Nachand Downs
Summary
Professional with strong background in customer interactions and service solutions. Highly skilled in conflict resolution, communication, and problem-solving, ensuring customer satisfaction and loyalty. Effective team collaborator, adaptable to changing needs, and consistently focused on achieving results through efficient and empathetic service. Known for reliability and proactive approach to meeting customer and organizational goals.
Overview
6
6
years of professional experience
1
1
Certification
Work History
PCA
Norton Healthcare, Norton Brownsboro Hospital
09.2024 - Current
- Assisted patients with daily living activities, promoting independence and wellbeing.
- Maintained clean and safe environment to promote patient safety and comfort.
- Changed linens in rooms, keeping spaces fresh and clean for patient health and satisfaction.
- Maintained a clean and safe environment for patients, reducing the risk of infections and accidents.
A/R Follow-up specialist
UofL Health
11.2023 - 08.2024
- Ensure all claims are filed electronically except for some paper claims
- Follow up on unpaid Medicaid and Managed Medicaid claims in a timely manner
- High dollar accounts will have consistent follow up until the account has been resolved
- Responsible for reviewing and understanding explanation of benefits/remittance advice
- Ensure statements are generated for the patient responsibility amounts
- Utilize insurance websites to view and resolve claims
- Document all follow up efforts in a clear and concise manner into the AR system
- Familiar with inpatient only procedure list and work with Revenue Cycle leadership to prevent denials
- Identify and report all trends that may provide insight into payment challenges
- Phone contact with patient, physician office, attorney, etc for additional information to process claims
- Improved customer satisfaction by promptly addressing and resolving follow-up inquiries.
- Maintained accurate records of customer accounts, payments and payment plans.
Recovery Specialist
Optum
06.2022 - 09.2023
- Follow up with attorneys & insurance carriers for medical payments
- Negotiated payment arrangements with customers, resulting in increased revenue and reduced delinquencies.
- Improved client satisfaction through timely communication and resolution of account discrepancies.
Care Management Support Assistant 2
Humana
04.2020 - 06.2021
- Utilized Care Management applications and systems (CRM, PAAG, NPPES)
- Assisted in the development of company policies, contributing to a more organized and structured work environment.
- Facilitated communication between departments for smoother workflow and better collaboration.
- Maintained a 100% production rate
Clinical Pharmacy Rep
Humana
11.2018 - 04.2020
- Accept Inbound Calls from physicians, pharmacies, and members concerning Prior Authorizations for medications
- Begin the authorization process on behalf of members; fax/email documents to providers for validation
- Analyze and Process test claims for certain medications to assess if there is a need for authorization
- Handled customer complaints quickly and professionally to restore customer confidence and prevent loss of business.
- Increased customer satisfaction by addressing and resolving complaints in a timely manner.
Education
Cosmetology -
PJ's School of Cosmetology
Clarksville, IN05-2022
High School -
Doss High School
05.2009
Skills
- Proficient in Microsoft Excel
- Proficient in Microsoft Word
- Troubleshooting
- Data Collection
- Detail Oriented
- Data Analysis
- Behavioral management
- HIPAA compliance
- Critical thinking
- Claims handling
- Claims documentation
- Data entry
- Problem resolution
- Complaint handling
- Payment processing
- Microsoft outlook
- Follow-up skills
Certification
- Certified Nail Technician (CNT) - National Cosmetology Association.
Bee Award
The Bee Award is an award presented to deserving Nurses/Nursing Assistants who demonstrate exceptional care for patients.
Languages
English
Full Professional
Timeline
PCA
Norton Healthcare, Norton Brownsboro Hospital
09.2024 - Current
A/R Follow-up specialist
UofL Health
11.2023 - 08.2024
Recovery Specialist
Optum
06.2022 - 09.2023
Care Management Support Assistant 2
Humana
04.2020 - 06.2021
Clinical Pharmacy Rep
Humana
11.2018 - 04.2020
High School -
Doss High School
- Certified Nail Technician (CNT) - National Cosmetology Association.
Cosmetology -
PJ's School of Cosmetology
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