Summary
Overview
Work History
Education
Skills
Certification
Languages
Work Availability
Timeline
Personal Information
Work Preference
POTTERY, SWIMMING, BOWLING, KARAOKE, DANCING, SHOPPING, NETFLIX, BRUNCHES
Personal Information
Goals
Generic
Nariah Pearsey

Nariah Pearsey

INSURANCE VERIFICATION SPECIALIST/ PRIOR AUTHORIZATION SPECIALIST/ CLAIMS SPECIALIST
Fort Myers,FL

Summary

I am an experienced health insurance claims, insurance verification, prior authorization, and pre-certification specialist with a combined total of 2 years of experience in the field. My expertise includes extensive knowledge of insurance policies, including private insurance, Medicare, and Medicaid, and I am skilled in interpreting insurance coverage details. I excel in performing insurance verifications, obtaining prior authorizations requirements, and utilizing EHR systems and insurance verification platforms to streamline processes. My meticulous attention to detail ensures accurate and complete authorization requests, and I have excellent communication skills when interacting with patients, healthcare providers, and insurance companies. I have a proven ability to collaborate with stakeholders to resolve insurance-related issues promptly. I am responsible for explaining and managing medical insurance claims, ensuring the validity of patients' insurance coverage, and obtaining prior authorization requirement information for specific medical procedures or treatments. I am known for my strong communication skills in handling claim issues and resolving denials or delays by collaborating with healthcare providers, patients, and insurance companies. I am a problem-solver when navigating claim disputes and pay great attention to detail in reviewing claim documentation to prevent errors or fraud. Committed to maintaining confidentiality and adhering to privacy regulations.

Overview

5
5
years of professional experience
1
1
Certificate
1
1
Language
1
1
year of post-secondary education

Work History

OUTPATIENT INSURANCE SPECIALIST - PROVIDER SERVICES

BLUE CROSS BLUE SHIELD ALABAMA
06.2023 - 12.2023
  • SPEAKING WITH JUST PROVIDERS ONLY
  • VERIFYING MEDICAL PRECERTIFICATION, PREDETERMINATIONS, AND PRE/PRIOR AUTHORIZATION INFORMATION
  • VERIFYING DENTAL BENEFITS
  • SYSTEMS: CARELON, EVICORE, JIVA6
  • THOROUGH UNDERSTANDING OF HIPAA LAWS

Health Insurance Customer Service Advocate

Alta Resources Health Care Service Corporation BCBSIL
05.2022 - 06.2023
  • Handle inbound calls and some outbound calls as needed
  • Create a case for each member and call
  • Review policies, claims, and Explanation of Benefits (EOBs)
  • Add temporary members as necessary
  • Run benefits for members
  • Explain online services to members
  • Email members for communication purposes
  • Find providers for members
  • Ensure compliance with HIPAA regulations
  • Run procedure/CPT codes for verification
  • Verify eligibility of members
  • Verify provider status as In Network/Out of Network

Package Handler

FedEx
01.2022 - 06.2022
  • Inspected packages for defects, damage, and improper labels
  • Followed company policies and guidelines for labeling, packaging, and shipping products
  • Helped maintain organization and efficiency in the yard
  • Organized stock and transported it to the correct location
  • Read pick lists and located products accurately
  • Sorted, handled, loaded, and unloaded freight using various equipment
  • Installed bracing, padding, and strapping to secure loads
  • Rigged up frames and platforms with tools
  • Safely operated forklifts, overhead cranes, and hoists
  • Confirmed incoming and outgoing packages to track shipments and delivery

Customer Service Representative

Lynx
05.2021 - 10.2021
  • Utilize FNOL interface efficiently
  • Schedule reservations for customers
  • Maintain up-to-date knowledge of customer accounts
  • Explain products and benefits to customers
  • Possess proficiency in Windows 10
  • Prioritize tasks effectively
  • Coordinate activities and resources
  • Build and maintain relationships with customers
  • Process transactions accurately and efficiently
  • Operate live chat system
  • Create customer appointments
  • Deliver high levels of service and support to customers
  • Validate data and resolve problems related to system-generated information
  • Utilize knowledge base systems and work processes to assist customers
  • Handle escalated callers in a constructive manner

Hostess

Bianca's Italian Ristorante
10.2020 - 04.2021
  • Managed reservations and coordinated seating
  • Processed cash and credit card payments
  • Informed guests about specials and menu changes
  • Monitored alcohol service and ensured a sanitary environment
  • Answered incoming calls and provided information
  • Planned reservations and seating arrangements
  • Resolved guest complaints
  • Supported servers and assisted with food service
  • Accommodated special guest requests
  • Memorized menu offerings and provided information to guests
  • Maintained a neat and well-groomed appearance
  • Set up and cleared tables during peak times
  • Maintained an organized hostess station and restocked supplies

Restaurant Hostess

Rib City
02.2020 - 05.2020
  • Pre-planned seating arrangements for large groups and reservations
  • Seated guests, accounting for special requests and available seating
  • Greeted and bid farewell to guests, presented menus, and announced server names
  • Answered phone to take delivery or pickup orders
  • Accommodated special seating requests and needs
  • Coordinated dining room personnel for timely and courteous service
  • Alerted staff of special dietary requirements
  • Utilized suggestive selling techniques to maximize sales
  • Answered calls, took messages, and confirmed reservations
  • Informed guests about specials and menu changes
  • Prepared beverages and expedited orders

Retail Sales Team Member

JP Sports
11.2019 - 01.2020
  • Interacted with customers, providing top-notch customer service
  • Determined customer needs and advised on purchases
  • Upheld company standards for brand and merchandise presentation
  • Described product features and deals to customers
  • Supported coworkers with customer needs
  • Handled cash and credit transactions
  • Resolved customer issues using listening and problem-solving techniques
  • Handled customer paperwork and tracked orders
  • Escorted customers to appropriate merchandise
  • Shelved and stocked products
  • Maintained a clean and orderly work environment
  • Completed opening and closing duties, including cash handling
  • Located out-of-stock items for customers
  • Maintained knowledge of sales, policies, and security practices
  • Encouraged customers to sign up for warranties and additional services
  • Maintained revenue through attractive sales displays

Lead Hostess

Leopardi's Italian Restaurant
02.2019 - 08.2019
  • Managed reservations and coordinated seating for appropriate dates, times, and party counts
  • Informed guests about daily specials, new dishes, and menu changes
  • Set up and cleared tables at peak times for faster seating
  • Maintained neat and well-groomed appearance
  • Observed dining room to monitor guest satisfaction and provide assistance
  • Greeted and bid farewell to guests, presented menus, and announced server names
  • Answered incoming calls and provided information about hours, location, and menu items
  • Handled banquet room and patio reservations for special events
  • Maintained organized hostess station and restocked supplies
  • Cleaned and sanitized tables, menus, and dining areas
  • Supported servers by greeting tables, providing water, taking beverage orders, and running food

Education

Bachelor's degree - Allied Health Management Medical Coding Track

NUC University - Florida Technical College
Pembroke Pines, FL
09.2022 - Current

HIGH SCHOOL DIPLOMA - Medical Assisting

South Fort Myers High School
Fort Myers, FL
05.2019

Skills

  • Reporting Abilities
  • Documentation Abilities
  • Account Management
  • Reporting Skills
  • Benefits Administration
  • Computer Literacy
  • Microsoft Office Suite
  • Teamwork Abilities
  • Policy Understanding
  • Policy Knowledge
  • Processing Mail
  • Setting up Files
  • Data Entry

Certification

Food Handler Certification

Languages

English

Work Availability

monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
swipe to browse

Timeline

OUTPATIENT INSURANCE SPECIALIST - PROVIDER SERVICES

BLUE CROSS BLUE SHIELD ALABAMA
06.2023 - 12.2023

Bachelor's degree - Allied Health Management Medical Coding Track

NUC University - Florida Technical College
09.2022 - Current

Health Insurance Customer Service Advocate

Alta Resources Health Care Service Corporation BCBSIL
05.2022 - 06.2023

Package Handler

FedEx
01.2022 - 06.2022

Customer Service Representative

Lynx
05.2021 - 10.2021

Hostess

Bianca's Italian Ristorante
10.2020 - 04.2021

Restaurant Hostess

Rib City
02.2020 - 05.2020

Retail Sales Team Member

JP Sports
11.2019 - 01.2020

Lead Hostess

Leopardi's Italian Restaurant
02.2019 - 08.2019

HIGH SCHOOL DIPLOMA - Medical Assisting

South Fort Myers High School

Personal Information

Willing To Relocate: Anywhere

Work Preference

Work Type

Full Time

Work Location

RemoteHybrid

Important To Me

Healthcare benefitsPaid sick leaveWork-life balancePaid time offCompany CultureWork from home optionFlexible work hoursCareer advancementPersonal development programs

POTTERY, SWIMMING, BOWLING, KARAOKE, DANCING, SHOPPING, NETFLIX, BRUNCHES

- Pottery: I engage in the art of pottery, utilizing my creativity and craftsmanship to create unique ceramic pieces.
- Swimming: I maintain an active lifestyle through swimming, which not only promotes fitness but also provides relaxation and tranquility.
- Bowling: I enjoy bowling as a recreational activity, fostering friendly competition and socializing with my close friends.
- Karaoke: Singing karaoke is a favorite pastime of mine, allowing me to showcase my vocal talents and have a great time with my friends.
- Dancing: Dancing is a passion of mine that allows me to express myself creatively and enjoy the rhythm and movement.
- Shopping: Exploring shopping centers and finding unique items is an enjoyable activity for me, allowing me to keep up with trends and indulge in personal style.
- Netflix: I appreciate unwinding with Netflix, watching a variety of shows and movies to stay entertained and engaged.
- Brunches: Gathering with my close friends for brunch is a delightful way to enjoy good food, conversation, and quality time together.

Personal Information

Willing To Relocate: Anywhere

Goals

As a young black woman of 22, my goal is to soon enroll in a CST program and become a Certified Surgical Technologist (CST) extraordinaire! With my passion for precision and my thirst for knowledge, I am excited to embark on this journey into the world of surgery. By mastering the art of setting up the operating room, preparing instruments, and anticipating the needs of the surgical team, I will ensure that every procedure runs like a well-oiled machine. With my passion for precision and my keen eye for detail, I aim to play a vital role in the operating room, ensuring that every procedure runs smoothly and efficiently. From assisting with surgical preparations to anticipating the needs of the surgical team, I'll bring my A-game and a touch of sweetness to create a supportive and harmonious environment.


Sincerely,

Nariah Pearsey

Nariah PearseyINSURANCE VERIFICATION SPECIALIST/ PRIOR AUTHORIZATION SPECIALIST/ CLAIMS SPECIALIST