Silburn R. Palmer
Lewisville,TX
Summary
Enthusiastic Healthcare professional who is eager to contribute to team success through hard work, attention to detail and excellent organizational skills. Clear understanding of patient services and training in project management. Motivated to learn, grow and excel in the healthcare industry.
Overview
8
8
years of professional experience
Work History
Home Health Office Supervisor
Dover Healthcare
McKinney, TX
06.2021 - Current
- Coordinate activities between clients and care giver
- Supervise attendant services and office staff
- Handle medical care submission
- Record keeping and management of documentation
- Monitor staffing and productivity
- Perform care given when necessary
- Monitor work to identify issues and track progress
- Assist with hiring and firing.
Inbound Contact Representative II (SME)
Humana
Irving, TX
09.2020 - 05.2021
- Addresses customer needs which may include complex benefit questions, enrollment, resolving claim issues, and referrals/authorization while educating members
- Records details of inquiries, comments or complaints, transactions or interactions and takes action in accordance to it
- Escalates unresolved and pending customer grievances
- Ensure accurate and timely processing of all requests by taking appropriate action, such as scheduling appointments, taking messages, transferring calls to appropriate staff/department
- Ensure thorough records are maintained by documenting discussion, messages and actions taken to process inquiries
- Resolve patient issues through independent problem solving and with a goal of first call
- Documenting processes and disseminating information to other agents, when requested
- Providing knowledge, resources and information to support agents
- Coaching and training agents on improving Customer Interaction and offering advisors guidance
- Provide comprehensive knowledge of products and services through continued self-improvement and following quality standards.
Member Service Representative
CHRISTUS Health
Irving, TX
06.2019 - 04.2020
- Responds to incoming calls from members and providers
- Assist members with demographic updates, new insurance card request, assist with web Portal registration, medication utilization and filing of complaints
- Accurately records all calls as applicable
- Achieves individual performance goals as it relates to call center objectives
- Engages and collaborates with other departments as applicable.
Insurance Verification Specialist
Alliance Rx Walgreen's Prime
10.2018 - 03.2019
- Verify that enough information is available for accurate verification and eligibility
- Which includes contacting physician office and/or the patient
- Utilize the Walgreen's selected vendor for claims and eligibility and/or individual payer websites, obtain eligibility, benefits and or pre-certs and authorization information
- Enter the patient insurance information into the patient accounting system ensuring the selection is the appropriate payer and associated financial class
- Calculate copay and estimated co-insurance due from patients per the individual contract and plan as applicable
- Document all findings, and information and outcomes in the patient accounting system
- Load patient insurance and run test claim on patient's medication using (script med) internal system
- View Prescription images to document patient diagnoses/ICD-10 or call physician office
- Utilize Cover My Meds to initiate prior authorization to send to provider and or insurance company.
Member Service Associate
Molina Healthcare
10.2017 - 07.2018
- Responds to incoming calls from members and providers
- Assist members with demographic updates, new insurance card request, assist with Web Portal registration, medication utilization and filing of complaints
- Accurately records all calls as applicable
- Achieves individual performance goals as it relates to call center objectives
- Engages and collaborates with other departments as applicable.
Patient Accounts Representative II
Infinity Behavioral Health Services
07.2015 - 09.2017
- Contact insurance carriers to obtain benefit, payments, coverage, policy limitations, authorization/ notification, and pre-certifications for identified patients
- Follows up with physician offices, financial counselors, patients and third-party payers to complete the pre-certification process
- Collaborates with Supervisor and internal departments as needed to provide account status updates, coordinate the resolution of issues, and appeal denied authorizations
- Undertake training to improve employees' performance
- Monitor work to identify issues and track progress
- Serve as a conduit between the call center management and agents
- Take agents' views and feedback on board, with an aim to set team goals
- Collect on HB and PB claims
Prior Authorization Specialist
Humana Clinical Pharmacy Review
10.2012 - 01.2015
- Responds to incoming calls, communicate with doctors, nurses and other health care professionals to complete prior authorization over the phone or send by fax
- Expedite medication request based on patient's urgency
- Provide accurate information to provider inquiries
- Addresses provider service inquiry in a timely and accurate manner
- Assist with member's eligibility, benefits and payment information for members claim
- Assist providers in obtaining prior authorization for required procedures in order to resolve unpaid claims
- Provide excellent customer service to providers while meeting monthly quality and adherence goals
Education
Bachelor of Science - Applied Project Management and Analysis
University of North Texas
No Degree - Business Management
Tarrant County College
Fort Worth, TXGED - General Studies
Pearson Education Center
Skills
- Medical Terminology (5 years)
- ICD-10 (2 years)
- Billing
- Organizational skills
- Problem-solving
- Team player
- Excel
- Microsoft word
- Healthcare Management
- Insurance Verification
- Conflict Management
- CPT Coding
- Medical Billing
- Data entry
- Documentation review
- Customer service
- Home health
- Communication skills
- Computer skills
- Home Health Care
- Anatomy Knowledge
- Analysis Skills
- Additional Information
- Skills:
- Call Center, Customer Service, Industry experience, Strong desire to learn & grow, Experience
- Working with insurance
- Special Skills:
- Proficient in conflict resolution
- High customer service standards, strong problem-solving ability
- Excellent written and verbal communication, great interpersonal skills
- Strong analytical/organizational skills
- Well-rounded team player, great work ethics and knowledge of Microsoft word/excel
- Experience in Billing, ICD-10 Coding and Pre-Authorizations
- Strong attention to detail
- Proficient knowledge working with EPIC (EMR) system
- Managed Care
Additional Information
- Willing to relocate: Anywhere, Authorized to work in the US for any employer
Timeline
Home Health Office Supervisor
Dover Healthcare
06.2021 - Current
Inbound Contact Representative II (SME)
Humana
09.2020 - 05.2021
Member Service Representative
CHRISTUS Health
06.2019 - 04.2020
Insurance Verification Specialist
Alliance Rx Walgreen's Prime
10.2018 - 03.2019
Member Service Associate
Molina Healthcare
10.2017 - 07.2018
Patient Accounts Representative II
Infinity Behavioral Health Services
07.2015 - 09.2017
Prior Authorization Specialist
Humana Clinical Pharmacy Review
10.2012 - 01.2015
Bachelor of Science - Applied Project Management and Analysis
University of North Texas
No Degree - Business Management
Tarrant County College
GED - General Studies
Pearson Education Center