Michele Eife
Haddon Township,NJ
Summary
Adept Utilization Management Technician with a proven track record at AmeriHealth Caritas, showcasing exceptional customer service and critical thinking skills. Excelled in streamlining claims processing, enhancing billing accuracy, and ensuring compliance with medical necessity. Achieved significant improvements in productivity, demonstrating a keen attention to detail and a strong multitasking ability.
Overview
22
22
years of professional experience
Work History
Utilization Management Technician
AmeriHealth Caritas
Newtown Square, PA
11.2022 - Current
- Using good listening skills, conducts calls as indicated, collecting data according to the script, tools, and protocols, meeting both productivity and performance expectations, as identified by a unit supervisor. Conducts all calls in a courteous and customer-service-friendly manner.
- Updates, maintains, and/or closes authorizations or tasks for services as assigned within process guidelines.
- Demonstrates a professional and courteous manner when communicating with others, with the ability to clearly and accurately state the agreed-upon resolution.
- Processes both incoming and outgoing correspondence and faxes in accordance with required standards and within respective timeliness guidelines. Refers episodes to the appropriate clinical team members for review, as defined by the workflow.
- Adhere to company policies and procedures, process standards, standard operating procedures, and maintain current knowledge of member benefits, rights, and responsibilities.
Medical Billing Coordinator
Advocare Haddonfield Pediatric Associates
Haddonfield, NJ
03.2003 - 03.2020
- Investigated denied or rejected claims due to incorrect coding or lack of authorization.
- Verified patient eligibility, coverage details, and payment information.
- Assessed unpaid claims to identify areas of improvement in billing process.
- Processed insurance claims, appeals, and follow-up documentation.
- Reviewed claims for coding accuracy.
- Collected, posted and managed patient account payments.
- Monitored reimbursement from managed care networks and insurance carriers to verify consistency with contract rates.
- Handled billing, waivers and claims for private and commercial clients.
Education
Certified Medical Assistant -
Omega Institute
Pennsauken, NJ04-1997
Skills
- Written/Verbal communication
- Customer service
- Critical thinking
- Claims processing proficiency
- Flexible & Adaptable
- Attention to detail
- Self-motivated professional
- Excellent multitasking ability
Timeline
Utilization Management Technician
AmeriHealth Caritas
11.2022 - Current
Medical Billing Coordinator
Advocare Haddonfield Pediatric Associates
03.2003 - 03.2020
Certified Medical Assistant -
Omega Institute
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