Nia Wooten
Customer Relations
Memphis,TN
Summary
Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Proficient in managing schedules, handling confidential documents, and communicating with internal and external stakeholders are strengths that I possess. Equipped with exceptional communication and interpersonal skills with a proven ability to work independently and as part of a team.
Overview
6
6
years of professional experience
1
1
Certification
Work History
Inbound/Outbound Prior Authorization Queue
CVS-Aetna
07.2024 - Current
- Reviewed, analyzed, and processed prior authorization requests to determine coverage, medical necessity, and compliance with payer and regulatory guidelines.
- Managed prior authorization, claim and appeal status while maintaining accuracy and confidentiality.
- Maintained 96%+ quality assurance by adhering to claims processing standards, reducing errors, and improving overall workflow accuracy.
- Led initiatives to streamline the prior authorization process, resulting in reduced turnaround times and improved service delivery.
Express Claims Specialist
Allstate Co.
02.2023 - 02.2024
- Coordinating appraisals, reporting details of claims, processing and authorizing payments.
- Proactively managed appointment schedules and confirmation protocols, enhancing client satisfaction and fostering positive relationships through timely and personalized interactions.
- Scheduled and managed adjuster appointments while ensuring clear communication with customers to maintain high satisfaction levels.
- Utilized claims management software to document claim activity, update statuses, and support timely claim resolution.
Neurodiagnostic Technologist
Aurora St. Luke’s Medical Center
11.2019 - 09.2022
- Collaborated with interdisciplinary teams to develop tailored patient assessments, improving diagnostic accuracy and treatment effectiveness.
- Established a meticulous hourly chart documentation process, recording key data related to patients' brain waves during epileptic events. This initiative significantly improved the accuracy and depth of data available for analysis, leading to more informed treatment decisions by doctors.
- Submitted procedure codes, verified insurance information, and ensured proper medical billing documentation for claim submission.
- Maintained compliance with organizational policies and HIPAA regulations.
Education
CompTIA A+ Certification - Information And Communication Technology
Tech901
Memphis, TN08.2024
High School Diploma - General Studies
Rufus King IB High School
Milwaukee05.2017
Skills
Insurance Eligibility Verification
Claims System Navigation (EHR/EMR, Claims Platforms)
Claims processing, review & documentation
HIPAA Compliance and Confidentiality
High-Volume Queue and Workflow Management
ICD-9, ICD-10, CPT Coding Knowledge
Medical and pharmacy terminology
Proficient in Microsoft Office Suite (Word, Excel, Powerpoint, etc)
Basic IT Support (Software/Hardware Troubleshooting)
Strong and effective/Verbal and Written Communication(Phone, E-mail, Chat)
Certification
CompTIA A+ Certified | Tech901 August 2024
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Timeline
Inbound/Outbound Prior Authorization Queue
CVS-Aetna
07.2024 - Current
Express Claims Specialist
Allstate Co.
02.2023 - 02.2024
Neurodiagnostic Technologist
Aurora St. Luke’s Medical Center
11.2019 - 09.2022
CompTIA A+ Certification - Information And Communication Technology
Tech901
High School Diploma - General Studies
Rufus King IB High School