VIRGINIA HEYMAN
Tampa,US
Summary
Detailed Insurance authorizations and claim specialist with over 12 years experience. Strong command of conflict resolution and negotiation combined with excellent reporting and research skills. Thorough understanding of Medical insurance and approval processes of Medicare/Medicaid, HMO and PPO plans.
Overview
12
12
years of professional experience
1
1
Certification
Work History
Case Manager Specialist
Abbvie
02.2023 - 04.2024
- Provide subject matter expertise and best-in-class customer service for all inbound and outbound customer calls to drive first call resolution
- Provide insurance coverage, verification details prior authorization statues and alternate funding options for existing and newly launched products
- Provide offices with current plan forms, portals, and websites for prior authorizations and appeal submissions
- Clearly communicate and educate customers on the results of the investigation
- Investigate and problem solve for patients experiencing escalated issues such as disadvantaged or complex access, savings card/copay card challenges or non-preferred formulary issues
- Where necessary, complete a benefit investigation, contact the HCP and/or patient or potentially the filling pharmacy or payor
- Documents information in the appropriate system of record and formats
- Accurately communicate insurance details to HCP and patients via phone, other electronic communication methods and fax, as per established policies and procedures
- Provide insurance coverage, verification details prior authorization statues and alternate funding options for existing and newly launched products
- Provide offices with current plan forms, portals, and websites for prior authorizations and appeal submissions
- Quickly learn and utilize all internal and external electronic tools, communicate/collaborate with payors and providers to investigate insurance coverage efficiently
- Identify potential Adverse Event situations for reporting to Pharmacovigilance ensuring AbbVie meets FDA regulations
Insurance Specialist
ENT ALLERGY AND ASSOCIATES
Tampa, FL
12.2017 - 12.2022
- Processed 50-65 invoices and mailed documentation to clients each daily
- Collaborated with the contracting department to resolve payer issues
- Worked with carriers to resolve discrepancies in insurance payments
- Provided financial estimates to patients for both HMO and PPO plans
- Scheduled fact-finding meetings and consultations with clients to determine their needs and financial situations
- Negotiated bills on an as-needed basis.
Inside Property Adjuster
Liberty Mutual
Plano, TX
08.2012 - 12.2017
- Investigates, determines coverage of loss and adjusts all elements of routine property loss
- Maintains accurate and current communication with insured and life of claim case file
- Determines and negotiates settlement amounts for damages claimed within assigned authority limits
- Issues payment to policy holder where possible
- Explains coverage of loss, assists policy holders with itemization of damages, emergency repairs and additional living arrangements if necessary.
Insurance Verification Specialist
Rose Radiology
Tampa , FL
08.2012 - 03.2015
- Reviewed medical records to ensure accuracy of required information needed for pre-authorization requests.
- Verified patient eligibility for insurance coverage by contacting insurance carriers and obtaining the necessary authorization numbers.
- Developed a working knowledge of insurance plans, including Medicare and Medicaid regulations and requirements.
Education
High School -
Largo Highschool
01.2002
Skills
- MS Office/Word/Publisher/Excel
- Advanced medical terminology knowledge
- Well versed in full Authorization procedures
- Policy renewals
- Property insurance
- Claims investigation and research
- Patient Care
- Claims reporting systems
Certification
- Florida Adjuster License- All lines 620
Timeline
Case Manager Specialist
Abbvie
02.2023 - 04.2024
Insurance Specialist
ENT ALLERGY AND ASSOCIATES
12.2017 - 12.2022
Insurance Verification Specialist
Rose Radiology
08.2012 - 03.2015
Inside Property Adjuster
Liberty Mutual
08.2012 - 12.2017
High School -
Largo Highschool
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