Chatni Brown

· Provide subject matter expertise and best-in-class customer service for all inbound and outbound customer calls to drive first call resolution. Provide insurance coverage, verification details prior authorization statues and alternate funding options for existing and newly launched products. Provide offices with current plan forms, portals, and websites for prior authorizations and appeal submissions. Clearly communicate and educate customers on the results of the investigation.

· Investigate and problem solve for patients experiencing escalated issues such as disadvantaged or complex access, savings card/copay card challenges or non-preferred formulary issues. Where necessary, complete a benefit investigation, contact the HCP and/or patient or potentially the filling pharmacy or payor.

Take inbound calls from a variety of entities including HCP's,patients, ambassadors, field access specialists, and pharmacies. Complete outbound calls to handle escalated issues regarding benefit verifications for the medication the patient has been prescribed.

Processing and monitoring prior authorizations to assist the patient in starting or continuing therapy. Checked documentation for accuracy and validity.

• Started as a claims specialist assisting claimants in completing applications.
• Reviewed applications for different aid programs and determined qualification criteria for individuals.
• Later moved to the back office team and trained to review documents to determine authenticity and verify employment information and promoted to Support Lead in which I gained the responsibility of answering all questions of agents on the team, handling escalations, and training new agents to complete various different back office task pertaining to verifying employment, calculating income, and detecting fraud.
• Verified timekeeping records and handled any discrepancies with employees.
• Monitored the statuses of 30-100 agents in rotating shifts to ensure productivity within the company and assisted with tech issues.
• Assisted in completing Quality Reviews by monitoring inbound and outbound phone calls and provided coaching as necessary.

• Evaluated accuracy and quality of data entered into agency management system
• Processed and recorded new policies and claims
• Managed large volume of medical claims on daily basis
• Paid or denied medical claims based upon established claims processing criteria
• Maintained strong knowledge of basic medical terminology to better understand services and procedures
• Reviewed provider coding information to report services and verify correctness
• Assisted in resolving escalated issues.

• Upheld strict financial controls by keeping funds secure and accurately transferring monies
• Handled accounts of Unemployment recipients; business accounts; child support recipients and various other entities
• Monitored customer behaviors and upheld strict protocols to prevent theft of assets
• Completed special procedures for customers such as stopping payments or investigating identity theft
• Helped clients protect assets through variety of strategies
• Checked accounts for fraud
• Initiated emergency transfers; Educated customers on use of banking website and mobile apps
• Assisted customers with compromised debit cards and issued new credentials
• Educated customers on account information such as balances and transactions history and any other questions they may have
• Answered telephone inquiries on banking products including checking, savings, loans and lines of credit.

• Ensured HIPAA compliance
• Reviewed customer survey information to prioritize areas of improvement
• Managed various general office duties such as answering multiple telephone lines, completing insurance forms and mailing monthly invoice statements to patients
• Greeted numerous visitors, including VIPs, and vendors
• Contacted patients regarding unpaid and underpaid accounts to resolve any issues
• Answered inquiries and addressed, resolved or escalated issues to management personnel to ensure client satisfaction
• Tracked the progress of all outstanding insurance claims
• Spent ample time with each customer going over and explaining documents to ensure that they understood key information
• Navigated through up to eight systems at a time
• Used Epic to verify patient information, services provided, update information, open disputes, etc
• Used Insurance portals to verify insurance information
• Maintained multiple passwords securely to enter systems and kept information confidential.

• Precisely completed appropriate claims paperwork, documentation and system entry
• Adeptly managed phone system and pleasantly greeted all patients
• Meticulously identified and rectified inconsistencies, deficiencies and discrepancies in medical documentation
• Maintained strict patient and physician confidentiality
• Precisely evaluated and verified benefits and eligibility
• Responded to correspondence from insurance companies
• Identified and resolved patient billing and payment issues
• Examined patients' insurance coverage, deductibles, possible insurance carrier payments and remaining balances not covered under their policies when applicable.

• Scheduled appointments for patients and determined whether their procedures should be authorized or whether they would require additional review
• Precisely completed appropriate claims paperwork, documentation and system entry
• Correctly coded and billed medical claims for various hospital and nursing facilities
• Professionally and courteously verified appointment times with patients
• Maintained updated knowledge of coding requirements, through continuing education
• Adeptly managed a multi-line phone system
• Verified patients' eligibility and claims status
• Quickly responded to and resolved all customer service issues in a timely manner.