Pacshen Owens
Palatka
Summary
Dedicated team player adept at managing customer service and claims processing for policyholders. Looking for a long-term position with a growth-oriented company. Friendly Customer Service promoting a background in keeping sensitive patient data confidential while maintaining knowledge of Medicaid and private policy benefits. Possessing great relationship building and communication skills. Looking to tackle new challenges with a company that values dynamic skills and a strong work ethic.
Overview
8
8
years of professional experience
1
1
Certification
Work History
Care Advisor
UnitedHealth Group
03.2024 - Current
- Provide comprehensive support to members and their families, addressing their complex healthcare needs, questions, and concerns.
- Resolve medical, behavioral, and pharmacy issues, including coordination of benefits, claims, billing, appeals, and prior authorizations, striving to remove burdens from the member.
- Help members navigate UnitedHealth Group resources, including myuhc.com, and encourage self-sufficiency.
- Support members in researching and identifying healthcare providers that meet their needs, and intervene with providers on behalf of the member.
- Advocate for members and families to ensure their needs and choices are fully represented and supported by the healthcare team.
- Document clinical data, demographic, and product information, appropriately routing cases to RNs for clinical review.
- Manage escalated calls and provide comprehensive support to resolve issues efficiently.
Patient Access Specialist
Spectraforce Technologies Inc.
10.2023 - 04.2024
- Applied HIPAA privacy and security regulations while handling patient information.
- Verified demographic and insurance information to register patients in computer system.
- Organized and maintained records by updating and obtaining both personal and financial information from patients and providers.
- Responded to patients and or providers concerns and inquiries professionally and efficiently.
- Complete data entry from the enrollment form into the CRM.
- Collect PA requirements, follow up with the insurance for the PA status, and communicate the results to the healthcare provider.
- Evaluate patient records against eligibility criteria to determine if they can continue the free drug assistance.
Customer Service Representative
Access2care Non-Emergency Medical Transportation
07.2023 - 11.2023
- Answer inbound calls to schedule non emergency medical transportation for eligible members.
- Changing or canceling a previously scheduled trip.
- Checking for ETA for scheduled transportation.
- Verifying insurance before scheduling trip.
CSR/Travel Claims Examiner
Wipro Technologies
05.2022 - 07.2023
- Verified patients eligibility and claims status with insurance agencies.
- Posted and adjusted payments from insurance companies.
- Identified and resolved patient billing and payment issues.
- Handled claims and appeals.
- Verified patients insurance coverage, deductibles, and remaining balance.
- Verified details with policyholder and requested more information.
- Documented specific claims by completing and recording forms, reports and logs.
- Processed large volume of medical claims.
- Review claims for accuracy before submitting for billing.
- Performed data entry into the computer system to record information regarding claim status.
- Investigated discrepancies in claims and resolved issues with customers via telephone or written correspondence.
Pharmacy Customer Service Representative
Qualfon
10.2021 - 10.2022
- Received A high volume of calls in regards to coverage of members billing and claims history.
- Address and direct inbound calls.
- Prepare faxes, email and handle all incoming and outgoing correspondences.
- Complied with HIPAA, PHI, and state and federal law regulation.
- Resolved and clarified coverage levels for patient medications.
- Handled over 50 customer accounts daily.
- Confirmed prescriptions for patients by placing calls and conferring with physicians office staff.
- Answered customers questions about prescribed and OTC medication.
- Assisted customers with questions regarding side effects for various types of medication.
Transport Supervisor
Tender Care Medical Services
06.2020 - 03.2021
- Ensured the safe and efficient transport of goods by supervising drivers, loading and unloading crews, and vehicle maintenance personnel.
- Provided regular feedback to team members on their performance in order to meet operational standards.
- Developed training programs for new employees on driving techniques, route planning, customer service skills.
- Organized periodic safety meetings for all staff involved in transport operations.
Customer Service Representative
SMA Behavioral Healthcare
12.2019 - 06.2020
- Greeted customers warmly and made them feel welcome.
- Answered incoming calls, redirected callers to the appropriate personnel or department and took messages as needed.
- Assisted with scheduling appointments for clients and visitors.
- Maintained an organized reception area and ensured that all guests were attended to promptly.
- Performed data entry into computer systems to maintain accurate records of customer information.
O.R Scheduler
Flagler Hospital
02.2017 - 11.2019
- Coordinated with surgeons and other medical staff to ensure accurate scheduling of procedures.
- Resolved conflicts between patient schedules, doctor availability, and equipment needs.
- Created reports for administrative purposes detailing the usage of operating rooms, personnel, and supplies.
- Communicated regularly with nursing staff regarding upcoming surgeries, changes in schedules, and any necessary adjustments.
- Performed data entry into various computer systems related to OR scheduling activities.
- Maintained accuracy of surgical block time allocations for all physicians utilizing the ORs.
- Verified accuracy of customer information by collecting and inputting data into system.
Education
High School Diploma -
St Johns River State College
Palatka, FL06.2018
Skills
- Familiar with commercial and private insurance carriers
- Resourceful and reliable worker
- Microsoft Excel
- Data Processing
- Data Verification
- Teams
- Calm and Professional Under Pressure
- Written and Verbal Communication
- Medical Terminology
- Claim Validity Determination
- HIPAA Compliance
- Customer Service
- Insurance Information Collection
- Eligibility Determination
- Healthcare documentation
- Medical record requests
- Client confidentiality
- HIPAA protocol adherence
- Multitasking
- Follow-up care
- Verbal and written communication
Websites
Certification
- Certified Nursing Assistant
- BMSPAF ELIQUIS
Timeline
Care Advisor
UnitedHealth Group
03.2024 - Current
Patient Access Specialist
Spectraforce Technologies Inc.
10.2023 - 04.2024
Customer Service Representative
Access2care Non-Emergency Medical Transportation
07.2023 - 11.2023
CSR/Travel Claims Examiner
Wipro Technologies
05.2022 - 07.2023
Pharmacy Customer Service Representative
Qualfon
10.2021 - 10.2022
Transport Supervisor
Tender Care Medical Services
06.2020 - 03.2021
Customer Service Representative
SMA Behavioral Healthcare
12.2019 - 06.2020
O.R Scheduler
Flagler Hospital
02.2017 - 11.2019
High School Diploma -
St Johns River State College
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