Asya Jones

Duties, accomplishments, and related skills- Creating acknowledgment and decision letters to the members of multiple health plans. State such as Pennsylvania, District of Columbia (D.C.), Michigan, Ohio, and Delaware. - Contacting health providers to retrieve a response for a member’s complaint or concerns. - Contacting various internal departments to obtain needed documents for a provider and/or member’s response. - Access to external state systems to verify a member’s eligibility with Medicaid benefits. - Experience with Excel and Word programs. - Verifying prior authorizations of medication and/or medical services. - Review of claims to ensure the proper information had been obtained. - Quality Customer Service Skills - Meeting deadlines to stay within the health plans compliance guidelines. - Experience with reviewing billing claims that include billing codes and procedures. I am then responsible with advising the outcome of billing claims to the member in simple terms in letter form or telephone communication.