TIAYANNA NEWTON

•Answered calls through a queue and submitted automobile claims.

•Answered status calls and transferred members to the appropriate party when necessary.

•In this position I discussed deductibles/coverage with members daily

• I attended scheduled meetings for quality and member satisfaction.

•I attended trainings to stay up to date on changes with policy.

•I Listened to playback calls and rated each call for quality assurance

•I communicated with adjusters via different channels to assist members or claimants

•I attended huddles to discuss improvements and individual success

• Maintained individual insurance policies daily for authorizations & verification of accuracy. Submitted appropriate treatment plans to carrier for approval/denial. Coordinated treatment between patients & office to ensure no lapse in treatment. Communicated verbally &/or email with insurance carrier regarding any denials or unpaid claims submitted. Submitted claims for payment to individual carriers. Submitted collections on past due accounts & followed up on status of each case. Verified insurance monthly/daily to ensure eligibility for each patient on the schedule.

• Maintained a case load of 200+ individual cases. Requested & documented all related & non-related documents to review prior to submission to appropriate carriers. Modeled exceptional customer service skills & appropriate diagnosis to adjusters for approvals/denials. Maintained open communication via email &/or verbally between all adjuster & Nurse Case Managers on each case. Upheld confidentiality of patient finances, records & health statuses. Answered telephone calls to offer office information, answer questions & direct calls to staff.

• Completed skilled administrative work to support all office staff & operational requirements. Documented patient medical/dental information, case histories and insurance details to facilitate smooth appointments & payment processing. Reviewed charts & flagged incomplete or inaccurate information effectively with staff, patients & insurance companies by email &/or telephone. Maintained office efficiency, coordinating charts, completing insurance forms & helping patients with diverse needs. Answered the phones for scheduling appointments.

• Completed full dental charting & evaluation alongside Dentist. Prepared full treatment plans & discussed treatment with patient's parents/guardian. Verified all HIPPA documentation was completed upon communication with underage patients. Took full mouth x-rays & properly mounted for the dentist to view. Performed dental cleanings & fluoride treatment. Assisted Dentist with dental procedures daily. Submitted treatment authorization request to proper insurance carriers. Verified appointments via phone & email. Scheduled dental appointments for treatment and follow-up care. Utilized proper radiation care for all parties.