Carlaire Hilaire
Pomona,USA
Summary
Hardworking Prior Authorization Specialist with successful background working closely with insurance company representatives to gain preapproval for procedures and testing. Detail-oriented performer with over a year of managing documentation. Considered team player with exemplary multitasking skills.
Overview
7
7
years of professional experience
Work History
Prior Authorization Specialist
Montefiore Einstein Advanced Care
12.2023 - Current
- Collaborated with physicians to obtain necessary clinical information for prior authorization submissions.
- Maintained thorough knowledge of insurance plan requirements, facilitating accurate and timely completion of authorization forms.
- Analyzed medical records and other documents to determine approval of requests for authorization.
- Reached out to insurance carriers to obtain prior authorization for testing and procedures.
- Researched denied claims and contacted insurance companies to resolve these issues.
Coach
Walmart
04.2020 - 11.2023
- .Provide excellent customer service
- .Carry out periodic inventory of items in stock and those out of stock
- .Provides supervision and development opportunities for associates by hiring and training
- Walked through store areas to identify and proactively resolve issues negatively impacting operations.
- Supervised and evaluated staff to help improve skills, achieve daily objectives, and attain advancement.
Team Lead
Walmart
09.2019 - 03.2020
- Provide information about products and services, to take orders or cancel accounts, or to obtain details of complaints
- Resolve customer's service or billing complaints by performing activities such as exchanging merchandise, refunding money, and adjusting bills
- Trained new team members by relaying information on company procedures and safety requirements.
- Worked different stations to provide optimal coverage and meet production goals.
Customer Service Representative
TRG
02.2018 - 11.2019
- Evaluate, analyze, and verify dates of service and billed amounts
- Troubleshoot customer's online account & educate customer on technical concerns
- Resolve product or service problems by clarifying the customer’s complaint; determining the cause of the problem; selecting and explaining the best solutions to solve the problem
Education
HS Diploma -
North Rockland high school
Thiells, NY06.2013
Associate Degree - Physical Therapy
Essex county college
Newark, NJ05.2016
Bachelor - Physical Therapy
Alfred State College
Alfred, NY05-2022
Skills
- Leadership
- Problem Solving
- Customer Service
- Inventory Management
- Insurance verification
- Prior authorization process
- Authorizations
- Medical office procedures
Languages
French
Haitian Creole
Timeline
Prior Authorization Specialist
Montefiore Einstein Advanced Care
12.2023 - Current
Coach
Walmart
04.2020 - 11.2023
Team Lead
Walmart
09.2019 - 03.2020
Customer Service Representative
TRG
02.2018 - 11.2019
Associate Degree - Physical Therapy
Essex county college
HS Diploma -
North Rockland high school
Bachelor - Physical Therapy
Alfred State College
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