Breana Spooner
Tucson,AZ
Summary
Accomplished Medicare/Medicaid Eligibility Specialist III at Centauri Health Solutions Inc - Human Arc, adept in Microsoft Office and demonstrating exceptional leadership qualities. Proven track record in enhancing new hire success rates and streamlining training processes at Centauri Health Solutions, showcasing unparalleled detail orientation and critical thinking skills.
Overview
8
8
years of professional experience
Work History
Medicare/Medicaid Eligibility Specialist III
Centauri Health Solutions Inc - Human Arc
06.2021 - Current
- Training support for new representatives
- Assist in new hire success throughout ramp up which includes shadowing, working with trainer and team leaders to provide additional support to new hires.
- Assist with case escalations, and reviews for both MSP and medicaid, including reviewing documents, and making calls to members to ensure the cases is being worked in a timely and accurate manner
- Provide support to Team leader with projects, including making the daily spreadsheet with aged and outreach tasks sent with daily directions on what to prioritize
- Assist in finding trends amongst team and providing solutions to team leader in how to assist in correcting errors found
Medical Billing Specialist
Pain Institute of Southern Arizona
06.2020 - 03.2021
- Examined patients' insurance coverage, deductibles, insurance carrier payments and remaining balances not covered under policies when applicable.
- Communicated with insurance providers to resolve denied claims and resubmitted.
- Researched CPT and ICD-9 coding discrepancies for compliance and reimbursement accuracy.
- Collected payments and applied to patient accounts.
- Printed and reviewed monthly patient aging report and solicited overdue payments.
- Posted and adjusted payments from insurance companies.
- Located errors and promptly refiled rejected claims.
- Reviewed patient diagnosis codes to verify accuracy and completeness.
Customer Service Representative I
Centene
08.2016 - 05.2020
- Answer phone calls for providers calling to inquire about their claims
- Assist providers in reviewing any mistakes in their billing, create cases for providers regarding their claims to send back to claim analyst for review
- Communicate with prior authorization department regarding authorization requires or any discrepancies in provider billing
- Provided member with information regarding copays, deductibles, and coinsurance
Education
High School Diploma -
Cienega High School
Vail, AZ 05-2012
Skills
- Microsoft proficient, excel, powerpoint, word
- Detail Oriented
- Active listening
- Patience
- Communication
- leadership
- Adaptability
- Time management
- Critical thinking
Timeline
Medicare/Medicaid Eligibility Specialist III
Centauri Health Solutions Inc - Human Arc
06.2021 - Current
Medical Billing Specialist
Pain Institute of Southern Arizona
06.2020 - 03.2021
Customer Service Representative I
Centene
08.2016 - 05.2020
High School Diploma -
Cienega High School
Similar Profiles
Janet FloresJanet Flores
Bilingual Senior Outreach Specialist at Centauri Health Solutions Inc - Human ArcBilingual Senior Outreach Specialist at Centauri Health Solutions Inc - Human Arc
Taylor SowellTaylor Sowell
Senior Outreach Specialist at Centauri Health Solutions Inc - Human ArcSenior Outreach Specialist at Centauri Health Solutions Inc - Human Arc
Tiffany LongTiffany Long
Case Manager III at Centauri Health Solutions Inc - Human ArcCase Manager III at Centauri Health Solutions Inc - Human Arc