medical receptionist/billing/referral management/prior authorization
After my Grandson was born, being over 1700 miles away from him just didn't work. I just moved back to Tennessee and am looking for my career home. Thank you for your time and consideration. I am looking forward to talking with you.
863 Smith Branch Road
Clarksville, TN 37042
Utilization Coordinator, Referral Management
March 2013 - August 2014
United HealthCare Military and Veterans
Startup of new division, UHC M&V, trouble shooting of new software, creation of referrals as well as prior authorizations for command approval for active duty personnel, retired military as well as family members. Verification processed through DEERS as well as type of insurance coverage and other health insurance coverage for inpatient, outpatient, and behavioral health, medical and durable medical equipment. Responsibilities included processing of civilian and Medical Treatment Facilities (MTF) requests including Right of First Refusal (ROFR) as well as prior authorizations to include Certificate of Medical Necessity, clinical notes and physician order from MD or DO. Coding using Encoder Pro software.
Customer Care Professional
August 2006 - October 2012
Card Member Services Division, Small Business Finance Division, and High Value Card Member Services Division
Telephone Service Center - Phoenix, Arizona
Business Customer Sales and Support, Reconciliations of Account(s), Resolution Specialist, Recommendation of Products for the Success of the Business Customer, as well as Training of Staff for Specialized Products including Line of Credit. Promoted from card member services to Small Business Finance Division within 5 months of starting with American Express, Small Business Finance within American Express was then disbanded and I was transferred back to Card member services. Within a 2 month time period, I was then promoted to High Value Card member services. This specialty team within American Express works with business card holders as well as business management to resolve any and all card problems, reconciliation of multiple card holders (up to 99 card holders) on one base account, dispute resolution, as well as recommendations of products or services.
May 2005 - August 2006
Western International University
Cold call to potential college students to convince to attend college to forward education, coached potential students on options for degree programs to fit their needs for education, registration of new, as well as, returning to college adult students. Instruction of students on website usage including FAFSA, financial aid websites, as well as walk through processes of posting for online college courses. Following of all active registered students as well as inactive students to assist them to stay devoted to their education goals established at time of registration. Influenced potential students to attain their dreams of attending college, attaining their dream degree and helping them to achieve their highest dreams, only to help them reach even higher!.
November 2003 - April 2005
Rental sales and services manager for a retail rental location and responsible of all restoration of prior rental items before sales or re-rental, which also included ordering or transferring of merchandise from corporate or other rental centers. In store credit, employment and reference checks as well as scheduling of delivery or pick-up of rental or sales items. Due to occasional staffing issues, required to deliver items (washers, dryers, full furniture sets, etc.) when needed as well. Refurbish of all laptop rentals and sales including on-site as well as in home repairs of all computer systems.
April 2003 - September 2003
Curvacious, Franchise for Curves for Women
Cave Creek, Arizona
Supervision of up to 9 fitness technicians, scheduling of staff for 2 locations, accounting, projections, training, motivation and discipline of all staff and club members. Interviewing and hiring of new employees, responsible for all member files, inventory, diet and nutritional classes.
May 2002 - February 2003
Williamson Medical Center
Responsibilities included scheduling of procedures within a large trauma hospital including stat or emergency procedures, including but not limited to radiology, endocrinology, nuclear medicine, ultrasound, biopsy and nuclear injections which would include patient registration, insurance verifications and insurance prior authorizations.
July 2001 - May 2002
Star Physical Therapy
Unit secretary requires greeting of all patients, patient registration, insurance verification, and insurance pre-authorizations, if needed, entry of physical therapy charges for insurance billing, assist with patient care in wound care center as well as in physical therapy.
November 1999 - April 2001
Various temporary positions in inventory control/merchandising, product management/sales account management, accounts payable/accounts receivable, payroll, financial analysis and assisting clients to prepare for retirement.
Customer Service Representative and Full Charge Bookkeeper
July 1998 – November 1999
Brown Insurance Services, Inc.
Licensed in Life and Health Insurance (Tennessee State), Payroll, payroll taxes, W-2, 1099's, accounts payable and accounts receivable, as well as all commissions for sales personnel.
President's List for Academics - Kaplan University, while working full time.
Licensed in Life and Health Insurance, Sales and Servicing, Tennessee
Top Performance Numbers Multiple Times at American Express
Promoted 3 times in 5 years of service with American Express
Top 5 Service Champion for 1995/1996 @ Omni Severin Hotel
Education And Sales Training
Associates Degree in Business Administration
GPA / 3.67
Diamond Consultant/Manager Training
Kay Jewelers 1979/1980