Ebony Little
Jonesboro,GA
Summary
Reliable Prior Authorization Representative with advanced skill in conferring with insurance companies to verify insurance coverage eligibility. Well-organized and thorough with excellent customer service skills. Adept in completing diagnostic and procedure coding. Offering 7 years of experience in the Healthcare Industry.
Overview
12
12
years of professional experience
Work History
Senior Appeals Coordinator
Cigna
09.2024 - Current
- Managed high caseloads effectively while maintaining strict deadlines for case resolution milestones.
- Enhanced team performance by providing ongoing training, support, and feedback for junior Appeals Coordinators.
- Conducted proactive audits of closed cases to identify areas of improvement in the appeals process.
- Crafted persuasive written arguments in support of appeal decisions that demonstrated clear knowledge of applicable regulations and guidelines.
- Liaised with external vendors and service providers as needed to gather additional information or expert opinions on disputed claims.
- Streamlined appeals processes by implementing efficient workflow strategies, resulting in improved case resolution times.
Prior Authorization Representative
Cigna
09.2023 - 09.2024
- Demonstrated adaptability by managing multiple priorities simultaneously, ensuring all tasks were completed accurately and on time
- Improved patient satisfaction by efficiently processing prior authorization requests and ensuring timely responses
- Contributed to a positive work environment by effectively communicating with team members and fostering collaboration
- Ensured compliance with HIPAA regulations by maintaining strict confidentiality in handling sensitive patient information
- Increased accuracy of insurance coverage validation by utilizing available tools and resources to verify eligibility requirements quickly.
Central Support Operations Coordinator
UnitedHealth Group
01.2023 - 10.2024
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
- Supported clinical staff by providing timely updates on the status of prior authorizations for various services.
- Reduced processing times by effectively managing a high volume of authorizations, referrals, and appeals.
- Collaborated with healthcare providers to obtain necessary documentation for prior authorization requests.
Provider Enrollment Specialist
Conduent
01.2019 - 02.2022
- Created and implemented provider acquisition initiative with focus on high-margin services
- Secured competitive advantage in market by establishing exceptional network of care providers
- Monitored credentials and contacted practitioners when expiration dates were nearing
- Contacted insurance carriers to obtain information regarding denials
Customer Service Manager
Amazon
09.2016 - 02.2019
- Resolved customer complaints while prioritizing customer satisfaction and loyalty
- Trained and regularly mentored associates on performance-oriented strategies and customer service techniques
- Supervised employees and assessed performances to determine training needs and define accurate plans for decreasing process lags
- Took ownership of customer issues and followed problems through to resolution
- Assumed ownership over team productivity and managed work flow to meet or exceed quality service goals.
Human Resource Specialist
JCI
06.2012 - 09.2016
- Worked closely with the public relations team to assist with preparing and processing all levels of counseling memoranda, written reprimands, predetermination conference letters, final action letters, dismissals and other related disciplinary correspondence
- Created new files as needed and logs new incoming cases into SharePoint
- Entered appropriate data correctly into Human Resources Tracking System (HRTS), as needed
- Entered information into Florida Department of Law Enforcement's Automated Training Management System (ATMS), as needed
- Handled government and regulatory communications
- Conflict Resolution
Education
Master of Science Human Resources Management -
Capella University
Minneapolis, MN07.2021
Bachelor of Science Healthcare Management - Healthcare Management
Florida Agricultural And Mechanical University
Tallahassee, FL08.2016
Skills
- Type 80 WPM
- Policyholder Communication
- Claims Information Gathering
- Policy Renewal's
- Computer Proficiency
- Customer service expert
- MS Office proficiency
- Competitive Market Analysis
- HIPAA Compliance
- Healthcare Industry Knowledge
- Electronic Records Management
- Medical terminology knowledge
Timeline
Senior Appeals Coordinator
Cigna
09.2024 - Current
Prior Authorization Representative
Cigna
09.2023 - 09.2024
Central Support Operations Coordinator
UnitedHealth Group
01.2023 - 10.2024
Provider Enrollment Specialist
Conduent
01.2019 - 02.2022
Customer Service Manager
Amazon
09.2016 - 02.2019
Human Resource Specialist
JCI
06.2012 - 09.2016
Master of Science Human Resources Management -
Capella University
Bachelor of Science Healthcare Management - Healthcare Management
Florida Agricultural And Mechanical University
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