Summary
Overview
Work History
Education
Skills
Timeline
Generic

Krystal Rogers

Frisco ,TX

Summary

Thorough Examiner 3 years of experience in the examiner and claims adjustment field. Strong knowledge of resolution procedures and claim settlement. Experienced handling irate and problematic customers. Organized and professional in stressful situations.

Overview

17
17
years of professional experience

Work History

Redetermination Examiner

Noridian Healthcare Solutions
06.2021 - Current
  • Respond to incoming appeals from Medicare appellants in a professional, timely, and accurate manner
  • Research and Identifies claims processing deficiencies and initiates corrective response
  • Evaluates medical documentation to determine if it meets outlined policy criteria
  • Submits educational referrals as necessary when claim billing errors are noted to decrease redeterminations and allow claims to pay at the lowest level of appeal
  • Process overpayment appeals as needed
  • Maintain knowledge of CMS and Joint Operating Agreement requirements
  • Conducts redeterminations reviewers per Medicare rules and regulations

Eligibility Representative

Cigna/Accredo Specialty Pharmacy
10.2020 - 06.2021
  • Prepare and review claims to ensure accuracy to payer requirements, coordinate and ensure services provided will be reimbursable and perform medical/pharmacy benefits verification/ prior authorization.
  • Managed high-volume caseloads while maintaining strict adherence to privacy regulations and confidentiality protocols.
  • Exceeded performance metrics consistently by accurately determining program eligibility within established timeframes.

Patient Service Rep

Triwest Healthcare Alliance (Full-time)
04.2016 - 04.2020
  • Place outbound calls to Veterans, take inbound calls from Veterans, provider office and Veteran Administration, data entry and completion of authorization, medical documentation and send necessary information to provider’s offices to get Veterans schedule for office visits
  • Handled sensitive patient concerns with professionalism and empathy, fostering an atmosphere of trust within the clinic.
  • Provided exceptional customer service to patients, answering questions and addressing concerns.
  • Processed medical records requests efficiently, safeguarding patient privacy while ensuring timely information access for healthcare providers.
  • Served as a reliable source of information for patients regarding appointment scheduling, insurance coverage inquiries, and general office policies.
  • Coordinated referrals efficiently between primary care providers and specialists, ensuring a seamless patient experience.
  • Streamlined appointment scheduling for increased patient convenience and reduced wait times.

Medical Assistant

West Jefferson Hospital – New Orleans La (Full-time)
06.2015 - 04.2016
  • Sanitized, restocked, and organized exam rooms and medical equipment.
  • Obtained client medical history, medication information, symptoms, and allergies.
  • Directed patients to exam rooms, fielded questions, and prepared for physician examinations.
  • Performed medical records management, including filing, organizing and scanning documents.
  • Called and faxed pharmacies to submit prescriptions and refills.
  • Documented vital signs and health history for patients in clinic and hospital environments.
  • Collected and documented patient medical information such as blood pressure and weight.
  • Coordinated patient referrals to specialists or other healthcare providers as needed for comprehensive care management plans.
  • Taught patients about medications, procedures, and care plan instructions.
  • Assisted with routine checks and diagnostic testing by collecting and processing specimens.

Medical Assistant

East Jefferson Hospital – New Orleans La (Full-time)
01.2015 - 06.2015
  • Sanitized, restocked, and organized exam rooms and medical equipment.
  • Obtained client medical history, medication information, symptoms, and allergies.
  • Directed patients to exam rooms, fielded questions, and prepared for physician examinations.
  • Performed medical records management, including filing, organizing and scanning documents.
  • Called and faxed pharmacies to submit prescriptions and refills.
  • Documented vital signs and health history for patients in clinic and hospital environments.
  • Collected and documented patient medical information such as blood pressure and weight.
  • Scheduled appointments, registered patients, and distributed sample pharmaceuticals as prescribed.

Customer Service Agent

Sykes Alpine Access – Denver, Co (Full-time)
02.2014 - 01.2015
  • Resolve customers billing complaints and recording details on inquiries, complaints and comments.
  • Helped large volume of customers every day with positive attitude and focus on customer satisfaction.
  • Demonstrated empathy in handling difficult situations, fostering trust and loyalty among customers.
  • Enhanced customer satisfaction by efficiently resolving inquiries and addressing concerns.

Medical Assistant

Ochsner Hospital – New Orleans, La (Full-time)
02.2007 - 02.2014
  • Sanitized, restocked, and organized exam rooms and medical equipment.
  • Obtained client medical history, medication information, symptoms, and allergies.
  • Directed patients to exam rooms, fielded questions, and prepared for physician examinations.
  • Performed medical records management, including filing, organizing and scanning documents.
  • Called and faxed pharmacies to submit prescriptions and refills.
  • Documented vital signs and health history for patients in clinic and hospital environments.
  • Collected and documented patient medical information such as blood pressure and weight.
  • Scheduled appointments, registered patients, and distributed sample pharmaceuticals as prescribed.
  • Assisted with routine checks and diagnostic testing by collecting and processing specimens.
  • Processed new medication and refill requests for authorization.

Education

Medical Assistant Certificate - Medical Assistant

Gretna Career College
Gretna, LA
01.2004

High School Diploma -

John F Kennedy High School
New Orleans, LA
05.2001

Skills

  • Claims Handling
  • Claims reports and documentation
  • Document Review
  • Authorizations
  • Retro-Authorizations
  • Patient Scheduling
  • Medical Coding
  • Cover determination requests
  • Insurance authorization
  • Understanding of insurance details
  • Medicare knowledge
  • Insurance procedures
  • Claim research
  • Medical Terminology
  • Billing Procedures
  • Proficiency in Onbase, CMS, Epic, Microsoft word, office, powerpoint and excel, Care Radius, outlook and sharepoint

Timeline

Redetermination Examiner

Noridian Healthcare Solutions
06.2021 - Current

Eligibility Representative

Cigna/Accredo Specialty Pharmacy
10.2020 - 06.2021

Patient Service Rep

Triwest Healthcare Alliance (Full-time)
04.2016 - 04.2020

Medical Assistant

West Jefferson Hospital – New Orleans La (Full-time)
06.2015 - 04.2016

Medical Assistant

East Jefferson Hospital – New Orleans La (Full-time)
01.2015 - 06.2015

Customer Service Agent

Sykes Alpine Access – Denver, Co (Full-time)
02.2014 - 01.2015

Medical Assistant

Ochsner Hospital – New Orleans, La (Full-time)
02.2007 - 02.2014

Medical Assistant Certificate - Medical Assistant

Gretna Career College

High School Diploma -

John F Kennedy High School

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