LEA PEIRCE
Orlando,FL
Summary
Professional detail-oriented individual with a background of 15+ years spent working in call center/medical offices, with strong knowledge/skills in managing Prior Authorizations and Insurance verification processes. Skilled in navigating complex systems, prioritizing tasks, and maintaining high standards of accuracy and efficiency. Demonstrates strong analytical, communication, and teamwork skills, with proven ability to quickly adapt to new environments and or tasks/issues. Eager to contribute to team success and further develop professional skills. Brings a positive attitude and commitment to continuous learning and growth most importantly dependability.
Overview
22
22
years of professional experience
Work History
Prior Authorization Specialist
Copilot
07.2018 - 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.
- Analyzed medical records and other documents to determine approval of requests for authorization.
- Verified eligibility and compliance with authorization requirements for service providers.
- Reached out to insurance carriers to obtain prior authorization for testing and procedures.
- Responded to inquiries from healthcare providers regarding prior authorization requests.
- Reduced turnaround time for prior authorization requests by utilizing electronic submission methods.
- Monitored pending cases closely, proactively following up on outstanding documentation needed for successful approval outcomes.
- Achieved high success rate in obtaining authorizations by effectively demonstrating medical necessity through comprehensive documentation and clear communication with insurance companies.
- Provided training to new staff members on the intricacies of various insurance plans and their specific prior authorization requirements.
- Input all patient data regarding claims and prior authorizations into system accurately.
- Tracked referral submission during facilitation of prior authorization issuance.
- Reviewed appeals for prior authorization requests and communicated with payers to resolve issues.
- Managed a high volume of incoming calls, maintaining professionalism while effectively addressing the needs of callers seeking assistance with prior authorizations.
- Maintained organized records and up-to-date files for all completed and pending authorization requests, ensuring easy access during audits or reviews.
- Contributed to a high level of customer service by quickly addressing questions or concerns from patients regarding their coverage or denials.
- Coordinated with billing department to resolve discrepancies related to denied claims due to incomplete or incorrect prior authorizations.
- Supported team members by providing guidance on complex cases requiring detailed understanding of medical necessity criteria.
- Provided prior authorization support for physicians, healthcare providers and patients in accordance with payer guidelines.
- Assisted in development of educational materials for patients and providers about prior authorization process.
- Reduced turnaround time for prior authorization decisions by implementing more efficient review process.
Insurance Verification Specialist
JC Medical Center
07.2018 - 08.2020
- Ensured compliance with HIPAA regulations while managing sensitive patient information during the verification process.
- Assured timely verification of insurance benefits prior to patient procedures or appointments.
- Updated patient records with accurate, current insurance policy information.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Improved communication between medical staff and patients by explaining insurance benefits and financial responsibilities.
- Collaborated with team members to resolve discrepancies in insurance verification, ensuring proper billing practices.
- Increased patient satisfaction by promptly addressing concerns regarding insurance coverage or billing issues.
- Assisted patients with understanding personalized insurance coverage and benefits.
- Demonstrated a high level of professionalism and attention to detail in all aspects of insurance verification specialist role, consistently exceeding performance expectations.
- Achieved insurance pre-authorizations to enable timely patient procedures.
- Developed strong relationships with insurance representatives, facilitating smooth communication channels for resolving inquiries or disputes.
- Reduced errors in billing by accurately maintaining patient records with updated insurance information.
- Optimized productivity within the department by prioritizing tasks according to urgency and importance levels.
- Coordinated with care teams across various departments to ensure seamless integration of verified coverage information into overall treatment planning.
- Trained new staff on current, correct insurance verification procedures.
- Minimized delays in treatment scheduling by promptly identifying potential coverage issues and working proactively towards their resolution.
- Supported timely claims processing by submitting accurate and complete documentation to insurance companies.
- Generated reports to track insurance verifications and claim progress.
- Maintained up-to-date knowledge of insurance policies and changes, aiding in accurate verification.
- Optimized use of insurance verification software, leading to faster processing times.
- Contributed to patient education by explaining complex insurance terms and procedures in understandable manner.
- Enhanced patient satisfaction by providing clear explanations of insurance benefits and coverage.
- Streamlined insurance verification process, reducing wait times for patients and medical staff.
- Coordinated referrals through insurance and other medical specialists and documented details in patient charts.
- Completed administrative patient intakes with case histories, insurance information and mandated forms.
- Prepared and processed patient referrals and transfer requests.
- Assisted with medical coding and billing tasks.
Patient Care Specialist
AllianceRx Walgreens Prime
10.2015 - 07.2018
- Managed high call volume while maintaining professionalism, empathy, and attention to detail in each interaction.
- Processed policy updates and changes accurately, ensuring client needs were met in an timely manner.
- Handled sensitive customer information with discretion, adhering to strict data privacy regulations at all times.
- Documented customer interactions and transactions for accurate, up-to-date records.
- Answered incoming phone calls to articulate product value to prospective customers and support current policyholders.
- Assessed customers with refill requests as well as setting up delivery of their specialty medications.
- Educated customers on available discounts, promoting loyalty and policy retention through tailored recommendations.
- Conducted comprehensive policy reviews for clients, identifying copays, refill requests and recommending appropriate solutions.
- Set up customer refill requests as well as set up delivery.
- Maintained up-to-date knowledge of insurance products to provide accurate information to customers.
- Managed high-volume call queues, ensuring minimal wait times for customer inquiries.
- Coordinated with other departments to streamline customer service procedures, enhancing overall service delivery.
- Conducted detailed policy reviews to advise customers on optimal coverage options.
- Implemented personalized follow-up system for unresolved issues, significantly increasing customer satisfaction rates.
- Verified client information by analyzing existing evidence on file.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- Assured timely verification of insurance benefits prior to patient procedures or appointments.
Customer Care Agent
Optum
10.2013 - 06.2015
- Assisted call-in customers with questions and orders.
- Responded to customer needs through competent customer service and prompt problem-solving.
- Helped large volume of customers every day with positive attitude and focus on customer satisfaction.
- Managed high call volume while maintaining exceptional service quality for all customers.
- Enhanced customer satisfaction by addressing and resolving issues promptly and professionally.
- Provided empathetic assistance to distressed customers, demonstrating genuine concern for their needs and fostering brand loyalty.
- Improved first-call resolution rates through thorough research of complex cases before escalating them to higher-level support teams.
- Adhered strictly to data protection guidelines, ensuring that the confidential information of customers was treated with utmost respect and diligence throughout all interactions.
- Maintained up-to-date knowledge of products and services to effectively assist customers with their needs.
- Conducted regular quality assessments, ensuring consistent adherence to company standards of excellence in customer care.
- Actively sought opportunities for professional development within the industry, participating in workshops and training sessions relevant to the role.
- Facilitated smooth transitions during peak seasons by coordinating staffing schedules according to anticipated workloads.
- Addressed customer complaints and mitigated dissatisfaction by employing timely and on-point solutions.
- Navigated multiple computer systems and applications to find information.
- Logged call information and solutions provided into internal database.
- Provided excellent customer care by responding to requests, assisting with product selection and handling ordering functions.
- Investigated and resolved accounting, service and delivery concerns.
- Investigated and resolved customer inquiries and complaints quickly.
- Met customer call guidelines for service levels, handle time and productivity.
- Promoted superior experience by addressing customer concerns, demonstrating empathy, and resolving problems swiftly.
- Promptly responded to inquiries and requests from prospective customers.
Caregiver
Home Instead Senior Care
07.2009 - 07.2013
- Assisted with dressing guidance, grooming, meal preparation, and medication reminders.
- Performed light housekeeping duties to maintain cleanliness standards while respecting the patient''s personal space.
- Assisted clients with daily living needs to maintain self-esteem and general wellness.
- Built strong relationships with clients to deliver emotional support and companionship.
- Engaged patients in meaningful conversation, socialization, and activity while providing personal care assistance.
- Maintained a safe and clean environment for patients, reducing risks and ensuring optimal health outcomes.
- Enhanced patient comfort by providing compassionate and attentive care, addressing individual needs and preferences.
- Assisted with feeding and monitored intake to help patients achieve nutritional objectives.
- Assisted patients with self-administered medications.
- Cleaned house, ran errands, managed laundry, and completed weekly grocery shopping.
- Assisted clients with activities of daily living, promoting independence and quality of life.
- Provided safe mobility support to help patients move around personal and public spaces.
Dietary Aide/Cook
Brian Center
12.2002 - 06.2011
- Prepared food items consistently and in compliance with recipes, portioning, cooking and waste control guidelines
- Verified proper portion sizes and consistently attained high food quality standards
- Maintained smooth and timely operations in preparation and delivery of meals and kitchen sanitation
- Properly labeled and stored all raw food ingredients including produce, meat, fish, poultry, dairy and dry goods in the appropriate storage room, walk-in refrigerator, freezer or cooler
- Cooked and served food and meals in accordance with planned menus, diet plans, recipes, portions, temperature control procedures and facility policies
- Positively engaged with customers, offering menu information, providing suggestions and showing genuine appreciation for their business
- Practiced safe food handling procedures at all times
- Prepared all meals in accordance with standards of quality, quantity control, taste and presentation
- Accurately and efficiently prepared healthy, delicious fish, meat and vegetable-based trends
- Maintained a clean kitchen as well as properly washed and stored clean dishes
- Prepared and served healthy snacks to members
Receptionist
Avante
01.2009 - 12.2009
- Ordered and distributed office supplies while adhering to a fixed office budget
- Directed guests and directed them to the correct designation and routed deliveries and courier services
- Answered and managed incoming and outgoing calls while recording accurate messages
- Greeted incoming visitors and customers professionally and provided friendly, knowledgeable assistance .
- Maintained a clean reception area, including lounge and associated areas
- Streamlined front desk operations for increased efficiency by effectively managing phone calls, emails, and walk-in clients.
- Answered central telephone system and directed calls accordingly.
- Supported office efficiency by performing clerical tasks such as data entry, photocopying, scanning, and faxing documents.
- Provided administrative support to staff members by handling correspondence, filing documents, and managing office supplies inventory.
- Maintained visitor log for entering and leaving facility for security purposes.
Education
Billing And Coding Certification - Billing And Coding
NHA
Leawood, KS04-2018
GED -
Rowan Cabarrus Community College
Concord, NC01.2009
Skills
- Electronic health records proficiency in Insurance verification, Medical terminology and Prior authorization process
- Professionalism and ethics
- Knowledgeable in Microsoft Office, Outlook, Script Med, Athena and Availity, Remote desk top as well as multi plan websites for Prior Authorization submission and multi line phones, copy/fax machines
- Multitasking and Problem-solving Abilities
- Self Motivational and Reliability
- Organizational skills
- Adaptability and flexibility
Timeline
Prior Authorization Specialist
Copilot
07.2018 - Current
Insurance Verification Specialist
JC Medical Center
07.2018 - 08.2020
Patient Care Specialist
AllianceRx Walgreens Prime
10.2015 - 07.2018
Customer Care Agent
Optum
10.2013 - 06.2015
Caregiver
Home Instead Senior Care
07.2009 - 07.2013
Receptionist
Avante
01.2009 - 12.2009
Dietary Aide/Cook
Brian Center
12.2002 - 06.2011
GED -
Rowan Cabarrus Community College
Billing And Coding Certification - Billing And Coding
NHA
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