BRIGHT C. IBEGBULEM
Las Vegas,Nevada
Summary
Customer service and Detail-oriented prior authorization specialist, insurance verification, referrals, and claim resolution. Handles high volumes of calls, faxes, and electronic requests while communicating clearly with providers, members, and payers to keep cases moving and maintain accurate records. with a background in medical billing, pharmacy benefits, and member support. Reviews coverage, verifies eligibility, routes clinical documents, and follows authorization requests through completion while managing sensitive information with accuracy, speed, and clear communication. Trained in all insurance lines of business - Medicare, Medicaid and Commercial.
Overview
1
1
Language
2027
2027
years of professional experience
Work History
Prior Authorization Specialist
Elevance Health
Las Vegas, Nevada
02.2024 - Current
- Reviewed prior authorization requests for Elevance Health members.
- Checking patient contract details and benefit plans to confirm coverage criteria for inpatient admissions or outpatient procedures.
- Routed clinical documents to support medical necessity reviews.
- Communicated with providers regarding authorization requirements and missing information.
- Reviewing basic medical documents for accuracy and completeness, then routing cases that require deeper clinical evaluation to a Nurse Reviewer or specialized clinical.
- Assisting with the processing of re-authorizations, logging insurance company feedback, and coordinating required documentation to support case resolutions or appeals.
- Interpreted plan guidelines for referral and authorization decisions.
- Responded to member and provider inquiries with clear status updates.
- Coordinated with utilization management teams on pending requests.
- Coordinated with other departments to obtain additional information needed for prior authorization.
- Verified patient insurance coverage, including eligibility, benefits and authorizations for medical services.
- Reviewed prior authorization requests to ensure accuracy and completeness of required information.
- Scheduled peer to peer reviews for physicians to discuss medical necessity with insurance providers.
- Contacted insurance carriers to obtain authorizations, notifications and pre-certifications for patients.
- Notified ordering providers of denied authorizations.
- Maintained accurate records of all authorization activities in the database system.
- Performed detailed medical reviews of prior authorization request, following established criteria and protocols.
- Responded promptly to inquiries from providers, patients and payers regarding status of prior authorization requests.
- Provided guidance to providers regarding the prior authorization process.
- Educated healthcare professionals on how to properly submit a request for pre-authorization.
- Provided accurate information to all parties, including patients, insurance providers, healthcare staff and office personnel by using effective written and verbal communication skills.
- Identified reasons behind denied claims and worked closely with insurance carriers to promote resolutions.
- Applied knowledge of Medicare, Medicaid and third-party payer requirements utilizing on-line eligibility systems to verify patient coverage and policy limitations.
- Facilitated communication between providers, payers and health plans regarding prior authorization processes.
- Assisted with developing policies and procedures related to prior authorizations.
- Advised provider offices on proper coding practices that are necessary for successful claim submission.
- Input claim, prior authorization, and other important medical data into system.
- Managing incoming phone calls, faxes, and electronic queues from healthcare providers requesting clinical authorizations
Customer Service Representative WFH
Support Teams For The (PBM) Division Of CVS Health -Caremark -IngenioRX
01.2021 - 01.2023
- -Assisting members with their pharmacy benefit plans.
- -Take inbound calls and answer questions regarding prescription insurance, medication coverage and mail order prescriptions so that our customers/members better understand their coverage and options.
- -Through my skills and knowledge, I offer the solutions needed to help simplify their health care experience.
Medical Billing Specialist
Las Vegas Pain Institute & Medical Center
01.2018 - 01.2020
- - Submitting Medical Claims to insurance companies and payers.
- - Obtaining Referrals and pre-authorization as required for procedures.
- - Checking eligibility and benefits verification for treatments, hospitalizations and procedures.
- - Reviewing Patients bills for accuracy and completeness and obtaining any missing information.
- - Preparing, Reviewing, and transmitting claims using billing software, including electronic and paper claim processing.
- - Following up on unpaid claims within standard billing cycle timeframe.
- - Checking each insurance payment for accuracy and compliance with contract discount.
- - Calling insurance companies regarding any discrepancy in payments if necessary.
- - Identifying and billing secondary or tertiary insurances.
- - Researching and appealing denied claims.
- - Answering all patient or insurance telephone inquiries pertaining to assigned accounts.
- -Put together a puzzle
- -Watching interesting Documentaries
- -Listening to music
- - Setting up patient payment plans and work collection accounts.
- - Updating billing software with rate changes.
- - Updating cash spreadsheets and running collection reports.
Ramp Service Agent
Worldwide Flight Services
01.2016 - 01.2017
- - Ramp Servicing
- - Ground Service Safety
- - Bag Tag Recognition
- - Arrival / Departure Operations
- - Potable Water Servicing / Equipment
- - FOR Walks before Arrival and Departure of any Flight- Wings Walker
Quality and Safety Inspector
Dana Airlines
, Nigeria
01.2013 - 01.2016
- - Inspected all aircraft by means of auditing, spot checks and daily inspections. Reported all maintenance concerns/issues to respective department quality manager.
- - Managed and monitored Aircraft Status Board
- - Managed audit program for airline in accordance with NCA A (Nigerian Civil Aviation Authority).
- - Tracked all certified staff and AMEL Technicians, managed all licenses, processed renewals in accordance with Nigerian regulations.
- - Variation of Operation Specifications of AOC Certificates
- - Processed Special Flight Permits
- - Met all Nigerian and international requirements for airline mandatory occurrence report Perform investigations on all airline incidents, created action plans with documentable goals to prevent reoccurrence and reported findings to Director of Quality and Safety Assurance.
- - Wrote and submitted all correspondence to NCA A as the company Quality Assurance Inspector.
- - Promoted safety awareness among employees by educating them on current safety trends and current laws, published articles and manuals for employees regarding safety.
- - Act as liaison with other aircraft operators and relevant organizations, attend seminars and courses to maintain Dana Airlines as a leader in industry Safety.
Quality Inspector
OAS Helicopters
, Nigeria
01.2011 - 01.2012
- Nigeria Audited ground handling agents at corporate location and branch locations Reviewed all audits to determine if action plans were carried out effectively.
- - Updates job knowledge by participating in educational opportunities, reading technical publications.
- - Accomplishes quality and organization mission by completing related results as needed.
- - Accomplishes quality and organization mission by completing related results as needed.
- - Supervised, managed and distributed all Civil Aviation Authority letters and any manual amendments to the appropriate personnel.
- - Obtaining all NCA A letters and licenses for airline.- Managed AOC operation plan and expiration date, certificate of airworthiness and certificate of registration.
Call Center Customer Care Representative
MTN Nigeria
, Nigeria
01.2009 - 01.2011
- - Took and entered all customer orders by managing large amounts of inbound and outbound calls in a timely manner. - Followed communication scripts when handling customers. - Provided excellent customer service by answering questions and offering assistance.
- - Kept equipment operational by following established procedures and reporting any malfunctions.
- - Updated job knowledge by participating in educational opportunities.
Medical Center Urgent Care Center
Las Vegas Pain Institute & Medical Center
- - Schedules all appointments for their scheduling area. This includes cancelling and rescheduling of appointments, giving patient directions on getting to their appointment, any special instructions needed for the appointment, informing patient where to check in and what to bring to appointment (i.e. Medical records, co-pay, referrals, insurance card, etc.)
- - Completes full registration for new patients as well as verifies and updates all information for any established patients who call to schedule appointments.
- - Diffuses irate customers. Employs sound judgment to ensure best possible public relations. Investigates and resolves customer service concern.
- - Retrieves messages, answers question or directs calls to the appropriate person, if caller has requests other than scheduling or registration.
- - Checks e-mails regularly throughout the day to keep up to date with any changes and receive information on patients who need to be scheduled.
- - Assists with quality control measures and special projects as situations demand. May include but is not limited to reviews own work and reviews reports to verify accurate information. Works with providers and clinic staff to ensure scheduling protocols are clear and up to date.
- - Answers questions about the organization and provides callers with a variety of information such as address, directions, and other agency information.
- - Keeps work area tidy and clean.
- - Perform other job-related duties, as may be assigned.
Helped Out As PBX Operator PRN (Switch Board)
Las Vegas Pain Institute & Medical Center
- - Places outgoing calls for employee which requires operator assistance records such calls, answers questions regarding patient condition according to established procedure.
- - Informs telephone company of equipment malfunction.
- - Answers “code phone” and pages appropriate information.- Assists in processing mail and patient accounts as time permits - Answers questions, direct visitors, to patient rooms, etc. - Files medical billing charts or other records, in prescribed manner, depending upon the department to which assigned.
- - Places material in file cabinet, drawers, boxes or in special filing cases.
- - Locates and removes requested information
- - Keeps record of materials removed, and traces missing record by searching files or contacting person to whom record is assigned. - May enter data on records.
- - May clear files at designated intervals under the direction of a supervisor.
- - Processing of mail returned by the postal service, distribution of both U.S. mail and inter-hospital mail.
Education
Incident Investigation Analysis Certificate -
University of Southern California
01-2014
B.SC HONS - CHEMISTRY
University of Calabar, Cross Rivers State
01-2009
Foundation Comprehensive College -
Oyigbo, Rivers State
01-2002
Skills
- High-Volume Multi-tasking: Safely navigating multiple screens, taking precise notes, and handling text, fax, or call lines simultaneously
- High-Pressure Communication: Maintaining composure, speed, and exceptional empathy when delivering complex or time-sensitive policy information to highly stressed callers
Hobbies
-Writing, -Reading, -Researching
AWARDS/CERTIFICATIONS
UPTO DATE PROFFESSIONAL TRAINING & CERTIFICATES: All Lines Of Business Insurance -Medicare, Medicaid and Commercial.
INTRODUCTION OF IOSA CERTIFICATE (Team Member On Behalf Dana Air/ By IATA, -DANA AIRLINES LIMITED / Safety Management System, -WEIGHT ON WHEELS AVIATION CONSULTING, CANADA/Quality Assurance and Auditing in Civil Aviation Course, -INDOCTRINATION TRAINING / for Maintenance / Quality Personnel (Dana Airlines), -AEROCONSULT/Airline Quality Management Systems; Airworthiness, Quality Audit Techniques, -AVIATION SAFETY & QUALITY SOLUTION (ASQS)/Computer Based Training for Reporting Part of IQSMS; Safety Management Systems for Operational Personnel; Human Factors, -MTN NIGERIA/How May I Help You.
Languages
English
Professional
Timeline
Prior Authorization Specialist
Elevance Health
02.2024 - Current
Customer Service Representative WFH
Support Teams For The (PBM) Division Of CVS Health -Caremark -IngenioRX
01.2021 - 01.2023
Medical Billing Specialist
Las Vegas Pain Institute & Medical Center
01.2018 - 01.2020
Ramp Service Agent
Worldwide Flight Services
01.2016 - 01.2017
Quality and Safety Inspector
Dana Airlines
01.2013 - 01.2016
Quality Inspector
OAS Helicopters
01.2011 - 01.2012
Call Center Customer Care Representative
MTN Nigeria
01.2009 - 01.2011
Medical Center Urgent Care Center
Las Vegas Pain Institute & Medical Center
Helped Out As PBX Operator PRN (Switch Board)
Las Vegas Pain Institute & Medical Center
Incident Investigation Analysis Certificate -
University of Southern California
B.SC HONS - CHEMISTRY
University of Calabar, Cross Rivers State
Foundation Comprehensive College -
Oyigbo, Rivers State