CHARICA BROWN

• Verified claims for accuracy and completeness, facilitating faster reimbursement timelines.
• Processed claims efficiently while following regulations and policy requirements.
• Reviewed billing issues and corrected discrepancies for accurate claim processing.
• Supported clear communication with providers to speed claims resolution.
• Collaborated with team members to streamline workflow and enhance claims processing efficiency.
• Communicated with healthcare providers to clarify billing issues and gather needed documentation.
• Audited claims thoroughly to find and fix inconsistencies.
• Participated in team meetings to strategize solutions for complex claim issues.

Provided expert guidance on complex medical and prescription insurance issues, including verification, claim billing, medication prior authorization, and appeal filing, ensuring clarity and compliance.

· Handled outbound and inbound calls from members, providers, and resources, completing non-clinical pathways and screenings to facilitate member support.

Analyzed information, identified trends, and generated reports to inform decision-making.

• Managed pre-authorization requests by collecting insurance information, accurate CPT and ICD-10 codes, and clinical documentation from referring physician.
• Directed patient record management practices to ensure privacy compliance and enhance data accuracy.
• Organized patient scheduling to improve clinic workflow and reduce wait times.
• Resolved claims discrepancies to keep processing on schedule and support prompt payment.
• Strengthened team communication to facilitate efficient daily operations among staff.