Crystal Muncy
Medical Authorization,Insurance Verification
Winston-Salem,NC
Summary
Dynamic professional with extensive experience in healthcare, including roles at Humana and Novant Health. Proven ability to deliver exceptional customer service while mastering insurance verification and prior authorization processes. Skilled in medical terminology and effective communication, ensuring compliance and enhancing patient satisfaction in fast-paced environments.
Overview
11
11
years of professional experience
Work History
Elderly Caregiver
Self-employeed
Winston-Salem, NC
06.2022 - Current
- Managed emergency situations with composure and efficiency.
- Drove mother-in-law to medical appointments and social engagements.
- Engaged clients through meaningful conversations and shared activities.
- Delivered comprehensive care for elderly mother-in-law, including laundry management and personal assistance.
Medicare Customer Service Representative
Humana/ Work from Home
Charlotte, NC
11.2023 - 08.2024
- Delivered exceptional customer service to providers by addressing inquiries, resolving issues related to benefits, claims, appeals, authorization status, checking patients' benefits, and pre-authorizations in a timely manner.
- Maintain a positive attitude while interacting with providers.
- Managed high volume of incoming calls efficiently, ensuring timely resolution of customer inquiries.
Insurance Verification Specialist
Novant Health, Inc/ Remote
Winston-Salem, NC
12.2020 - 09.2023
- Mastered state and Federal benefit laws Including ERISA, FMLA, COBRA, HIPPA and 401k administration.
- Ensured accurate insurance verification and coverage benefits, creating estimates for patient procedures.
- Verified medical insurance for Medicare, commercial, and Medicaid patients scheduled for Radiology tests and procedures.
- Secured prior authorizations from insurance companies for upcoming patient appointments.
- Communicated with patients regarding their insurance benefits and potential out-of-pocket expenses.
Benefit Specialist
The Neil Group
Winston-Salem, NC
02.2016 - 07.2016
- Verified benefits for substance abuse and mental health treatment from Medicare, Medicaid, and commercial insurances.
- Gathered accurate information from live insurance representatives and navigated insurance portals efficiently.
- Ensured compliance with federal, state, and local regulations.
- Facilitated drug testing procedures for patients , ensuring compliance with company policies.
Collections /Medical Claims Specialist
Central Carolina OB/ GYN
Greensboro, NC
07.2014 - 02.2016
- Identified incorrect charges on invoices by comparing them against contracts and fee schedules.
- Modified and updated existing policies and claims to reflect change in beneficiary, amount of coverage or type of insurance.
- Generated monthly reports detailing collection activities, delinquencies, trends.
- Remained calm, stayed professional, and provided exceptional service on calls, even when interacting with difficult individuals.
- Drafted letters to delinquent customers to inform them of their past due balances.
- Prepared and sent out demand letters and collection notices to delinquent accounts.
Education
GED -
Forsyth Technical Community College
Winston-Salem, NC05-1991
Skills
- Medical care support
- Client safety and first aid
- Emotional companionship
- Call center experience
- Medicare
- CMS guidelines
- Medical terminology
- Strong communication skills
- Insurance plan verification
- Prior authorization processing
- Insurance terminology
- Insurance benefits verification
- Medicaid
- Data entry proficiency
- Deductible & co-pay calculation
- Allscripts
- Healthcare industry
- Electronic medical records
- Eligibility determination
- Patient communication
- Customer service
- Skilled in Epic
- Referral coordination
- Insurance billing
- Radiology
- Coverage and authorizations
- EMR
- Claims processing
- HIPAA regulations
- Diagnostic appointments
- Insurance pre-certification processes
- Multi-line phone proficiency
- Patient scheduling
- Appointment scheduling
- Pre-authorizations
- Outbound calls
References
References available upon request.
Education and Training
GED
Trained in pharmacy part B drugs such as Biogen,Biovise
References
References available upon request.
Timeline
Medicare Customer Service Representative
Humana/ Work from Home
11.2023 - 08.2024
Elderly Caregiver
Self-employeed
06.2022 - Current
Insurance Verification Specialist
Novant Health, Inc/ Remote
12.2020 - 09.2023
Benefit Specialist
The Neil Group
02.2016 - 07.2016
Collections /Medical Claims Specialist
Central Carolina OB/ GYN
07.2014 - 02.2016
GED -
Forsyth Technical Community College
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