Ursula Ransom
Gonzales,USA
Summary
Dynamic professional with extensive experience in authorization management claims and customer service. Proven track record in efficiently processing claims and routing cases, enhancing operational workflows. Adept at utilizing CRM software to improve member satisfaction and streamline communication, ensuring timely resolutions and support for healthcare providers.
Overview
13
13
years of professional experience
Work History
UM Tech
Amerihealth Caritas
Baton Rouge, LA
06.2019 - Current
- Process incoming and outgoing correspondence/faxes in accordance with required standards and within respective guidelines.
- Creates, updates, maintains and/or closes authorizations or tasks for services as assigned within process guidelines. Route cases to the appropriate department worklist/or team member that is assigned to the case.
- Build authorizations request that are received daily and assign. Attach faxes to already approved/denied/pending cases and assign.
- Perform other related duties and projects as assigned within the assigned timeframe.
- Maintain a current knowledge base of UM processes and timelines.
CSR I
Louisiana Healthcare Connections
Baton Rouge, LA
04.2017 - 06.2019
- Respond to telephone or written correspondence inquiries from members and/or providers within established time frames utilizing current reference materials and available resources.
- Helped members and/or providers regarding website registration and navigation.
- Document all activities for quality and metrics reporting through the Customer Relationship Management (CRM) application.
- Maintain performance and quality standards based on established call center metrics including turn-around times.
- Submit claim cases when provider showed dissatisfaction with claim denial.
Provider Service Rep
Louisiana Healthcare Connections
Baton Rouge, LA
06.2014 - 04.2017
- Assisted providers with claim denials through Amisys and CRM.
- Advised providers on payable codes and authorizations through the Medicaid Fee Schedule.
- Worked with other departments on cross functional tasks and projects.
- Administrated support for providers and advising them on utilizing Louisiana Healthcare Connections website secure web portal.
- Submitted claim cases when provider showed dissatisfaction with claim denial.
Member Service Rep
Louisiana Healthcare Connections
Baton Rouge, LA
10.2012 - 06.2014
- Answered any member questions regarding billing errors or inquiries.
- Assisted members with assigning a primary care doctor and finding different specialist in our network.
- Assisted members with their coverage and benefits.
- Assisted members with updating demographics information.
- Educate members and/or providers on health plan initiatives.
Education
High School -
Glen Oaks High School
Skills
- Authorization management
- Claim processing
- Customer service
- Case routing
- Data entry
- CRM software
Timeline
UM Tech
Amerihealth Caritas
06.2019 - Current
CSR I
Louisiana Healthcare Connections
04.2017 - 06.2019
Provider Service Rep
Louisiana Healthcare Connections
06.2014 - 04.2017
Member Service Rep
Louisiana Healthcare Connections
10.2012 - 06.2014
High School -
Glen Oaks High School