Mya Patterson
Winter Park,FL
Summary
An experienced healthcare call center specialist with a strong background in insurance verification, claims processing, and customer service. Over the course of [X] years, I have developed a comprehensive understanding of healthcare policies, billing procedures, and insurance protocols, making me adept at assisting patients and providers with accurate insurance information and resolving discrepancies. Known for my exceptional communication skills, attention to detail, and ability to navigate complex insurance systems, I am committed to delivering outstanding service while maintaining confidentiality and compliance with regulatory standards. I thrive in fast-paced environments, utilizing my problem-solving abilities to ensure seamless patient care and accurate claims processing.
Overview
4
4
years of professional experience
Work History
Eligibility Specialist
Cigna
Remote, FL
06.2021 - 03.2025
- Coached team members and conducted quality audits to enhance productivity and operational efficiency.
- Received, processed, and reviewed prior authorization requests via fax, phone, and electronic systems, ensuring compliance with all regulatory and accreditation standards.
- Analyzed and interpreted members’ eligibility, claim history, and Pharmacy Program data using PBM claims software; communicated findings to internal and external stakeholders via phone and email.
- Interpreted medical and pharmacy data accurately and entered information into systems in alignment with regulatory and NCQA accreditation requirements.
- Resolved issues related to formulary administration and pharmacy benefit discrepancies through detailed analysis and follow-up.
- Acted as a liaison between Member Services and internal departments, providing real-time support on pharmacy benefit and plan design interpretation.
Education
Bachelor of Arts - Healthcare Administration
Seminole State College of Florida
08-2027
Skills
- Insurance & Healthcare Knowledge: Medicare and Medicaid, Insurance Verification, Coinsurance, Deductibles, Copays
- Medical Billing & Coding: ICD-9, ICD-10, CPT, HCPCS, DRG, DME, SNF, Revenue Codes
- Medical Knowledge: Medical Terminology, HIPAA Rules and Regulations
- Software Proficiency: Microsoft Outlook, Excel, Word, PowerPoint, Access
- Team & Project Management: Team Leadership, Project Coordination, Process Improvement
Timeline
Eligibility Specialist
Cigna
06.2021 - 03.2025
Bachelor of Arts - Healthcare Administration
Seminole State College of Florida
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