Dedicated Customer Service professional with knowledge of service delivery and proven multitasking abilities. Committed to maintaining professional relationships to increase profitability and drive business results.
Overview
10
10
years of professional experience
Work History
Licensed Practical Nurse
New York State Insurance Fund
08.2023 - Current
Provided advice to customers regarding claims, rights and insurance processes to prevent disputes.
Responded to inquiries by answering questions, providing information and directing customers to appropriate resources.
Checked documentation for accuracy and validity on updated systems.
Carried out administrative tasks by communicating with clients, distributing mail, and scanning documents.
Analyzed medical records and other documents to determine approval of requests for authorization.
Provided prior authorization support for physicians, healthcare providers and patients in accordance with payer guidelines.
Verified eligibility and compliance with authorization requirements for service providers.
LPN
Supplemental Health Care
11.2022 - Current
Cared for wounds, provided treatments, and assisted with procedures.
Managed patient care through closely monitoring respiration, blood pressure, and blood glucose levels.
Administered controlled narcotics, maintained IVs, and performed catheterizations.
Delivered updates in patient status to charge nurse, recording changes in medical records.
Efficiently provide care to 20-40 residents on long term care unit.
Office Manager
A Nice Ride LLC
05.2018 - 11.2022
Reconciled end-of-day reports to determine accurate billing and payment processing.
Managed compliance to keep organization operating within legal and regulatory guidelines.
Created, maintained and updated filing systems for paper and electronic documents.
Assisted in organizing and overseeing assignments to drive operational excellence.
Updated reports, managed accounts, and generated reports for company database.
Customer Service Rep III
Maximus
02.2015 - 05.2018
Handled customer service inquiries in person, via telephone and through email. Made decisions based on the policies and procedures implemented by the company.
Investigated insurance claims denials and appeals.
Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns. Explained the rules, policies, and procedures in order to maintain customers understanding of certain processes.
Licensed Practical Nurse
Sunnyview Rehabilitation Hospital
09.2013 - 02.2015
Monitored patient vital signs including respiration, oxygen, and pain levels
Administered medications, cared for wounds, and collected urine samples for testing
Administered tube feedings.
Used aseptic techniques to provide sterilized wound care and dressing applications.
Provided care to approximately 12-15 adult and adolescent patients on brain injury unit.
Education
No Degree - Licensed Practical Nursing
Mildred Elley
Albany, NY
05.2013
Skills
Microsoft Word
Account Management
Money Handling Abilities
Computer Proficiency
Timeline
Licensed Practical Nurse
New York State Insurance Fund
08.2023 - Current
LPN
Supplemental Health Care
11.2022 - Current
Office Manager
A Nice Ride LLC
05.2018 - 11.2022
Customer Service Rep III
Maximus
02.2015 - 05.2018
Licensed Practical Nurse
Sunnyview Rehabilitation Hospital
09.2013 - 02.2015
No Degree - Licensed Practical Nursing
Mildred Elley
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