Laquita Pirtle
Memphis,TN
Summary
Results-driven professional provides customers with tailored solutions to meet needs. Successfully establishes relationships with customers and delivers quality service. Agile individual with excellent communication and customer service skills. Excellent communicator and dependable team player with strong understanding of insurance industry. Adept at building relationships with clients, brokers and other stakeholders while delivering outstanding service. Highly organized and detail-oriented with strong ability to identify potential risks and develop solutions.
Overview
17
17
years of professional experience
Work History
Prior Authorization Specialist
Evicore Healthcare
07.2023 - Current
- Collaborated with physicians to obtain necessary clinical information for prior authorization submissions.
- Maintained thorough knowledge of insurance plan requirements, facilitating accurate and timely completion of authorization forms.
- Verified eligibility and compliance with authorization requirements for service providers.
- Analyzed medical records and other documents to determine approval of requests for authorization.
- Responded to inquiries from healthcare providers regarding prior authorization requests.
- Obtained and logged accurate patient insurance and demographic information for use by insurance providers and medical personnel.
- Managed a high volume of incoming calls, maintaining professionalism while effectively addressing the needs of callers seeking assistance with prior authorizations.
Licensed Insurance Representative
E-Telequote Insurance
12.2022 - 06.2023
- Calculated quotes and educated potential clients on insurance options.
- Recommended type and amount of coverage based on analysis of customers' circumstances using persuasive sales techniques.
- Leveraged knowledge of company insurance products and services to advise customers on appropriate choices.
- Obtained underwriting approval by completing application for coverage.
- Upsold additional products and services after identifying customer needs and requirements.
Licensed Health Insurance Agent
Connexion Point
08.2017 - 06.2023
- Identified and educated eligible consumers about Medicare product lines via call center, generate enrollment leads and referral, assist prospective members with selecting and enrolling in Medicare health plans, achieving sales goals via incoming calls, and making outbound sales calls to prospective members.
- Verified insurance coverage by telephone and online to guarantee proper reimbursement of benefits and estimate patients' financial responsibilities.
- Performed needs analysis to obtain information required to make appropriate health insurance product recommendations.
- Explained features, disadvantages and advantages of policies to promote insurance sales.
Contact Representative
Treasury
10.2016 - 07.2018
- Assisted taxpayers with refund inquiries over the phone, balance due, payments, and any other tax related questions
- Processed tax returns and other tax related forms
- Adhered to company policies and scripts to consistently achieve call-time and quality standards.
- Learned and maintained in-depth understanding of product information, providing knowledgeable responses to diverse questions.
Patient Care Advocate
Accredo Health Group
11.2014 - 02.2016
- Handled inbound calls, customer service inquiries from members, providers, physicians, and internal and external clients related to pharmacy benefits
- Worked to research to research and resolve problems in a timely manner.
- Developed rapport to create safe and trusting environment for care.
- Monitored progress and documented patient health status changes to keep care team updated.
Customer Service Representative
Sitel Work
11.2014 - 05.2015
- Answered inbound calls for customers with satellite service
- Calls involved billing inquiries, account or product inquiries, product or service orders, installation scheduling or technical product trouble.
- Answered customer telephone calls promptly to avoid on-hold wait times.
- Answered constant flow of customer calls with minimal wait times.
- Offered advice and assistance to customers, paying attention to special needs or wants.
Customer Service Representative
Advance Services Incorporated
01.2014 - 11.2014
- Provided consumer assistance (phone/on-line) with the interpretation and resolution of problems, communicating correct product operation and care instructions, promoting features and benefits of GE branded products and services, selling use and care guides, parts and service contracts, referring consumer calls to appropriate business component, service provider or internal customer relations for assistance, adhering to safety policies and procedures to ensure a safe work environment for all, and other duties as assigned
- Answered inbound calls on a multi- line phone system, handle all customer concerns and issues, and make outbound calls to customers as needed
- Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns.
- Answered constant flow of customer calls with minimal wait times.
Special Education Assistant
Shelby County Schools
02.2007 - 10.2013
- Delivered personalized educational, behavioral and emotional support to individual students to enable positive learning outcomes.
- Assisted teachers with classroom management and document coordination to maintain positive learning environment.
- Monitored student classroom and outdoors activities to promote student safety.
- Aided elementary school special education teachers in reinforcing efforts for children with various learning and behavioral needs.
Direct Care Professional
Open Arms Care Corporation
12.2007 - 11.2010
- Ensured a safe and comfortable environment by maintaining clean and organized living spaces for clients.
- Assisted patients with handling daily chores and errands by transporting to appointments, cleaning personal spaces, and purchasing supplies.
- Supported clients'' emotional well-being through compassionate listening, empathy, and encouragement during difficult times.
- Kept close eye on behavior and emotional responses of clients to address concerns and protect each person from harm.
- Maintained accurate records of client progress, medication administration, and incident reports to ensure effective communication among team members.
- Upheld ethical standards in all aspects of care provision, maintaining confidentiality and respecting the dignity of each individual client.
- Analyzed overall patient performance and recommended adjustments to care plan goals, supporting individual progression.
- Helped with home management tasks, meal preparation, grocery shopping, and routine cleaning.
- Contributed to higher quality of life for clients by addressing any barriers or challenges that arose within their home settings or daily routines.
Education
Associate of Science - General Studies
Southwest Tennessee Community College
Memphis, TN12.2023
Diploma - Limited Scope X-Ray/ Medical Assistant
Anthem College - Bryman School
Phoenix, AZ05.2014
Skills
- Prior Authorization Process
- Medical Terminology
- Insurance Verification
- Authorizations
- Medicare and Medicaid knowledge
- HIPAA Compliance Knowledge
- Client Support
- Compassionate Caregiving
- Direct Patient Care
- Client documentation
- Medication Administration
- ADL support
Timeline
Prior Authorization Specialist
Evicore Healthcare
07.2023 - Current
Licensed Insurance Representative
E-Telequote Insurance
12.2022 - 06.2023
Licensed Health Insurance Agent
Connexion Point
08.2017 - 06.2023
Contact Representative
Treasury
10.2016 - 07.2018
Patient Care Advocate
Accredo Health Group
11.2014 - 02.2016
Customer Service Representative
Sitel Work
11.2014 - 05.2015
Customer Service Representative
Advance Services Incorporated
01.2014 - 11.2014
Direct Care Professional
Open Arms Care Corporation
12.2007 - 11.2010
Special Education Assistant
Shelby County Schools
02.2007 - 10.2013
Associate of Science - General Studies
Southwest Tennessee Community College
Diploma - Limited Scope X-Ray/ Medical Assistant
Anthem College - Bryman School
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