Experience with patient support, medical, pharmacy benefits. Specialty medications, grievance and appeals. Working in a provider's office using Epic EMR systems.
Overview
27
27
years of professional experience
Work History
Fraud Prevention Specialist
Regions Bank
Killeen, TX
06.2024 - Current
Resolved electronic banking inquiries and troubleshooting issues to improve customer satisfaction.
Facilitated implementation of online banking tools and systems, enhancing user experience.
Assisted customers with electronic banking inquiries and troubleshooting issues.
Partnered with team members to enhance service delivery and streamline operational processes.
Appeals Specialist
Global Health Care Services
Killeen, TX
06.2023 - 06.2024
Processed appeals and grievances in compliance with regulatory requirements.
Coordinated cross-departmental communication to resolve issues promptly.
Developed training materials for staff on grievance resolution protocols to enhance compliance.
Maintained comprehensive records of grievances and outcomes to support accountability.
Mortgage Consultant Assistant
LoanCare
Athens, TX
06.2019 - 06.2024
Analyzed mortgage applications for compliance with regulations and internal policies, reducing risk of errors.
Guided clients in understanding loan options, delivering customized solutions to meet individual financial goals.
Verified financial documents for accuracy, facilitating timely processing of mortgage requests and enhancing client satisfaction.
Collaborated with cross-functional teams to streamline loan approval processes and enhance customer experience.
Authorization Coordinator
Humana - Work at Home
Tempe, AZ
10.2007 - 04.2019
Coordinated prior authorization requests, ensuring timely and accurate processing to support patient care.
Collaborated with healthcare providers to resolve authorization issues efficiently.
Collaborated with healthcare providers to resolve authorization issues, enhancing service delivery.
Streamlined workflows by implementing best practices in authorization processes, improving overall efficiency.
Office Assistant/Receptionist
Dr Rosenberg, gastrointestinal
Largo, FL
01.2000 - 10.2007
Scheduled appointments, answered multi-line phone, and requested authorization for MRI and X-ray procedures to facilitate patient care.
Requested medical records from healthcare providers. Patient coordination with physicians. Working in Epic systems.
Managed appointment scheduling for patients, ensuring efficient workflow and minimal wait times.
Coordinated patient intake processes to enhance data accuracy and streamline documentation.
Assisted in maintaining office supplies inventory, optimizing ordering procedures for cost efficiency.
Education
General studies - Office career focused
Hobbs High school
Hobbs, NM
06-1988
Skills
Customer service, Time management, Communication skills, Documentation review, English, Microsoft word, Microsoft excel
Eligibility, Processing & Fraud Prevention Specialist at Protiviti Government Services, Inc. (Robert Half)Eligibility, Processing & Fraud Prevention Specialist at Protiviti Government Services, Inc. (Robert Half)