Summary
Overview
Work History
Education
Skills
Timeline
Generic

Debbie Blevins

Kissimmee,United States

Summary

Dedicated professional with strong communication and customer service skills. Experienced in medical billing and claims processing, ensuring accuracy and compliance while effectively resolving inquiries and discrepancies.

Detail-oriented Precertification Specialist with proven expertise in analyzing trends in claims denials and resolving discrepancies.

Skilled in data entry accuracy and insurance verification, committed to ensuring timely processing and compliance with HIPAA regulations.

Proficient in delivering exceptional customer service and support within the healthcare industry. Known for strong organizational skills and effective communication, driving successful outcomes in claims processing and patient inquiries. Certified Precertification Specialist with experience in the healthcare industry. Familiarity with insurance coverage, medical coding, and patient authorization procedures proves advantageous. Strengths include strong communication skills, adaptability to evolving guidelines, and ability to efficiently handle high volume of precertifications. Contributed significantly to streamlining processes and improving patient satisfaction in previous roles. Highly-motivated employee with desire to take on new challenges. Strong work ethic, adaptability, and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills. Experienced in fast-paced environments and adaptable to last-minute changes. Thrives under pressure and consistently earns high marks for work quality and speed. Dedicated and adaptable professional with a proactive attitude and the ability to learn quickly. Strong work ethic and effective communication skills. Eager to contribute to a dynamic team and support organizational goals.

Overview

4
4
years of professional experience

Work History

Precertification Specialist

Parallon
Kissimmee, Florida
05.2025 - Current
  • Processed appeals when necessary following denial or rejection of claims due to lack of proper authorization.
  • Analyzed trends in denials or rejections of claims due to lack of proper authorization.
  • Resolved any discrepancies identified during the precertification process.
  • Reviewed patient medical records to determine medical necessity for requested services and procedures.
  • Verified insurance eligibility, coverage levels, and benefit parameters prior to submission of precertification requests.
  • Evaluated clinical criteria against existing health plan guidelines to determine authorization status.
  • Utilized various software applications such as electronic medical record systems for data entry purposes.
  • Compiled and submitted precertification requests for review by payers in accordance with established timelines.
  • Provided follow-up on pending precertification requests to ensure timely processing.
  • Ensured compliance with all HIPAA regulations pertaining to protected health information.
  • Assisted with answering provider inquiries regarding preauthorization requirements and processes.
  • Managed intake of new claims and performed routine follow-ups.
  • Scheduled and confirmed patient appointments and consultations.
  • Scheduled tests, lab work or x-rays for patients based on physician orders.

Medicare Customer Service Representative

Ehealth Insurance
Kissimmee, Florida
06.2021 - 03.2025
  • Answered incoming calls from Medicare beneficiaries, providing them with information regarding their benefits.
  • Maintained accurate records of customer interactions and transactions.
  • Followed up with customers via telephone or email to ensure that their needs were met.
  • Provided guidance and support to customers regarding billing issues and payment plans.
  • Delivered patient information, appointment results and insurance information to other office staff for reporting and billing purposes.
  • Responded to member questions regarding plan benefits and provisions.
  • Handled new enrollments by entering customers' data and reviewing information.
  • Expertly assigned charges and payments for medical procedures.
  • Provided beneficiaries with information about plan benefits and eligibility determinations.
  • Contacted customers about potential service upgrades, new services and account changes.
  • Engaged in conversation with customers to understand needs, resolve issues and answer product questions.
  • Increased customer satisfaction ratings by effectively answering questions, suggesting effective solutions, and resolving issues quickly.
  • Updated system with order specifics and customer details, preferences, and billing information.
  • Collected deposits or payments and arranged for billing.
  • Maintained accurate records of customer interactions, transactions and comments in the company's database.
  • Resolved customer complaints promptly and professionally.
  • Verified patient eligibility for benefits according to healthcare policies and procedures.
  • Reviewed medical bills for accuracy prior to submission to insurance companies.
  • Provided accurate information regarding insurance coverage, billing and payment processing.
  • Educated patients on how to access online portals for scheduling appointments, making payments or viewing lab results.
  • Handled incoming correspondence from insurance companies regarding claims processing issues.
  • Collected patient demographic and insurance information for new patients.
  • Provided technical support to customers having difficulty navigating online systems or websites related to medical services.
  • Communicated effectively with various departments within the organization in order to resolve customer issues quickly.
  • Processed payments for medical services rendered using appropriate software applications.
  • Informed customers about services available at the clinic or hospital.
  • Applied HIPAA privacy and security regulations while handling patient information.
  • Verified demographics and insurance information to register patients in computer system.
  • Obtained necessary signatures for privacy laws and consent for treatment.

Education

High School Diploma -

ORANGE HIGH
Orange, CA
06-1980

Some College (No Degree) - Health Information Management

College of Southern Nevada
Las Vegas, NV

Skills

  • Insurance verification
  • Time management
  • Medical terminology proficiency
  • Electronic health records management
  • Medical coding
  • Medical billing
  • Conflict resolution
  • Effective communication
  • Data entry accuracy
  • Benefits explanation
  • Detail orientation
  • Customer service
  • Precertification requests
  • Medical record review
  • Claims processing
  • Clinical criteria evaluation
  • Healthcare regulations
  • Problem solving
  • Recordkeeping and data input
  • Public assistance programs
  • HIPAA compliance awareness
  • Insurance verification expertise
  • Prior authorization
  • Documentation and reporting
  • Knowledgeable in [software]
  • Microsoft office
  • Strong communication skills
  • Professionalism and ethics
  • Patient confidentiality adherence

Timeline

Precertification Specialist

Parallon
05.2025 - Current

Medicare Customer Service Representative

Ehealth Insurance
06.2021 - 03.2025

High School Diploma -

ORANGE HIGH

Some College (No Degree) - Health Information Management

College of Southern Nevada
Debbie Blevins