Charity Chiles
Cedar Hill,TX
Summary
Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals. Detail-oriented prior authorization specialist proudly offering several years' experience managing medical documents meticulously. Polished professional known for working closely with insurance companies to alleviate denied claims and obtain necessary prior approvals for services. Multitasks expertly in fast-paced environments.
Overview
9
9
years of professional experience
Work History
Research Specialist
PennyMac
Fort Worth, TX
07.2021 - 07.2023
- Created detailed reports summarizing key findings from conducted research studies.
- Managed project timelines by setting deadlines for tasks involved in the completion of research objectives.
- Developed surveys and questionnaires for research projects, analyzed data, and presented results.
- Developed and maintained databases, pulling relevant data.
- Utilized data from program participants and survey respondents for research and evaluation purposes.
- Obtained data from patient medical records, histories and surveys.
- Provided exceptional customer service by responding promptly to inquiries and resolving issues efficiently via email and live chat.
Account Resolutions Specialist
EECU
09.2019 - 07.2021
- Performed credit reviews prior to approving account extensions or new services.
- Provided exceptional customer service by responding promptly to inquiries and resolving issues efficiently via email and live chat.
- Ensured compliance with all applicable laws and regulations pertaining to debt collection practices.
- Worked closely with legal counsel on matters related to litigation or bankruptcy cases.
- Identified and resolved customer issues in a timely manner.
- Analyzed financial data to accurately assess risk associated with collections activities.
- Prepared reports related to collection activities and account statuses.
- Maintained accurate records of customer interactions, transactions, comments and complaints.
Prior Authorization Specialist
Parkland Hospital
Dallas, TX
06.2016 - 09.2019
- Researched clinical criteria and determined eligibility for requested services based on plan provisions.
- Ensured compliance with state and federal regulations pertaining to prior authorizations.
- Conducted quality assurance audits of prior authorization processes according to established standards.
- Processed appeals in a timely manner as per policy guidelines.
- Reviewed prior authorization requests to ensure accuracy and completeness of required information.
- Responded promptly to inquiries from providers, patients and payers regarding status of prior authorization requests.
- Reviewed claims submitted without valid pre-authorization codes and took corrective action when necessary.
- Advised provider offices on proper coding practices that are necessary for successful claim submission.
- Coordinated with other departments to obtain additional information needed for prior authorization.
- Facilitated communication between providers, payers and health plans regarding prior authorization processes.
- Verified patient insurance coverage, including eligibility, benefits and authorizations for medical services.
- Contacted insurance carriers to obtain authorizations, notifications and pre-certifications for patients.
- Input claim, prior authorization, and other important medical data into system.
Quality Assurance Analyst
US Bank NA
Irving, TX
01.2014 - 05.2016
- Maintained up-to-date knowledge of industry standards related to software testing best practices.
- Assisted other members of the QA team in identifying areas for improvement in processes and procedures.
- Conducted detailed analysis of business requirements and developed test plans to ensure quality assurance.
- Maintained policy, procedures, work instructions, and projects for quality and continuous improvement agendas.
- Utilized client satisfaction surveys to improve service quality.
- Created, edited, and updated project manuals and technical documentation used by entire QA team.
Education
BBA - Business Administration And Management
Western Governors University
Salt Lake City, UT05-2016
High School Diploma -
A. Maceo Smith High School
05-2003
Skills
- Database Research
- Information Research
- Data Collections
- Research Procedures
- Active Listening
- Research Support
- Administrative Support
- Customer Satisfaction
- Effective Communication
- Customer Accounts Management
- Complex Problem-Solving
- Customer Inquiries
- Data Entry Software
- Accounts Payable and Accounts Receivable
- Bankruptcy Processes
- Client Correspondence
- Outbound Calls
- Data Entry
- Customer Needs Assessments
- Verbal and Written Communication
- Conflict Resolution Tactics
- Documentation Processing
- Corrective Actions
- Customer Care
- Conflict Resolution
- Data Collection
- Data Interpretation
- Policy analysis
- MS Excel
- Analytical Thinking
- Advanced Research Techniques
- Feedback Analysis
- Interpersonal Skills
- Project Management
- Relationship Building
- Organizational Skills
- Self-Driven and Motivated
- Task Prioritization
- Attention to Detail
Timeline
Research Specialist
PennyMac
07.2021 - 07.2023
Account Resolutions Specialist
EECU
09.2019 - 07.2021
Prior Authorization Specialist
Parkland Hospital
06.2016 - 09.2019
Quality Assurance Analyst
US Bank NA
01.2014 - 05.2016
BBA - Business Administration And Management
Western Governors University
High School Diploma -
A. Maceo Smith High School
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