Sharon Bamberg

Simplified claims discrepancy process resulting in a significant reduction in audit errors.

Ensure proper processing of claims and timely accurate payment for services rendered using rules and guidelines for claims processing.

Collaborate cross-functionally and support other departments as needed.

Worked on extensive projects from beginning to completion.

Process daily reports tracking inventory.

Researched and resolved claims disputes for providers, facilities and members, with one call resolution using multiple systems.

Achieved high productivity levels, exceeding performance standards in resolving claim inquiries and ensuring prompt resolution for denied claims.

Provided exceptional customer service by professionally and efficiently addressing claim inquiries using multiple systems.

Processed denied claims for payment using claim rules and guidelines.

Triage calls and facilities referrals to appropriate outpatient services.

Data entry in multiple platforms such as sharepoint.

Coordinates and facilitates the transfer of patients with behavioral health needs.

Dispatches remote assessor and collaborates for next step patient care.

Assist Mobile Assessment Team Evaluator with communication to ER/hospital to include copy of assessment and recommendations.

Assisted to serve in emergency or diaster situations.

Crisis intervention and risk assessment, psychiatric diagnoses symptomology, basic chemical dependency.

Answered calls and took demographic information related to the person being assessed.

Received calls from referral sources for psychiatric assessment and dispatches a Mobile Assessment Team Evaluator.

Accurate documentation of calls and other related paperwork which was a critical component of the job.

Managed client authorizations by providing precertifications for providers and members.

Demonstrated strong communication skills. Handled multiple inbound calls from providers and members and deescalated calls from persons upset about their pre-certifications not being approved. Provided resolutions or next steps whichever was applicable.

Worked the dedicated members line to assist members with inquiries and to help them navigate across multiple domains.

Committed to customer satisfaction.

Resolved member inquiries with professionalism and empathy.

Enhanced member satisfaction by providing a thorough knowledge of member benefits and eligibility.

Applied this knowledge through the use of multiple

applications.

Provided support to members and providers, contributing to a positive experience and fostering trust in the healthcare system.

Assisted members with health insurance questions and concerns.

Provided information pertaining to skilled nursing, eligibility, prescriptions and drug coverage, billing and authorizations.

Connected callers to case management personnel regarding specialized cases. Performed PCP changes.

Researched grievances and utilized strong interpersonal skills with attention to detail.