I have experience of knowledge in the following areas. Provider application and enrollment, Eligibility verification and PCP referrals, Prior authorization, Billing and follow-up, Customer Service, Medicare, Medicaid, CMS, Claims, DME, Microsoft word, outlook, excel. Working on Multiple monitors. Financial industry, Data entry.
• Research issues by navigating across multiple databases
and working with support resources to resolve providers’
concerns and/or partner with others to resolve escalated
issues
• Determine if prior authorization is required based on the
state mandates, CMS Medicare guidelines, and benefit
plan. If prior authorization is needed, submit for review to
appropriate nurses for approval or denial.