Destinee Wilder
Chicago,IL
Summary
Dynamic Prior Authorization Representative at The Cigna Group with expertise in medical billing and crisis management. Proven track record in enhancing authorization processes and ensuring compliance, while delivering exceptional customer service. Skilled in ICD-10 coding and adept at resolving complex issues, fostering strong relationships with healthcare providers and clients alike.
Overview
8
8
years of professional experience
1
1
Certification
Work History
Prior Authorization Representative
The Cigna Group
Philadelphia, PA
01.2024 - Current
- Reviewed and processed prior authorization requests for medical services, procedures, and treatments in accordance with established guidelines and payer requirements.
- Verified patient eligibility, benefits, and coverage details to ensure accuracy and compliance with policy criteria.
- Communicated with healthcare providers, medical offices, and internal departments to obtain required clinical documentation and resolve authorization-related issues.
- Entered and maintained authorization data within internal systems while ensuring timely and accurate processing.
- Followed HIPAA regulations and confidentiality standards when handling protected health information.
- Managed multiple requests simultaneously while meeting productivity, quality, and turnaround time expectations.
- Provided professional customer service support by responding to inquiries regarding authorization status and coverage determinations.
SPOC (remote customer service)
Dovenmuehle Mortgage, Inc.
Lake Zurich, IL
02.2022 - 01.2024
- Responsible for the quality assurance of all work performed within the department.
- Help determine a set of options that a lender can use to help borrowers avoid foreclosure.
- Analyze financial documents.
- Initiate and maintain communications with borrowers and explain the options available to them, including educating them about any programs or resources that may provide assistance.
- Review and update department procedures in a timely manner to reflect all regulatory and compliance updates.
- Confirm payment or negotiate payment arrangements.
Authorization Representative
Direct Energy
01.2020 - 03.2022
- Code each diagnosis of service and procedures according to standards.
- Enlisting non-contracted service providers to perform repairs for HWA customers.
- Inbound call center environment from service providers and current internal and external customers nationwide; additional admin/clerical duties; outbound follow-up with service providers and customers with outstanding questions/concerns.
- Provide resolution to service provider and customer concerns, deescalate concerns by providing professional, courteous, and clear communication of repairs and warranty information.
- Receive service provider repair info, record in claim notes and provide coverage/repair decision.
- Responsible for establishing rapport with service providers and new and existing customers.
- Facilitating the scheduling of service appointments between service providers and customers in a timely, professional manner.
Customer Service Representative/Call Center
Augeo Fi
Naperville, IL
03.2019 - 01.2020
- Provide a comprehensive, high-touch solution to our clients by offering diverse ways to earn points, omnichannel redemption capabilities and the broadest redemption offerings.
- Managed client records.
- Assisted customers with a warm and professional attitude.
- Answered general questions.
- Resolved customer information and complaints.
- Responsible for tracking and maintaining inventory.
- Handled online orders and credit card transactions.
Nurse Technician
St. John Hospital
Springfield, IL
10.2017 - 10.2018
- Provide excellent care to patients while adhering to health, safety, and hospitals regulations.
- Provide patient care activities such as record vital signs and physical condition.
- Educate patients on health conditions, taking medications, and wound care techniques.
- Assist with transferring patients, bath and hygiene of patients, emptying bedpans, and dressing patients.
- Respond promptly and effectively in emergency cases to help stabilize patients.
Education
Bachelor of Science - Cyber Security
Northwestern University
Evanston, IL06-2027
High school diploma -
Lincoln Land College
Springfield, IL06-2016
Skills
- Microsoft Word, Excel, PowerPoint, and Windows operating system
- Google Workspace
- Trouble Shooting and Technical Support
- Crisis management and Patient Care
- CPR License Technician
- ICD-10
- Medical billing
- Performance Improvement (PI)
- Assist nurse in providing health care techniques
- Equipment: Stethoscope, thermometers, blood pressure cuff, hoyer lift, wheelchairs, hygiene supplies, gloves, masks, aprons, patient charts, and hospital equipment
- Evaluate Patient Chart
- Knowledge of medical terminology
Certification
- CPR Certification
- CNA
Timeline
Prior Authorization Representative
The Cigna Group
01.2024 - Current
SPOC (remote customer service)
Dovenmuehle Mortgage, Inc.
02.2022 - 01.2024
Authorization Representative
Direct Energy
01.2020 - 03.2022
Customer Service Representative/Call Center
Augeo Fi
03.2019 - 01.2020
Nurse Technician
St. John Hospital
10.2017 - 10.2018
Bachelor of Science - Cyber Security
Northwestern University
High school diploma -
Lincoln Land College