Ateiah Riley
Orlando,FL
Summary
Dedicated and adaptable professional with a strong work ethic and effective communication skills, consistently exceeding standards of quality and professional expectations. Demonstrated leadership abilities and integrity gained through diverse work experiences. Proactive learner eager to support organizational goals within a dynamic team environment.
Overview
15
15
years of professional experience
Work History
Planned Career Break
Orlando, USA
09.2020 - Current
- Revitalized and prepared to resume professional duties with eagerness.
- Advanced productivity with refined time management practices.
- Enhanced soft skills such as adaptability, innovative thinking, and maintaining composure in high-pressure situations.
- Engaged in training and development programs.
- Developed networking opportunities via professional memberships and virtual events.
- Exploring the next stages in my career following organizational restructuring and layoffs as a result of COVID-19.
- Delivered comprehensive caregiving ensuring consistent health management.
Health Provider Service Representative
Sunshine Health Plan
Orlando, USA
08.2017 - 09.2020
- Supported providers with medical billing claims submitted to Sunshine Health Insurance.
- Reviewed provider claims for payments.
- Directed providers to relevant sections in provider manuals for necessary corrections.
- Facilitated authorization process to ensure timely patient care.
- Familiarity with CPT codes and medical terminology utilized.
- Completed data entry tasks with precision and speed.
- Followed data entry guidelines, ensuring effective team communication.
Subject Matter Expert / Rapid Response Lead
Optum
Orlando, USA
06.2010 - 08.2017
- Resolved supervisor-level inbound queries for United Health Care Medicaid Members.
- Upheld company metrics and performance targets.
- Addressed challenging member concerns such as health benefits evaluations, case resolutions, and medical documentation.
- Trained and mentored agents, enhancing their skill sets.
- Compiled reports to illustrate trends and recommend solutions.
- Managed client concerns by effectively handling emails.
United Healthcare Prior Authorization Intake Specialist
Optum
Orlando, USA
04.2015 - 04.2015
- Processed pre-authorization codes from doctors and hospitals for approval.
- Ensured each patient was classified under the appropriate diagnosis group.
- Ensured 100% compliance with hospital and government regulations.
- Handled transactions for both timely and delayed payments.
- Ensured compliance with HIPAA guidelines, policies, and regulations.
- Utilized resources to keep up-to-date regulatory information.
- Oversaw client information updates, ensuring effective notation.
- Oversaw and organized mailboxes alongside additional aligned tasks.
- Managed inbound and outbound calls effectively.
Education
High School Diploma -
Maynard Evans High School
Orlando, FL05-2008
Skills
- Good Telephone Etiquette
- Leadership
- Multitasking Abilities
- Data entry
- Time management
- Organization and time management
- Active listening
- Calm under pressure
- Quality assurance
- Problem-solving
- Medical billing and collections
- CPT Code Proficiency
- ICD-9 / ICD-10
- Conflict Resolution Skills
- Data entry
- Insurance Eligibility Verification
- Trainer
- Fast Learner
Timeline
Planned Career Break
09.2020 - Current
Health Provider Service Representative
Sunshine Health Plan
08.2017 - 09.2020
United Healthcare Prior Authorization Intake Specialist
Optum
04.2015 - 04.2015
Subject Matter Expert / Rapid Response Lead
Optum
06.2010 - 08.2017
High School Diploma -
Maynard Evans High School
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