LaWanda Hill

• Handled customer service calls from providers and members, resolving issues to enhance satisfaction.
• Provided a high level of customer service to clients and prospects, responded to inquiries, and resolved customer complaints in a professional manner.
• Ensured effective customer relations by responding accurately and courteously to inquiries via telephone, written, web, or in-person.
• Utilized various computer systems to streamline processes, contributing to improved service delivery.

Met deadlines and achieved goals by processing a large influx of prior authorizations accurately daily (Top Performer Recognition)

• Processed and submitted prior authorizations in approved systems to ensure timely approval
• Obtained prior authorizations from insurance carriers for different drugs and secured them before a patient received the drug(s)
• Facilitated coordination of urgent, priority, or STAT prior authorizations with various doctors' offices via fax to expedite patient care
• Reviewed and maintained compliance with ERISA, CMS, Medicare, Medicaid, and client-specific requirements
• Executed non-clinical duties and functions per established procedures and policies under supervision of Prior Authorization Supervisor

• Delivered timely customer service to internal and external customers, ensuring satisfaction and retention
• Updated managers and customers on changes to existing orders, facilitating clear communication and workflow
• Logged customer orders into the database accurately to ensure order processing
• Resolved discrepancies and collected post-counted items, maintaining accurate inventory records
• Provided supply quotes to managers for customer fulfillment
• Created daily and weekly billing reports for managers

• Managed high-volume incoming calls, web inquiries, and emails regarding COVID-19 results, preparing and delivering accurate test result correspondence to participants.
• Contacted customers through outbound calls to deliver test results and medical follow-up information, ensuring clarity and support throughout the process.
• Provided information on free testing locations, hours, and information on vaccines
• Ensured compliance with HIPAA guidelines while making outbound calls to provide essential information to customers and case managers.
• Entered and stored data, such as test results, using Microsoft Excel

• Enhanced customer relations by efficiently managing high call volume, reducing call duration, and conducting daily outbound calls
• Educated callers on any outstanding balances and provided In-and-out-of-network cost information
• Provided claim information on medical, drug, dental, Medicare, and Medicaid claims
• Educated members on deductibles, clarified plan coverage, and advised on application of deductibles for better understanding
• Coordinated communication with providers regarding claims, amounts, and patient responsibilities to ensure clarity and support
• Verbally provide details on the member's plans in depth for covered and non-covered services, in addition to assisting in scheduling follow-up care appointments
• Processed claims at 100% and non-medical appeals according to contract regulations, identified complaints and inquiries on a complex level

• Answered high-volume incoming calls in regards to patient inquiries, balances, and estimated drug costs
• Assisted customers by resolving issues through first call resolution methods, enhancing customer satisfaction
• Resolved mail-order pharmaceutical billing issues and initiated prior authorizations, facilitating timely access to medications
• Followed up by calling drug suppliers to inquire about inconsistencies with mail-order prescriptions and processed mail-order medications
• Followed up with customers about the home delivery benefit
• Managed confidential information, including protected health information (PHI), ensuring compliance with privacy regulations
• Entered orders into a computerized system for medication(s), gathered and processed payments for mail-order drugs