Shannen Erika C. Sanchez

* Verified Patient Eligibility
• Coordination of Benefits
• Payment Posting Verification
• Utilized EHR systems like how to search up claims, edit claims, demographics, insurance info., etc
• Edited Payment Postings (who is responsible for payment)
• Resubmitted claims
• Processed Patient Chart Notes/Medical Records and how to navigate systems
• Worked on Excel spreadsheets to keep track of each claim worked per day
• Navigated through multiple Provider Portals to verify Patient Eligibility and claims status:
• Regular Medicaid (MC)
• N Medicaid
• HPN
• UHC Portal
• Tri-Zetto
• Office Ally
• Codify
• Availity
• Silver Summit
• Called and left voicemail to patients to verify COB/Insurance info
• Worked on 2 different types of spreadsheets while also having to have EOBs to scan over to transfer to patient to verify COB/Insurance info
• Worked on 2 different types of spreadsheets while also having to have EOBs to scan over to transfer to a shared drive in G-mail.

• Answered inbound calls (Script), Verified HIPAA each call and NPI, Verified HCPCS codes (primarily J-codes) to see if Authorization is required for that specific code to start new authorization, or if it is required in a different department (warm transfer/cold transfer experience), Checked status of Prior-Authorizations, Data Entry, and Notating Authorizations/Claims, Systems used: MBM-Now and ICUE (& Outlook, OneNote, Excel, Word), Average calls per day: 30-40+, Received Perfect Attendance award and received multiple 100% QA (Quality Assurance) on calls, Nominated for Employee of calls, Nominated for Employee of Month, Prior authorization submissions and status checks

• Answered phones, Excellent Customer Service experience, Handled travel voucher submissions, Award letters, Correspondence letters, Administrative and clerical work, Team-oriented, Loading and unloading boxes, and supplies, Worked in various duties and activities out of town (missions), Worked on the Military ship and provided excellent verification and editing skills.