Katina Gurley
Tickfaw,LA
Summary
Analytical problem-solver with excellent communication skills. Effective at interviewing claimants, compiling records and documenting findings. Well-versed in insurance policies, practices and standards. Dedicated Customer Service professional with knowledge of service delivery and proven multitasking abilities.
Overview
9
9
years of professional experience
1
1
Certification
Work History
Rep I Inbound Call Prior Authorization
CVScaremark
07.2024 - Current
- Managed customer inquiries, providing timely and accurate information to enhance satisfaction.
- Handled customer complaints quickly and professionally to restore customer confidence and prevent loss of business.
- Developed and maintained positive customer relations and coordinated with team members to properly handle requests and questions.
- Greeted customers warmly to set tone of customer experience and provide welcoming and friendly atmosphere.
- Responded to customer questions via telephone and written correspondence regarding insurance benefits, provider contracts, eligibility, and claims.
- Developed and maintained strong customer relationships to enhance satisfaction and loyalty.
- Handled high volume of inbound calls per shift to offer callers product and service information and generate quotes.
- Delivered prompt and accurate assistance to Medicare beneficiaries regarding coverage and benefits inquiries.
- Enhanced customer satisfaction by efficiently addressing and resolving Medicare-related inquiries.
- Worked effectively in fast-paced environments.
- Proven ability to learn quickly and adapt to new situations.
- Self-motivated, with a strong sense of personal responsibility.
- Excellent communication skills, both verbal and written.
- Organized and detail-oriented with a strong work ethic.
- Paid attention to detail while completing assignments.
- Reviewed and verified data for consistency and accuracy prior to entry.
- Entered and maintained high volumes of data accurately into company databases.
- Maintained a high level of accuracy in data entry tasks, resulting in improved overall data quality.
Prior Authorization Specialist
Centene
09.2023 - 08.2024
- Analyzed prior authorization requests to ensure compliance with policies and regulations.
- Collaborated with medical professionals to gather necessary documentation for treatment approvals.
- Implemented process improvements to enhance the efficiency of authorization workflows.
- Mentored junior staff on best practices for managing complex authorization cases.
- Responded to inquiries from healthcare providers regarding prior authorization requests.
- Monitored pending cases closely, proactively following up on outstanding documentation needed for successful approval outcomes.
- Input all patient data regarding claims and prior authorizations into system accurately.
- Managed a high volume of incoming calls, maintaining professionalism while effectively addressing the needs of callers seeking assistance with prior authorizations.
- Coordinated with billing department to resolve discrepancies related to denied claims due to incomplete or incorrect prior authorizations.
- Delivered prompt and accurate assistance to Medicare beneficiaries regarding coverage and benefits inquiries.
- Self-motivated, with a strong sense of personal responsibility.
- Skilled at working independently and collaboratively in a team environment.
- Worked effectively in fast-paced environments.
- Proven ability to learn quickly and adapt to new situations.
- Excellent communication skills, both verbal and written.
- Organized and detail-oriented with a strong work ethic.
- Paid attention to detail while completing assignments.
- Managed time efficiently in order to complete all tasks within deadlines.
- Demonstrated strong organizational and time management skills while managing multiple projects.
- Processed and verified data entries for accuracy and completeness.
- Utilized advanced data management software to streamline input procedures.
- Demonstrated exceptional attention to detail when entering complex datasets, resulting in increased reliability of information records.
- Maintained a high level of accuracy in data entry tasks, resulting in improved overall data quality.
Pharmacy Customer Service Representative
Winn Dixie SE Grocers
Covington, USA
12.2022 - 09.2023
- Demonstrated adaptability through cross-training in various roles within the pharmacy setting to better serve customers as needed.
- Assisted customers in navigating insurance claims, resulting in fewer denials and improved coverage understanding.
- Resolved customer complaints with empathy, resulting in increased loyalty and repeat business.
- Handled escalated calls, successfully deescalating situations while finding solutions to meet client expectations.
- Verified and processed Medicare claims with accuracy and efficiency.
- Ensured compliance with all applicable federal regulations related to Medicare billing processes.
- Utilize electronic health record systems to track authorization statuses and manage follow-up communications.
- Provided prior authorization support for physicians, healthcare providers and patients in accordance with payer guidelines.
- Managed a high volume of incoming calls, maintaining professionalism while effectively addressing the needs of callers seeking assistance with prior authorizations.
- Reviewed appeals for prior authorization requests and communicated with payers to resolve issues.
- Self-motivated, with a strong sense of personal responsibility.
- Worked effectively in fast-paced environments.
- Proven ability to learn quickly and adapt to new situations.
- Managed time efficiently in order to complete all tasks within deadlines.
- Organized and detail-oriented with a strong work ethic.
- Paid attention to detail while completing assignments.
- Demonstrated strong organizational and time management skills while managing multiple projects.
- Skilled at working independently and collaboratively in a team environment.
- Excellent communication skills, both verbal and written.
- Worked well in a team setting, providing support and guidance.
Medical Claims Specialist
Touro LCMC Health
New Orleans, USA
05.2022 - 11.2022
- Reduced errors in claims submissions through meticulous attention to detail and thorough review processes.
- Improved claim processing efficiency by streamlining workflows and implementing best practices.
- Provided cross-training to colleagues on various aspects of the health claims process, leading to a more versatile and adaptable team.
- Managed high-volume caseloads while maintaining strict attention to detail in order to ensure successful processing of each individual claim submission.
- Adhered to HIPAA regulations while managing confidential patient information.
- Reviewed claims for accuracy before submitting for billing.
- Demonstrated respect, friendliness and willingness to help wherever needed.
- Strengthened communication skills through regular interactions with others.
- Self-motivated, with a strong sense of personal responsibility.
- Demonstrated strong organizational and time management skills while managing multiple projects.
- Worked effectively in fast-paced environments.
- Worked well in a team setting, providing support and guidance.
- Paid attention to detail while completing assignments.
- Proven ability to learn quickly and adapt to new situations.
- Organized and detail-oriented with a strong work ethic.
- Processed and verified data entries for accuracy and completeness.
- Demonstrated exceptional attention to detail when entering complex datasets, resulting in increased reliability of information records.
- Maintained a high level of accuracy in data entry tasks, resulting in improved overall data quality.
Customer Service Representative
Len Transportation
Hammond, USA
05.2017 - 12.2021
- Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
- Resolved customer complaints with empathy, resulting in increased loyalty and repeat business.
- Managed a high volume of 80 calls daily, maintaining composure under pressure while providing exceptional service.
- Actively listened to customers, handled concerns quickly and escalated major issues to supervisor.
- Managed time efficiently in order to complete all tasks within deadlines.
- Excellent communication skills, both verbal and written.
- Demonstrated strong organizational and time management skills while managing multiple projects.
- Strengthened communication skills through regular interactions with others.
- Organized and detail-oriented with a strong work ethic.
- Passionate about learning and committed to continual improvement.
- Assisted with day-to-day operations, working efficiently and productively with all team members.
Certified Pharmacy Technician
Walgreens
Amite, USA
12.2018 - 12.2020
- Championed company values by modeling exemplary behavior throughout all stages of the Wing Certified Trainer position, inspiring colleagues to strive for excellence in their work.
- Trained new pharmacy technicians on proper procedures and best practices, ensuring consistent quality of service.
- Answered incoming phone calls and addressed questions from customers and healthcare providers.
- Performed eligibility verifications for Medicare patients utilizing online databases.
- Ensured compliance with all applicable federal regulations related to Medicare billing processes.
- Researched and resolved discrepancies in medical billing codes, insurance coverage details, and other data required for claims submission.
- Responded to inquiries from healthcare providers regarding prior authorization requests.
- Managed a high volume of incoming calls, maintaining professionalism while effectively addressing the needs of callers seeking assistance with prior authorizations.
- Self-motivated, with a strong sense of personal responsibility.
- Worked effectively in fast-paced environments.
- Skilled at working independently and collaboratively in a team environment.
- Excellent communication skills, both verbal and written.
- Worked well in a team setting, providing support and guidance.
- Passionate about learning and committed to continual improvement.
- Managed time efficiently in order to complete all tasks within deadlines.
- Organized and detail-oriented with a strong work ethic.
- Paid attention to detail while completing assignments.
- Demonstrated strong organizational and time management skills while managing multiple projects.
- Maintained a high level of accuracy in data entry tasks, resulting in improved overall data quality.
- Processed and verified data entries for accuracy and completeness.
- Utilized advanced data management software to streamline input procedures.
- Completed data entry tasks with accuracy and efficiency.
Education
Pharmacy Tech Certification -
Mainstop Master Prep
New Orleans, LA10.2018
High School Diploma -
St. Helena Central High School
Greensburg, LA05.2007
Skills
- Customer service expertise
- CMS guidelines
- Problem-solving aptitude
- Microsoft office
- Insurance verification
- Strong attention to detail
- Claims processing
- HIPAA compliance
- Prior Authorization Process
- Medicaid and Medicare knowledge
- Typing proficiency: 45 wpm
- Inbound and outbound calling
- Medical billing software
- Data entry and analysis
- Work independently
- Data entry
- Customer service
- Attention to detail
- Multitasking
- Reliability
- Organizational skills
- Active listening
- Effective communication
Certification
Certified Pharmacy Technician
Timeline
Rep I Inbound Call Prior Authorization
CVScaremark
07.2024 - Current
Prior Authorization Specialist
Centene
09.2023 - 08.2024
Pharmacy Customer Service Representative
Winn Dixie SE Grocers
12.2022 - 09.2023
Medical Claims Specialist
Touro LCMC Health
05.2022 - 11.2022
Certified Pharmacy Technician
Walgreens
12.2018 - 12.2020
Customer Service Representative
Len Transportation
05.2017 - 12.2021
Pharmacy Tech Certification -
Mainstop Master Prep
High School Diploma -
St. Helena Central High School