Summary
Overview
Work History
Education
Skills
Work Preference
Timeline
Marilyn Taylor

Marilyn Taylor

Pre-Authorization/Referral Specialist
Austin,TX
One of the deep secrets of life is that all that is really worth doing is what we do for others.
Lewis Carroll

Summary

Astute customer service professional with knowledge of service delivery and proven multitasking abilities. Committed to maintaining professional relationships to increase profitability and drive business results.
Diligent authorization verification specialist with 11 years of experience addressing customer requests and concerns. Expert at providing relevant information and options to successfully resolve issues. Upbeat and energetic handling difficult situations through resourcefulness and adaptability.

Overview

11
11
years of professional experience

Work History

Customer Service Advocate-Remote

Pyramid Consulting
11.2023 - 03.2024
  • Resolved customer inquiries on claims and authorizations, providing dedicated support and ensuring satisfactory solutions as a primary contact
  • Maintained strict adherence to HIPAA regulations and company policies to uphold confidentiality and professionalism in all customer engagements
  • Guided clients in navigating member portals, understanding benefits, and managing appeals, enhancing their experience and knowledge of services.

Quality Assurance

Balance Staffing - Remote
07.2023 - 10.2023
  • Reviewed client life insurance applications, ensuring adherence to performance metrics while maintaining professional standards
  • Complied with HIPAA regulations and state laws, securing necessary consents for specialized signature requirements
  • Documented clients' medical histories and prescription information, supporting the accuracy of the underwriting process.

Clinical Intake Specialist/UM - Remote

Healthcare Support
11.2022 - 03.2023
  • Processed inbound prior authorization and referral requests, ensuring accurate data entry as per established update protocols
  • Consistently met regulatory deadlines by effectively utilizing Care Management software to manage pre-certification and inpatient notifications.
  • Ensured the appropriate departments or vendors received all pre-certification and referral inquiries according to quality assurance standards.

Billing Specialist

Care Centrix - Remote
07.2021 - 11.2022
  • Managed and accurately recorded a high volume of financial transactions by processing daily incoming payments
  • Collaborated with healthcare insurers to rectify billing and claims issues, guaranteeing precise and prompt payment processing
  • Improved client satisfaction by efficiently resolving customer inquiries and concerns, focusing on effective communication and problem resolution.

Contact Center Representative II Remote

Medtronic - San Antonio, TX
10.2016 - 07.2021
  • Demonstrated ability to handle over 50 calls per day, consistently meeting performance metrics and ensuring adherence to quality standards
  • Elevated customer awareness of Medicare guidelines for diabetic supplies, resulting in improved comprehension and adherence to medical protocols.
  • Leveraged comprehensive understanding of product financial implications to enhance sales through strategic recommendations.

Customer Care Representative

Aerotek - San Antonio, TX
09.2015 - 10.2016
  • Addressed and resolved medical pump therapy queries, ensuring detailed and compassionate customer assistance
  • Increased client contentment through the prompt and empathetic resolution of various issues
  • Managed a substantial number of inbound and outbound customer service interactions, maintaining high-quality support
  • Processed required authorizations for Medicare and Commercial Health Plans to facilitate continuous pump therapy access.

Customer Care Representative

Maximus - San Antonio, TX
10.2014 - 09.2015
  • Ensured adherence to HIPAA regulations, providing high-quality customer support for Medicare/Medicaid and SNAP program inquiries
  • Utilized strong communication skills to submit appeals and resolve customer requests through tailored solutions
  • Maintained compliance with service level agreements by managing call times and meeting performance metrics, leveraging complex computer systems for information retrieval.

Insurance Verification Specialist

Dental & Medical Staffing - Portland, OR
05.2014 - 07.2014
  • Verified Medicare and Medicaid eligibility on a monthly basis, ensuring uninterrupted coverage for patients in compliance with healthcare regulations
  • Liaised with insurance providers to confirm patient benefits, securing required referrals and authorizations while upholding stringent confidentiality standards.

Customer Service Representative

Rotech-Centennial Medical Equipment-Portland, OR
04.2013 - 03.2014
  • Verified insurance eligibility and obtained required prior authorizations for patient treatments, ensuring consistent delivery of oxygen services
  • Coordinated order processing activities and optimized delivery schedules to align with patient demands, ensuring accurate system recordkeeping.

Education

Associate of Science: Medical Billing Coding -

Ultimate Medical Academy
06.2012

Skills

  • OMNI Software
  • MS Office (Word, Excel, Outlook)
  • EMR Systems
  • Central Point
  • HIPAA Guidelines
  • Embark
  • One Source
  • CPT Coding
  • 48 WPM
  • Patient Referral
  • Computer Proficiency
  • Calabrio One
  • Medical Terminology (Intermediate)
  • Patient Health Information Access
  • Tru-Care
  • Call Center
  • Remote Experience
  • Detail Oriented
  • Softheon
  • Time Management
  • Multi-tasking
  • Medical Billing
  • CMS Medicaid/Medicare
  • Commercial Insurance
  • DME
  • ABN
  • AOB
  • EOB
  • CLAIMS
  • PBM
  • EHR
  • Probity
  • Autodidactic
  • Versatility
  • Experiential Learning
  • Email Communication
  • Organizational Skills
  • Problem-solving
  • Interpersonal Skills
  • Persistence
  • Call Triaging
  • Electronic Authorization Processing
  • Referral Coordination
  • Payment Scheduling and Collection

Work Preference

Work Type

Full Time

Location Preference

Remote

Important To Me

Personal development programsWork from home optionCompany CulturePaid time offCareer advancement

Timeline

Customer Service Advocate-Remote - Pyramid Consulting
11.2023 - 03.2024
Quality Assurance - Balance Staffing - Remote
07.2023 - 10.2023
Clinical Intake Specialist/UM - Remote - Healthcare Support
11.2022 - 03.2023
Billing Specialist - Care Centrix - Remote
07.2021 - 11.2022
Contact Center Representative II Remote - Medtronic - San Antonio, TX
10.2016 - 07.2021
Customer Care Representative - Aerotek - San Antonio, TX
09.2015 - 10.2016
Customer Care Representative - Maximus - San Antonio, TX
10.2014 - 09.2015
Insurance Verification Specialist - Dental & Medical Staffing - Portland, OR
05.2014 - 07.2014
Customer Service Representative - Rotech-Centennial Medical Equipment-Portland, OR
04.2013 - 03.2014
Ultimate Medical Academy - Associate of Science: Medical Billing Coding,

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Marilyn TaylorPre-Authorization/Referral Specialist