April Thompson
Miami,FL
Summary
28 Years of Customer Service Experience
28 Years Medical Insurance Experience
Various roles including:
Provider Service Rep
Network Information Rep
Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.
Overview
29
29
years of professional experience
Work History
HC And Insurance Operations Analyst
NTT DATA – AvMed Health Plans
01.2019 - Current
- Responsible for researching and responding to member grievances forwarded by Member Engagement in an efficient and professional manner.
- Forward claims for review/appeal.
- Handle incoming phone calls from providers related to claims, benefits and authorizations.
- Act as a liaison between the provider and internal/external entities including the Claims Dept. and Network Liaisons when necessary.
- Educate network providers on their contractual agreement and responsibilities.
- Provide information to providers regarding their credentialing status, demographic changes, tax id changes and additions.
- Aid providers on how to navigate through the provider portal.
- Handle incoming emails and faxes from providers.
Provider Service Coordinator
AvMed Health Plans
01.1997 - 01.2019
- Responsible for researching and responding to member grievances forwarded by Member Engagement in an efficient and professional manner.
- Forward claims for review/appeal.
- Research and respond to inquiries via Macess EXP service forms forwarded by other key departments (such as Clinical Coordination, Network, Claims Operations) in reference to educating providers on AvMed’s policies and guidelines.
- Provide information to providers regarding their panel, eligibility list, claims, and capitation payments.
- Maintain thorough knowledge of contractual agreements in order to provide accurate responses regarding contractual changes, contractual rates, and fee schedules.
- Assist supervisor with research of complex cases and special projects.
- Research and respond to inquiries forwarded by the Dept of Insurance, CMS, etc.
- Create provider logins to AvMed’s website.
- Aid providers on how to navigate through the provider portal.
- Handle incoming emails and faxes from providers.
Education
High School Diploma -
Miami Southridge Senior High School
Skills
- HRP
- Salesforce
- Amisys
- Macess(EXP)
- Support Point
- Microsoft Office
- ESI Scripts
- Cypress
- Vistar
- Acuity
- Data Oceans
- PA HUB
- Novologix
Timeline
HC And Insurance Operations Analyst
NTT DATA – AvMed Health Plans
01.2019 - Current
Provider Service Coordinator
AvMed Health Plans
01.1997 - 01.2019
High School Diploma -
Miami Southridge Senior High School
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