Jeffrey Pandato

• Serves as Tier 3 advocate to service clients for a TeleHealth company (Remedy Meds, GPlans, and Futur Health) which offers weight-loss programs to patients.
• Streamlined communication channels between clients, pharmacies, healthcare providers/CMAs, patient support (Tier 1 and 2), and technical support teams to improve issue resolution times.
• Working on different queries from clients through Slack channels and Zoho ticketing system to address clinical, and technical issues in a timely manner.
• Reviewing patients' charts in Healthie to ensure the accuracy of the weight management encounters, initial and refill intakes, after-visit summary, compound orders (Semaglutide, Tirzepatide, and Zepbound), and provides communication to patients via email if needed.

• Billing and Invoicing. Generating and sending out invoices to patients or insurance companies for medical services provided. This includes ensuring that all billing codes are accurate, and that charges align with the services rendered.
• Claims Management. Handling submission of claims to insurance companies/IPA Medical Groups, follow up on any denied or unpaid claims, and work to resolve any discrepancies or issues that may arise in the claim process.
• Payment Collections. Tracking and collecting payments from patients or insurance providers, managing accounts to ensure timely payment, and following up on overdue accounts to ensure that outstanding balances are addressed.
• Account Reconciliation. Reviewing and reconciling patient accounts, ensuring that all payments and adjustments are accurately recorded, and that any discrepancies are promptly investigated and resolved.

• Validating Dental insurances and advised patients of benefits and coverage.
• Attending to Email endorsements from Front Desk including Complimentary Benefits Request for same day appointments, 1 Day Out and 2 Days Out.
• Doing patient contact to gather active insurance information and calling insurances and/or checking carrier's website for validation of coverage.
• Manually entering patient's information, benefits including frequency limits and coinsurance percentage for both In and Out of Network coverage.
• Knowledgeable in navigating Open Dental System and insurance' websites and has strong familiarity in dental codes.

• Supports the Team by reviewing insurance claims denied for payment on behalf of our client hospitals and/or healthcare providers.
• Billing Health insurances in a timely manner, maintaining the accuracy of all the information that is being entered in the claim forms (UB04/HCFA1500), doing follow-up via phone call and/or through web portal to check if claim has been adjusted or has been denied.
• Creating both Technical and Clinical appeals and reconsideration to overturn claim denial for healthcare providers to receive payment from the rendered services.
• Reviewing EOBs/Remittance Advices and manually entering the payment information to the healthcare system. Meeting client's expectations in reaching the monthly, quarterly, and annual revenue target.

• Guaranteed first-class customer service, enthusiastically anticipating and catering to customer needs and requirements.
• Assisted Customers with their insurance benefits (Vision, Dental, Medical, OTC & Pharmacy) and claims information.
• Attending to Irate callers and helping them to raise, escalate and resolve their complaints/grievances.

• Assessed client needs and made targeted product recommendations to build trust and increase revenue.
• Ensured timely payment collections by promptly following up on outstanding balances and negotiating payment plans.
• Improved cash flow management with consistent follow-up on overdue invoices and establishing clear lines of communication with patients regarding their financial responsibilities.

AetnaMedicare | CVS Caremark

• Provided friendly, attentive service by promptly responding to customer inquiries and processing order requests especially in Prescription refills for both Point of Sale Service and Mail Order. Performing Prescription overrides Including but not limited to (Quantity limits Override).

Cigna Insurance Company | Express Scripts

• Assisted customers with products-related concerns, feedback and complaints about their Medical and Pharmacy coverage and benefits. Also handled claims inquiries.

Vaccine Scheduling (CoVac)

• Assisted all the 50 States of America in scheduling vaccines (J&J, Moderna, Pfizer) during the midst of pandemic mandated by the National Government of America/Centers for Disease Control and Prevention (CDC).