Freda Deming
Grand Prairie,TX
Summary
Pioneered innovative strategies to minimize denial of coverage and improve billing accuracy, enhancing overall operational effectiveness.
Overview
18
18
years of professional experience
Work History
Benefits Verification Rep II
CVS Specialty Pharmacy
Flower Mound, TX
10.2021 - Current
- Directed all facets of inbound communications for pharmacy benefits management and major medical insurance inquiries.
- Request and loads PBM major medical insurance plans
- Resolve questions and problems submitted by customers and PBM’s, utilizing guidelines established by SOP’s following procedures for the best solution concerns or resolution
- Assist physicians in the prior authorization process including initiation of prior authorizations
- Cross trained to work on major medical specialized plans
- Verified major medical benefits via online resources or over the phone
- Facilitates reimbursement windshields for PBM and major medical claims
- Provide support for specialized support such as patient assistance programs or special handling
Denial Analyst
Parallon/ HCA
Irving, TX
06.2015 - 09.2020
- Communicated with insurance companies to obtain pre-authorizations for treatment.
- Evaluated accuracy and quality of data entered into agency management system.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology and procedures and HIPAA regulations.
- Communicated effectively with staff, including members of operations, finance and clinical departments.
- Tracked all pending authorizations to resolve discrepancies and avoid revenue loss.
- Coordinated with the contracting department to resolve payer issues.
- Responded to correspondence from insurance companies.
- Reviewed outstanding requests and redirected workloads to complete projects on time.
- Maintained excellent attendance record, consistently arriving to work on time
Member Service Agent
Prime Therapeutics
Irving, TX
10.2012 - 06.2015
- Communicated with patients to collect information about prescriptions and medical conditions or arrange consultations with pharmacists.
- Consulted with insurance company representatives to complete claims processing, resolve concerns and reconcile payments.
- Performed various pharmacy operational activities with strong commitment to accuracy, efficiency and service quality.
- Collected co-payments or full payments from customers.
- Answered incoming phone calls and addressed questions from customers and healthcare providers.
- Verified patient data and billing information to discover and resolve erroneous bills due to system errors.
- Assisted patients in minimizing medical expenses by recommending generic alternative prescription medications.
Business Services Specialist II
Sprint
Irving, TX
11.2007 - 01.2012
- Completed new connects, reconnects, disconnects and service changes for residential and commercial customers.
- Performed troubleshooting of systems with techniques such as speed and ping tests.
- Analyzed user-generated trouble tickets to determine causes of problems and took appropriate action for resolution.
- Diagnosed and resolved complex integrated customer issues for implementation, add-on, maintenance and support of voice, data, VoIP and CTI applications.
- Coordinated installation of new users and relocations of existing users.
- Prepared a variety of different written communications, reports and documents to ensure smooth operations.
Education
Radiology
Tarrant County College
Fort Worth, TXSkills
Statistic analysis
Information gathering
Financial Management
Account Reconciliation
Trend forecasting
Good listening skills
Analytical skills
Good telephone etiquette
Data management
Self-motivated professional
Timeline
Benefits Verification Rep II
CVS Specialty Pharmacy
10.2021 - Current
Denial Analyst
Parallon/ HCA
06.2015 - 09.2020
Member Service Agent
Prime Therapeutics
10.2012 - 06.2015
Business Services Specialist II
Sprint
11.2007 - 01.2012
Radiology
Tarrant County College