Melinda Neagle
Georgetown,IN
Summary
Versatile professional serves as first point of contact for patients by verifying insurance, handling paperwork and preparing records. Patient-oriented and helpful candidate familiar with MS Office and EHR systems coupled with thorough knowledge of medical terminology. Committed to providing personalized service and quality patient care.
Overview
5
5
years of professional experience
1
1
Certification
Work History
Prior Authorization Coordinator
Baptist Healthcare System Inc.
11.2022 - Current
- Verified eligibility and compliance with authorization requirements for service providers.
- Tracked referral submission during facilitation of prior authorization issuance.
- Fielded telephone inquiries on authorization details from plan members and medical staff.
- Obtained and logged accurate patient insurance and demographic information for use by insurance providers and medical personnel.
- Evaluated clinical criteria for approval or denial of services requiring pre-authorization.
- Responded to inquiries from healthcare providers regarding prior authorization requests.
- Reached out to insurance carriers to obtain prior authorization for testing and procedures.
- Provided prior authorization support for physicians, healthcare providers and patients in accordance with payer guidelines.
- Reviewed appeals for prior authorization requests and communicated with payers to resolve issues.
- Analyzed medical records and other documents to determine approval of requests for authorization.
- Developed and maintained productive working relationships with healthcare providers.
- Researched denied claims and contacted insurance companies to resolve these issues.
- Performed various administrative tasks by filing, copying and faxing documents.
Pharmacy Technician
Knipper Pharmaceutical
08.2021 - 11.2022
- Answered incoming phone calls and addressed questions from customers and healthcare providers.
- Solved customer problems in-person or over telephone by providing assistance with placing orders, navigating systems, and locating items.
- Performed wide range of pharmacy operations with strong commitment to accuracy, efficiency and service quality.
- Communicated with patients to collect information about prescriptions and medical conditions or arrange consultations with pharmacists.
- Reviewed and verified customer information and insurance provider information.
- Communicated directly with doctors offices via telephone, fax and email.
- Performed various pharmacy operational activities with strong commitment to accuracy, efficiency, and service quality.
- Helped large volume of customers every day with positive attitude and focus on customer satisfaction.
- Responded to customer calls and emails to answer questions about products and services.
- Utilized active listening skills to identify customer needs and provide appropriate solutions.
- Maintained and managed customer files and databases.
- Coordinated with operations staff to resolve service problems and boost client satisfaction.
- Maintained accurate record-keeping with proactive attention to client information updates.
- Educated clients on account services and resolved client inquiries regarding statement information and account balances.
- Trained and supervised junior customer service representatives on best practices to meet organization goals.
- Delivered prompt service to prioritize customer needs.
- Investigated and resolved customer inquiries and complaints quickly.
- Met customer call guidelines for service levels, handle time and productivity.
- Cross-trained and provided backup support for organizational leadership.
Patient Service Representative
Optum, UnitedHealth Group
01.2019 - 08.2021
- Provided exceptional customer service to patients, answering questions and addressing concerns.
- Verified insurance eligibility and coverage for patients.
- Entered patient demographic and insurance data into electronic medical record system.
- Filed and maintained patient records in accordance with HIPAA regulations.
- Built and maintained positive working relationships with patients and staff.
- Took copayments and compiled daily financial records.
- Applied administrative knowledge and courtesy to explain procedures and services to patients.
- Answered incoming phone calls and addressed questions from customers and healthcare providers.
- Completed paperwork, entering prescription and insurance or billing information into patient profiles.
- Entered and processed patients' prescriptions into internal system.
- Performed various pharmacy operational activities with strong commitment to accuracy, efficiency, and service quality.
- Communicated with patients to collect information about prescriptions and medical conditions or arrange consultations with pharmacists.
- Set up and modified patient profiles to include current medications and insurance details.
Education
Associate of Applied Science - Medical Assisting
Ivy Tech Community College
Sellersburg, IN06.1994
Skills
- Office Supplies and Inventory
- Information Assistance
- Strategic Initiatives
- Prior Authorization Processing
- Benefit Coverage
- Medical Terminology
- Clinical Messaging
- Operational Requirements
- Electronic Patient Medical Record
- Authorization Procedures
- Software Applications
- Call Transfers
- Medical Coding
- Diagnostic Codes
- Medical Transcription
- Eligibility Checks
- Demographics Information
- Electronic Health Records Systems
- Standards Compliance
- Service Quality
- Patient Identification
- Customer Satisfaction
- Explaining Patient Benefits
- Computerized Time Management Systems
- Effective Communication Skills
- Records Maintenance
- Health Insurance Plan Knowledge
- Insurance Procedures
- Insurance Authorizations
- Benefits Verifications
- CPT Coding
- Data Entry
- Registration Processes
- Registration Paperwork
- Private Insurance
- Creative Thinking
- Adaptable and Flexible
- Assistance Authorization
- Patient Health Information Access
- Data Entry Software
- Federal Laws
- Application Assessments
- Payment Collection
- Computer Proficiency
- Managing Medical Practices
- Customer Interaction
- Compassionate Communication
- Retro-Authorizations
- Pharmacology
- Authorizations
- Recordkeeping
Certification
- CPhT - Certified Pharmacy Technician
Timeline
Prior Authorization Coordinator
Baptist Healthcare System Inc.
11.2022 - Current
Pharmacy Technician
Knipper Pharmaceutical
08.2021 - 11.2022
Patient Service Representative
Optum, UnitedHealth Group
01.2019 - 08.2021
Associate of Applied Science - Medical Assisting
Ivy Tech Community College
- CPhT - Certified Pharmacy Technician
Similar Profiles
Kelli KnightKelli Knight
Mental Health Technician at Baptist Healthcare System Inc.Mental Health Technician at Baptist Healthcare System Inc.
Melissa WilemonMelissa Wilemon
RN Case Manager at Baptist Memorial Hospital MemphisRN Case Manager at Baptist Memorial Hospital Memphis
CHRISTY GRAHAMCHRISTY GRAHAM
Surgery Scheduling Coordinator at Baptist HealthSurgery Scheduling Coordinator at Baptist Health