Excellent
Verbal Communication Skills – Skilled in engaging with clients and
tea-----------mbers to ensure clear, effective, and empathetic communication.
Customer
Service Expertise – Proven experience delivering high-quality support
in fast-paced environments, both in healthcare and telecommunications.
Proficient
in Microsoft Office Applications – Competent in Word, Excel, Outlook,
and PowerPoint for documentation, reporting, and communication.
Inbound
and Outbound Call Handling – Experienced in managing high call
volumes with professionalism and efficiency. Avaya, 8x8 and RingCentral
proficient.
Accurate
Data Entry and Processing – Detail-oriented with strong typing and
documentation skills for maintaining accurate records.
Healthcare
Benefits and Claims Processing – Knowledgeable in verifying benefits,
processing claims, and resolving insurance-related inquiries.
Revenue
Cycle Management (RCM) & Prior Authorization – Skilled in
end-to-end billing processes, including eligibility checks and
authorization workflows.
Utilization
Management – Experienced in reviewing clinical documentation and
determining medical necessity using established guidelines.
MCG and
InterQual Guidelines Expert – Proficient in applying evidence-based
criteria for clinical decision-making and utilization review.
HIPAA
Compliance – Trained in maintaining patient confidentiality and
adhering to U.S. healthcare privacy regulations.
EMR/EHR
Systems Expertise – Proficient in Cerner, Epic, Allscripts, and
NextGen for managing patient records and clinical workflows.
Medical
Intake, Scheduling, and AR Billing – Background in front-office
operations, appointment coordination, and accounts receivable billing.
Medical
Records Review – Skilled in analyzing clinical documentation for
accuracy, completeness, and compliance.
Workers’
Compensation Claims Specialist – Experienced in managing workers’
comp cases, including documentation, coordination, and claims resolution.
U.S.
Health Insurance Knowledge – Familiar with various insurance plans,
coverage policies, and healthcare reimbursement systems.
Familiarity
with medical terminologies.
