Avis Clark

• Assist with inquiries from members, providers, and brokers via the web portal or departmental Outlook email addressesResearch health plan benefits information for plan participants.
• Outbound calling, as needed, to provide further member support or meet the requirements of the request.
• Research, document, and resolve all inquiries within the outlined turnaround times.
• Describe medical and dental benefits according to group contracts.
• Provide claim status, including an accurate explanation of patient financial responsibility, ineligible amounts, and plan payments.
• Provide information to employees' regarding their Flexible Spending Accounts (FSAs), Health Savings Accounts (HSAs), and Health Reimbursement Accounts (HRAs).
• Assist claimants with the prescription drug plan program.
• Request stop pays/ tracers.
• Assist collectors in reconciling patient accounts.
• Treat all calls and correspondence using the Member Services Procedures, paying attention to the sections relating to HIPAA guidelines and the HIPAA Privacy Rules.
• Assist with navigating the benefits portal to plan participants.
• Order health insurance cards upon request.
• Coordinate communication between plan participants and designated departments, resolving inquiries efficiently.
• Assisted in resolving complex benefits issues, leading to increased member satisfaction and account resolutions.
• Reported member life event changes, ensuring timely updates to benefits and coverage for qualifying events such as marriage or the birth of a child.
• Coordinated with the claims department to resolve claim issues, ensuring members received accurate benefits and coverage for eligible medical services.
• Explained benefits to plan participants in easy-to-understand terms to educate each on health coverage options.

• Cross-trained in both oncology/primary medication processes.
• Provided patients with assistance for various medications: Eliquis, Orencia, OPDIVO, Yervoy and Sprycel.
• Explained eligibility requirements and reviewed financial guidelines per the foundation’s policy for assistance with prospective patients and providers.
• Triaged prescription shipments for delivery to patients or health care providers offices.
• Mailed outbound correspondence such as: foundation enrollment applications, approval/denial letters and annual renewal applications to patients and health care provider offices.
• Actively participated in team meetings focused on improving workflows and enhancing overall practice performance.
• Provided compassionate support for patients facing financial challenges, assisting them in navigating available resources and payment options.
• Provided excellent customer service to patients and medical staff.
• Managed patient inquiries to ensure timely resolution and support

• Delivered superior customer service to patients and internal customers while serving as a patient advocate during the cycle of the account.
• Reviews all accounts assigned for collection prior to, during, or after admission and discharge.
• Verifies insurance as needed to resolve account balances.
• Provided outstanding customer service to stakeholders in a diverse and fast-paced environment.
• Provided ledgers and claim forms to patients and health insurance payers.
• Setup payment plans on accounts with current self-pay balances to resolve account balances.
• Create tasks and refer accounts to specialty departments for review and specialty assistance.
• Reconciles patient accounts with credits that have zero balances.
• Ensures that all patient information, payment information, and documents adhere to HIPAA, PCI, and other established quality control standards.
• Prepared reports detailing billing actions, flags, and other key information.
• Processed invoices, notices, and other documents.
• Reviewed patient's EOBs and discussed options to satisfy remainder of patient financial obligations.
• Assisted colleagues during peak periods or absences, showcasing teamwork skills while maintaining personal workload demands efficiently.
• Posted payments and processed refunds.
• Worked with outside entities to resolve issues with billing, claims, and payments.
• Promoted a positive work environment by actively participating in team meetings and contributing ideas for process improvements.
• Provided exceptional customer service, handling sensitive patient situations with professionalism and empathy.
• Utilized computer programs to create invoices, letters, and other documents.
• Negotiated payment plans with patients experiencing financial difficulties, supporting them in meeting their obligations without undue stress.
• Reduced outstanding balances by implementing effective collection strategies tailored to individual patients'' needs.
• Educated patients on financial policies, promoting understanding of their responsibilities within the healthcare system.
• Reconciled statements with patient records.
• Promptly received and forwarded incoming communications, such as phone calls, emails, and letters, to appropriate staff.

• Answered inbound calls for the billing office regarding patient accounts.
• Reviewed patient accounts to ensure all charges were billed correctly.
• Referred accounts with errors or billing discrepancies to the insurance follow-up department.
• Processed insurance follow-up claims for review of explanation of benefits.
• Made outbound calls for follow-up to all patient account inquiries.
• Applied patient payments to their accounts, such as co-payments and time of service charges.
• Mailed receipt of payment statements to patients.
• Provided patients with itemized financial statements.
• Setup payment plans for patients to resolve account balances.
• Contacted patients after insurance was calculated to obtain payments.
• Educated patients on billing procedures and financial options, enhancing understanding of services rendered.
• Reviewed account statements for accuracy, identifying and correcting errors proactively.
• Coordinated with collections teams to resolve outstanding balances while maintaining positive patient relationships.
• Supported staff on special assignments and ad hoc projects.
• Posted payments and processed refunds.
• Provided exceptional customer service, handling sensitive patient situations with professionalism and empathy.
• Reduced outstanding balances by implementing effective collection strategies tailored to individual patients'' needs.

• Provides advanced services to patient, providers, and caregivers.
• Services could include but not limited to: Benefit verification result call, make outbound calls to insurance payers to verify patient eligibility/benefits.
• Billing/Coding Support.
• Coordination of benefits.
• Prior Authorization assistance/tracking.
• Advanced alternate coverage research.
• Coordinates with internal and external service providers to ensure services are performed in accordance with program policy and within expected service level agreements (SLAs).
• Familiar with payers: Medicare, Medicare Advantage/Replacement, PPO, HMO and POS plans.
• Conducted benefits verification for patient eligibility and coverage accuracy.
• Collaborated with healthcare providers to obtain necessary documentation for claims processing.
• Assisted in training new team members on benefits verification protocols and software usage.
• Contributed to company-wide initiatives aimed at improving the quality of service delivery across departments, fostering a culture of collaboration and excellence within the organization as a whole.
• Collaborated with healthcare providers to ensure accurate billing and benefit coverage information.
• Maintained up-to-date knowledge on industry regulations, ensuring compliance throughout all benefit verification processes.
• Explained benefits to plan participants in easy to understand terms in order to educate each on available options.

• Provide access options for biosimilar medications to patients and providers.
• Assists patients with online enrollment for copay savings card.
• Enroll patients in copay card savings programs.
• Complete copay assessments for specific patient support and benefit tier levels.
• Complete document review on faxed in enrollment forms.
• Provide benefits verification investigation.
• Provide prior authorization outcomes/details.
• Complete welcome calls to patients.
• Coordinates Video Injection Training with nursing staff for patients.
• Coordinates fulfillment orders to ship sharps disposals for patients.
• Provide alternate coverage research for patients with no pharmacy benefits coverage.
• Familiar with payer trends, updates, and benefits coverage for medical and pharmacy.

• Answered inbound phone queue to support both clinical and general program inquiries.
• Received and reported adverse events as directed.
• Avaya softphone/CTI call capture.
• Provided eligibility requirements to patients and providers per program guidelines for copay assistance.
• Referred patients with government/federally funded health plans to the free drug program (Patient Assistance Foundation).
• Aided by the HUB-supported copay portal.
• Created appropriate program cases as generated by phone call in patients' accounts to keep the flow of processing annual renewal and new enrollment applications.
• Assists patients and providers with follow-up regarding missing information, benefit verifications, and prior authorizations for application processing.
• Reviewed program determinations with patients and providers.
• Collect various information to assist or provide correspondence to patients and providers via phone, fax, email, and online methods.
• Provide general information regarding claims submission requirements and process.
• Assisted small new-hire teams in onboarding training for the annual reverification period
• Managed patient inquiries to ensure timely resolution and support
• Assisted in insurance verification processes, enhancing claim efficiency
• Collaborated with healthcare teams to streamline communication and service delivery
• Trained new staff on operational protocols and customer service best practices
• Implemented feedback mechanisms to improve patient experience and service quality
• Participated in ongoing training programs related to HIPAA compliance, maintaining up-to-date knowledge on regulatory requirements.
• Verified insurance eligibility and coverage for patients.
• Handled sensitive patient concerns with professionalism and empathy, fostering an atmosphere of trust within the clinic.
• Filed and maintained patient records in accordance with HIPAA regulations.
• Provided exceptional customer service to patients, answering questions and addressing concerns.
• Managed patient registration process, confirming data accuracy and completeness.
• Facilitated patient registration by accurately entering demographic and insurance information into electronic health record systems.
• Assisted with insurance verification tasks, ensuring accurate billing and timely reimbursement for services rendered.

There is an employment gap during the period when I left Cencora to seek other opportunities.

Rehired in 2022 until 2024.