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Client-focused Sales Representative and Business Leader with 12+ years of providing solutions to customers. Solid understanding of the business building rapport associated with customer centered service and experience.

 Experienced Healthcare Professional with over five years of expertise in Prior Authorization, Medical Claims Processing, and Customer Service. Skilled in handling high-volume inbound and outbound calls, verifying insurance coverage, and working with commercial, Medicare, and Medicaid payers. Proficient in CRM systems, Epic, and McKesson, Salespoint with strong knowledge of ICD-9/10 coding and CPT. Resolving claim issues, ensuring timely authorizations, and maintaining accurate documentation to support healthcare reimbursement processes. Tracked and analyzed payer payment processes, including prior authorization status, and followed up on outstanding claims and denials through regular calls. Utilized Microsoft Excel to track authorization status, maintain detailed records, and generate weekly reports for management. Initiated and completed claim investigations when indicated, including prior authorizations, pre-existing conditions, accidents, medical necessity and appropriateness, eligibility, and coordination of benefits. Reviewed incoming claims and related documentation, verifying prior authorization and ensuring accuracy and completeness. 

Proactive and goal-oriented professional with excellent time management and problem-solving skills. Known for reliability and adaptability, with swift capacity to learn and apply new skills. Committed to leveraging these qualities to drive team success and contribute to organizational growth.

To seek and maintain full-time position that offers professional challenges utilizing interpersonal skills, excellent time management and problem-solving skills. History of working with substance abuse and mental health clients who have been adjudicated guilty. Knowledge of treatment modalities and Kentucky Revised Statutes. Enjoys writing technical reports and good at streamlining documentation. Familiar with the Chicago Manual of Style, 17th Edition and the APA Format. Skilled at data verification, research and document review. Good at active listening and enjoys a collaborative work environment. Demonstrates a strong foundation in Microsoft Office Suite and a commitment to professional development, learning and training. Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy. Capable of managing multiple priorities with a positive attitude, although a slightly sarcastic sense of humor that is not intended to offend anyone. Willingness to take on added responsibilities to meet goals and will work until a goal is finished. Service-oriented; skilled at applying creative approaches to solving problems. Good organizational and communication skills with a desire to learn grant writing.

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Claims Examiner

Customer Experience Executive

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Bachelor Of Science - Travel Management

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Claims Examiner

Customer Experience Executive

Receptionist

Bachelor Of Science - Travel Management

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