within 24 hours while documenting discussions, issues, and any action items
- Worked with internal departments and external organizations to resolve appeals
- Tracked status and progress of denials and appeals
- Conducted relevant research to assist with completing appeals process and to stay informed on best practices and policy reforms
- Worked with other departments on cross functional tasks and projects
- Completed special projects as assigned
- Demonstrated solid judgment and discretion working with confidential information.
Account Liaison
Network Synergy Group
Tampa, FL
05.2005 - 02.2009
- Entered Therapy and Occupational Medicine Referrals
- Managed and monitored patient compliance
- Provided excellent customer service to Network Synergy's biggest client summit claims center
- Maintained diary compliance
- Evaluated medical treatment provided by primary care physicians for worker's compensation claimants workman comp claims
- Prepared patients for treatments, assist during administration of treatments, and provides routine treatment
- Assisted in office coordination with answering phones and scheduling appointments
- Assists patient to put on and remove supportive devices, such as braces, splints, and slings, before and after treatments
- Safeguarded, motivated, and assisted patients practicing exercises and functional activities under direction of professional staff
- Initiated and assisted clinicians with credentialing application process by sending, receiving, and analyzing documents
- Responsible for accurate data entry.
- Produced weekly performance reports to inform decision making
- Performed effectively in self-directed work environment, managing day-to-day operations and decisions
- Recorded accurate and efficient records in customer database
- Gained customer trust and confidence by demonstrating compelling, persuasive and composed professional demeanor
Concentra Integrated Services
Tampa, FL
02.2002 - 08.2004
- Review and processed one hundred plus workers comp claims per hour
- Maintained physician provider demographic in company’[s provider networks using EDI system
- Maintained database records in Formworks system
- Corresponded with different insurance companies
- Audited physician information and claims
- Keyed from image HCFA 1500 and UB 92’s, assisted with Bill Coding and ICD 9 coding in conjunction with adding Modifiers when needed.
- Resolved conflicts and negotiated mutually beneficial agreements between parties
- Proved successful working within tight deadlines and fast-paced atmosphere
- Exceeded goals through effective task prioritization and great work ethic
Education
High School Diploma -
Continental Academy
Miramar, FL01.2010
Skills
- Proven ability to work effectively in team environment
- Excel, Word, Outlook, and Microsoft Office
- Customer Service Orientation - Satisfying customers
- Responsible for accurate Data Entry and 10 key 50 WPM
- Complex Problem-Solving
- Active Listening
- Liaison skills
- Medicare and Medicaid eligibility
Timeline
Medicaid Liaison
Great Lakes Medicaid
02.2018 - 03.2020
Hearing Officer
Change Healthcare
08.2013 - 02.2018
Resolve Application Specialist
Chamberlin Edmonds
02.2010 - 08.2013
Claims Processing Specialist
Chamberlin Edmonds
05.2009 - 02.2010
Account Liaison
Network Synergy Group
05.2005 - 02.2009
Concentra Integrated Services
02.2002 - 08.2004
High School Diploma -
Continental Academy
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