Jennifer Taylor

Transitioned from Contract to Full time employee.

• Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
• Performed prior authorization review of services requiring notification.
• Reviewed documentation for accuracy and assessment of necessity.
• Implementing Policies, Procedures, and Standards of Conduct. While maintaining Ethics compliance with patient privacy and security regulations such as HIPAA
• Maintained files and controlled records to show correspondence activities.
• Gathered records pertinent to specific problems, reviewed for completeness and accuracy and attached records to correspondence as necessary.
• Create and approve authorizations for inpatient and outpatient, FEP (ABD), transplant, orthognathic, gastro, OPAP cases
• Entered client details and notes into system for interdepartmental access and review.
• Reviewed authorizations from payer to determine approved or denied items.
• Used coordination and planning skills to achieve results according to schedule needs of business
• Input all patient data regarding claims and prior authorizations into system accurately.
• Obtained and logged accurate patient insurance and demographic information for use by insurance providers and medical personnel.
• Verified eligibility and compliance with authorization requirements for service providers.
• Communicated pertinent information to client's prescribing provider to facilitate quality service.
• Authorized Behavioral, sleep study , OPAP request in accordance with applicable plan guidelines.
• Daily encounter and broad understanding of Medicaid part A and B, FEP, Indemnity insurance, and routing for medical necessity.
• Mentor employees transitioning from contract worker to permanent full time, and internally relocating to the UM non-clinical fax only department.

Developed and deepened client relationships in the health care industry by Utilizing my skills in medical billing and coding, and providing temporary assistance to insurance organizations.

Carefirst (Contingent) UM Coordinator Approver (current contract)

• Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
• Performed prior authorization review of services requiring notification.
• Reviewed documentation for accuracy and assessment of necessity.
• Implementing Policies, Procedures, and Standards of Conduct. While maintaining compliance with patient privacy and security regulations such as HIPAA
• Maintained files and controlled records to show correspondence activities.
• Gathered records pertinent to specific problems, reviewed for completeness and accuracy and attached records to correspondence as necessary.
• Create and approve authorizations for inpatient and outpatient cases
• Entered client details and notes into system for interdepartmental access and review.
• Reviewed authorizations from payer to determine approved or denied items.
• Used coordination and planning skills to achieve results according to schedule needs of business
• Input all patient data regarding claims and prior authorizations into system accurately.
• Obtained and logged accurate patient insurance and demographic information for use by insurance providers and medical personnel.
• Verified eligibility and compliance with authorization requirements for service providers.
• Communicated pertinent information to client's prescribing provider to facilitate quality service.
• Authorized Behavioral, sleep study , OPAP request in accordance with applicable plan guidelines.
• Daily encounter and broad understanding of Medicaid part A and B, FEP, Indemnity insurance.

• Introduced higher standards for customer service and increased efficiency by streamlining operations.
• Proficient in color coding and color matching
• In person relationship building with top clients producing over $200k sales per yr
• Addressed potential cancellations and offered catered solutions to retain accounts.
• Supervised employees and assessed performances to determine training needs and define accurate plans for decreasing process lags.
• Kept accurate records to document customer service actions and discussions.
• Exceeded team goals and collaborated with staff members to implement customer service initiatives.
• Negotiated contracts with outside carriers to minimize costs to company and customers.
• Developed service procedures, policies and standards.
• Controlled resources and utilized assets to achieve qualitative and quantitative targets.
• Monitored customer service operations to assess agent performance and provide feedback.
• Followed through with client requests to resolve problems.
• Created and reviewed invoices to confirm accuracy.
• Researched and observed emerging markets and market shifts to take advantage of potential leads and new markets.

• Provided primary customer support to internal and external customers.
• Provide excellent service to customers with information regarding basic eligibility, benefits and claims status with emphasis on customer retention.
• Analyzed and implemented ICD & CDT codes for dental procedures
• Expediently accesses reference materials to analyze and determine appropriate responses to telephone, electronic and written inquiries.
• 
  
• Collected and analyzed customer information to prepare product or service reports.
• Recorded accurate and efficient records in customer database.
• Researching and responding to customers by telephone, electronic or written inquiries
• Accurately completes online, hard copy forms and route to the appropriate department.
• Responds to basic telephone, electronic, written inquiries from dental or vision professionals, groups, subscribers and brokers or customers.
• Identifies, reports and documents system discrepancies.
• Documents each customer encounter or resolution in the appropriate computer tracking system.
• Established and maintained detail filing for customers and company materials.

• Creating long term business relationship with providers, doctors and INN/OON facilities throughout America.
• Specializing in ICD10 coding (diagnosis codes), procedure coding, Claims and Appeals for Dialysis.
• Analyze and resolve benefits issues for Prior authorization/ denials.
• Understand Prior authorization and Medical terminology.
• Assist with escalated cases on Expiration/New ESA/Missing AUTHS Reports.
• Verify and Report patients medical information to providers, medical reviewers and facility.
• Managed business scheduling, Faxes, daily calls, emails, copies, filing tickets, follow ups, ECC
• Specialize in Initial, follow up and completed Authorization/Denials via FAX, Phone, Email or insurance portals
• Prepared reports detailing billing actions, flags and other key information.
• Monitored flags and resolved urgent items with accuracy and efficiency.
• Worked with outside entities to resolve issues with billing, claims and payments.
• Electronically submitted bills according to compliance guidelines.
• Reconciled statements with patient records.
• Reviewed and corrected claim errors to facilitate smooth processing.

• Maintained over 200 solid safety record with no OSHA-recordable incidents.
• Responded to emergencies and outages that required additional labor and assistance for repairs.
• Observed company safety rules and regulations to minimize workplace accidents and reduce electric shocks.
• Devoted special emphasis to punctuality and worked to maintain outstanding attendance record, consistently arriving to work ready to start immediately.
• Worked with residential and commercial customers, to understand needs and provide extraordinary service.
• Specializing in identifying, marking and mapping utility lines for both design and construction projects.
• Utilized commercial equipment for accurate markings on gas, electric, and telecommunication lines.
• Ensuring safe environment for communities while managing tickets in organized and timely manner.
• Engaging in USIC, DOT safety trainings and codes.

• Met and exceeded store revenue targets for net activations, accessories, data sales, and customer renewals.
• Drove both individual and team sales performance results to 150% by proactively implementing sales techniques and sharing ideas.
• Ensured customer satisfaction and resolved all customer issues and concerns.
• Acted as first level of contact for customer escalation issues.
• Offered hands-on assistance to customers, assessing needs and maintaining current knowledge of consumer preferences.
• Strengthened merchandising and promotional strategies to drive customer engagement and boost sales.
• Trained team members in successful strategies to meet operational and sales targets.
• Used weekly financial data to analyze company growth and optimize operational strategies.
• Technical Support Specialist.
• Provided extraordinary customer service to assure customer satisfaction and de-escalate customer concerns.
• Completed store opening and closing procedures.
• Submitted reports to senior management to aid in business decision-making and planning.