Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic

Chiquita Baker

Wendell,NC

Summary

Chiquita is a highly skilled professional in insurance and customer service. She has experience and expertise in insurance products, benefits, premiums, enrollment guidelines, billings, and customer needs. She has worked in many roles analyzing documentation, facilitating communication between parties, and handling routine and complex issues. In her previous positions as a Senior Reimbursement Analyst at AbbVie Pharma and Appeals Coordinator at Healthcare Corporation of America, she provided subject matter expertise and top-notch customer service for both inbound and outbound customer calls. The focus was on achieving first-call resolution and ensuring customer satisfaction. She also provided offices with up-to-date plan forms, portals, and websites to facilitate processes like prior authorizations and appeal submissions. Chiquita was responsible for coordinating insurance billing, claims processing, and appeal filings. She kept meticulous records of all relevant information in the appropriate online systems and formats. Additionally, she helped patients navigate the often-complex world of insurance claims, explaining coverage, assisting with record-keeping, and clarifying the claims process. Furthermore, she proactively identified opportunities for policyholders to maximize their benefits, including preventive care, wellness programs, and available resources. Chiquita was proficient in Microsoft Word and Microsoft Excel.

Overview

17
17
years of professional experience
1
1
Certification

Work History

Senior Reimbursement Analyst

AbbVie Pharma-Remote
01.2023 - 03.2023
  • As part of my job, I provided subject matter expertise and excellent customer service for all inbound and outbound customer calls
  • My aim was to resolve any issues on the first call
  • I provided insurance coverage, verification details, prior authorization statuses, and alternate funding options for existing and newly launched products
  • I also provided offices with up-to-date plan forms, portals, and websites for prior authorizations and appeals submissions
  • Assist with credentialing documentation collection, primary source verification processes, audits preparation and other credentialing activities as needed.I communicated and educated customers on the results of the investigation
  • I investigated and resolved issues for patients experiencing escalated problems such as disadvantaged or complex access, savings card/copay card challenges, or non-preferred formulary issues
  • I completed a benefits investigation and contacted the healthcare provider and patient to discuss options, or potentially the filling pharmacy or payor
  • I created individualized proposals for clients that included coverage options, premiums, and enrollment guidelines
  • I coordinated enrollment into plan benefits directly with insurance companies or the marketplace
  • I quickly learned and executed business process and system changes for all drugs and channel sources as applicable
  • I maintained an understanding of current business procedures, deviations, and case processing for all brands and channel sources
  • I documented and formatted information in the appropriate health care system of record
  • I accurately communicated insurance details to healthcare providers and patients via phone, other electronic communication methods, and fax, per established policies and procedures
  • I provided billing and coding information related to specific products
  • I conducted general payer research, investigated benefits via phone/Internet and web portals, and coordinated insurance billing, claims processing, and appeal filings
  • I maintained accurate documentation of all relevant information in appropriate online systems and formats
  • I managed call inquiries and investigations on patient insurance benefits and financial assistance opportunities for specialized medications
  • I had the ability to analyze, interpret, apply reason and logic, and conduct research to structure a clear and thorough response
  • I was proficient in proofreading, spelling, grammar, punctuation, and math.

Appeals Coordinator/Insurance Verification

TrialCard-Remote
01.2022 - 10.2022
  • In this role, I conducted medical and pharmacy benefit investigations and facilitated the submission of necessary documentation for payer/plan review for prior authorization, step edit identification, and appeals, in accordance with program standard operating procedures
  • I reached out to patients via outbound calls to discuss their out-of-pocket costs, payment options, and coverage
  • I adhered to program guidelines and escalated complex cases following program policy and procedures
  • I maintained open communication channels with patients and providers to discuss financial resources, access restrictions, policy changes, and other reimbursement landscape changes
  • I helped patients and providers navigate the necessary steps for patients to receive the help they needed
  • I effectively managed and worked through the action item list to ensure that it was current and that tasks were promptly completed
  • I maintained accurate and complete documentation of all inquiries to continuously improve the customer service process and reduce potential legal concerns
  • I demonstrated the ability to apply policies and procedures to arrive at accurate conclusions
  • I demonstrated the ability to analyze, interpret, apply reason and logic, and conduct research to structure a clear and thorough response
  • I demonstrated the ability to quickly learn and navigate diverse products and information systems
  • Collaborate with Contracting in securing new payors and a new payor setup
  • Assist with clinician communication, data collection, and follow up with payors and clinicians and their deliverables
  • In collaboration with Manager, produce various regulatory reports and monthly submissions of roster updates.

Senior Reimbursement Analyst

Advance Community Health-Raleigh, NC
07.2020 - 12.2020
  • I managed the appointment scheduling and patient registration process while adhering to HIPAA privacy regulations to ensure the accuracy of patient records in the computer system
  • To improve the department's call-taking rate, I effectively managed patient calls while verifying demographics and insurance information for precise registration
  • I also conducted patient communication for intake data, appointment scheduling, and medical record updates while ensuring adherence to HIPAA regulations and accurate data management in EPIC/Salesforce
  • I maintained organized records of customer interactions, issue resolutions, and feedback while adhering to data privacy and compliance standards
  • Additionally, I assisted patients in navigating insurance claims, explaining coverage, record keeping, and helping them understand the claims process
  • I guided individuals through healthcare insurance enrollment, helping them understand available options and eligibility requirements
  • Moreover, I proactively identified opportunities for policyholders to maximize their benefits, including preventive care, wellness programs, and available resources
  • Finally, I accurately documented and reviewed healthcare claims, ensuring all required information is captured for processing, and maintained detailed records of claims submissions and outcomes.

Senior Reimbursement Analyst/ Insurance Verification Specialist

Healthcare Corporation of America-Cary, NC
09.2019 - 12.2019
  • I completed the annual enrollment and yearly benefits for enrollees
  • I provided a detailed explanation of coverage benefits and provisions
  • I educated customers about the fundamentals and benefits of consumer-driven healthcare, guiding them on topics such as selecting the best benefit plan options and maximizing the value of their health plan benefits
  • I ensured accurate documentation and plan selection
  • I provided an estimate of the potential patient responsibility based on the benefits coverage
  • Perform various activities including gathering data for submission of enrollment applications to and monitor the progress of enrollment
  • Create and analyze enrollment rosters for internal and external customers
  • Assure accuracy of enrollment data in our credentialing/ enrollment database
  • Strong letter writing and proofreading skills
  • Excellent verbal and written communication skills
  • High attention to detail and remain organized
  • High regard for quality work, accuracy, and confidentiality
  • The ability to use and apply previous experiences and knowledge when encountering new or unfamiliar situations.

Bookkeeper

Foodlion
02.2006 - 09.2015
  • Maintained and processed invoices, deposits, and money logs.
  • Managed accounts payable and receivable activities, maintaining vendor relationships and positive cash flow.
  • Handled payroll processing for employees, ensuring timely payment and adherence to tax regulations.
  • Monitored incoming payments from clients, ensuring prompt application of funds against outstanding invoices.

Education

Bachelor's degree in Science -

University of Phoenix - Phoenix, AZ
11.2024

Associate degree in Business Fundamentals -

University of Phoenix - Phoenix, AZ
03.2022

High school diploma -

Wake Technical Community College - Raleigh, NC
06.2017

Skills

  • Regulatory Compliance
  • Performance Management
  • Interdepartmental Communication
  • Healthcare
  • Problem Solving
  • Patient Advocacy
  • Reconciled customer disputes as they pertain to payment of outstanding balances that are due
  • Documented in Salesforce all details surrounding the patient's healthcare benefit coverage and recommended appropriate payment options
  • Financial Reporting
  • Claims Processing
  • Document Formatting
  • Process Improvement
  • Insurance Verification
  • Made outbound calls to patients to review out-of-pocket costs and discuss payment options
  • Technical Proficiency
  • Data Management
  • Knowledge of preparing appropriate claim documents
  • Administration
  • Leadership
  • Documentation Review
  • Provided an estimate of the potential patient responsibility based on the benefits coverage
  • Ability to manage multiple priorities and meet deadlines
  • Excellent written and verbal communication skills demonstrated ability to communicate with others at all levels
  • Customer Service
  • Processed and troubleshooted internet and telephone claims and responded to e-mails using
  • Project Organization
  • Insurance Processing
  • Program Coordination
  • Maintained confidentiality of patient data and medical records in compliance with HIPAA regulations
  • Policy Implementation
  • Billing Management
  • Able to perform charge review, claim submission, claim follow-ups, payment posting, and patient statements
  • Updated records with complete patient and insurance information
  • Excellent customer skills, patience in explaining details and processes repeatedly, and excellent phone presentation skills
  • Resource Coordination operating procedures
  • Medical Billing
  • ICD-10
  • CPT coding
  • Medical terminology
  • Medical coding
  • Salesforce
  • Epic
  • Microsoft Office
  • Microsoft Excel (Intermediate)
  • CRM software
  • Zendesk (Less than 1 year)
  • Medicare/Medicaid (10 years)
  • HIPAA knowledge
  • Healthcare Reimbursement
  • Microsoft Excel
  • Denial Management

Certification

College of Business and Information Technology Dean's List

Timeline

Senior Reimbursement Analyst

AbbVie Pharma-Remote
01.2023 - 03.2023

Appeals Coordinator/Insurance Verification

TrialCard-Remote
01.2022 - 10.2022

Senior Reimbursement Analyst

Advance Community Health-Raleigh, NC
07.2020 - 12.2020

Senior Reimbursement Analyst/ Insurance Verification Specialist

Healthcare Corporation of America-Cary, NC
09.2019 - 12.2019

Bookkeeper

Foodlion
02.2006 - 09.2015

Bachelor's degree in Science -

University of Phoenix - Phoenix, AZ

Associate degree in Business Fundamentals -

University of Phoenix - Phoenix, AZ

High school diploma -

Wake Technical Community College - Raleigh, NC
Chiquita Baker