CHAUNTINA ALLEN
Plantation,FL
Summary
- Medical Terminology
- Billing & Collection
- Patient Referrals
- Excellent Problem solver
- Detail Oriented
- Excellent multi-tasker
- Well-equipped expert in MS Office
- Insurance
- Records & Information Management
Overview
17
17
years of professional experience
Work History
Medicare Advocate
Cigna
05.2023 - Current
- A passion for serving others with the ability to be empathetic and the desire to go over and beyond to help resolve members' questions at a first point of contact
- A customer advocate willing to listen and find creative solutions to address and resolve customers' questions, issues or concerns
- A composed individual able to multitask, navigating, multiple computer applications and working efficiently while communicating and serving the customer
- Have a strong work ethic and sense of responsibility to my teammates and members, demonstrated by the simplest thing like being on time, and available to meet members needs, to be accountable to meet commitments made to members or others and ensuring that follow-ups are completed
- A flexible and quick learner, willing to adapt to changing member and business needs; Bill insurance companies for therapies provided
- Document all pertinent communication with patient, physician, insurance company as it may relate to collection procedures
- Identify and coordinate patient resources as it pertains to reimbursement, such as copay cards, third party assistance programs, and manufacturer assistance programs
- Handle inbound calls from patients, physician offices, and/or insurance companies
- Resolve claim rejections for eligibility, coverage, and other issues
Customer Service Specialist
The Hartford
09.2021 - 04.2023
- Provide high quality, low effort experience for policyholders by providing digital first solution and handling policy service requests
- Calls coming into the service center interactions may include any number of policy changes or service requests including coverage changes or billing inquiries
- Follow daily scheduled activities, remaining available to service customers through desktop workspace tools
- Responds to incoming calls, assisting customers with complex insurance needs
- Work with other areas to complete requests (billing)
- Underwriting, and use process/ recourses like IKE.
Program Coordinator I (LTC)
Centene Management Corp
03.2016 - 03.2021
- Initiate authorization requests for output or input services in keeping with the prior authorization list
- Research claims inquiry specific to the department and responsibility
- Perform tasks necessary to promote member compliance such as verifying appointments, obtaining lab results
- Assess and monitor inpatient census
- Data enter assessments and authorizations into the system
- Coordinate services with community-based organizations
- Attend marketing and outreach meetings as directed to represent the plan
- Produces and mails routine CM letters and program educational material
- Screen for eligibility and benefits
- Identify members without a PCP and refer to Member Services
- Screen members by priority for case management (CM) assessment
- Perform transition of care duties to include but not limited to contacting the member’s attending physician, member or medical power of attorney, other medical providers (home health agencies, equipment vendors) for information pertaining to special needs.
Customer Service Rep II
Centene Management Corp
01.2014 - 03.2016
- Resolve customer inquiries via telephone and written correspondence in a timely and appropriate manner
- Provide assistance to members and/or providers regarding website registration and navigation
- Document all activities for quality and metrics reporting through the Customer Relationship Management.
Medical Customer Service Representative (Temp)
American Anesthesiology
06.2013 - 11.2013
- Placed and received high volume calls to patients regarding their bill
- Accepted payments from patients over the phone and by mail
- Knowledgeable of insurance billing
- Processed mail correspondence such as Bankruptcies and attorney requests while following the HIPAA guidelines
- Verified patient’s eligibility and submitted claims to the appropriate insurance companies.
Billing/Collection Specialist
Chrysalis Center
11.2010 - 05.2013
- Prepared 250+ claims daily & submit to private and commercial carriers such as Aetna, Amerigroup
- Medicaid, HMO, third party insurances and patients
- Performed heavy data entry, answered the phones, filed, faxed and copied documents and evaluated & processed 350 benefits from various insurance carrier and followed-up on status of outstanding claims
- Prepared & submitted claims in an accurate & timely manner
- Resubmitted denials and managed 500 patient accounts daily
- Verified patients' eligibility and claims status with insurance agencies
- Reviewed and recommended write-off and/or adjustments of accounts.
Customer Service Specialist
Plaza Health Solution
02.2009 - 11.2010
- Promoting and selling of medical devices/supplies for diabetic patients
- Made 150 outbound calls per day to hear the reaction to the customer about their devices
- Followed up with the customers if they should have any objections, problems or concerns with their devices
- Posted and adjusted payments from insurance companies
- Identified and resolved patient billing and payment issues.
Provider Service Representative
United Health
12.2007 - 11.2008
- Assisted Medicare customers with enrollment in reviewing and approving their applications
- Mailed out approved ID card receipt, and provided accurate information to members on available products-based plans of the employers group
- Responsible for complying with Medicare state sales and marketing requirements, ensured Medicare beneficiaries were accurate with their benefits and products that they have available to them
- Met or exceeded service and quality standards every review period.
Member Service Representative
Coventry Health
10.2006 - 12.2007
- Verified benefits and eligibility
- Managed various general office duties such as answered multiple telephone lines, completed insurance forms and mailed monthly invoice statements
- Experience with Availity Health Billing System.
Education
Associate of Science in Medical Administrative Billing and Coding -
Keiser College
Ft. Lauderdale, FL11.2024
High School Diploma -
Northeast High School
Oakland Park, FL01.1992
Skills
- Policy Development
- Training Delivery
- Document Review
- Benefits Administration
Timeline
Medicare Advocate
Cigna
05.2023 - Current
Customer Service Specialist
The Hartford
09.2021 - 04.2023
Program Coordinator I (LTC)
Centene Management Corp
03.2016 - 03.2021
Customer Service Rep II
Centene Management Corp
01.2014 - 03.2016
Medical Customer Service Representative (Temp)
American Anesthesiology
06.2013 - 11.2013
Billing/Collection Specialist
Chrysalis Center
11.2010 - 05.2013
Customer Service Specialist
Plaza Health Solution
02.2009 - 11.2010
Provider Service Representative
United Health
12.2007 - 11.2008
Member Service Representative
Coventry Health
10.2006 - 12.2007
Associate of Science in Medical Administrative Billing and Coding -
Keiser College
High School Diploma -
Northeast High School
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