Barbra Young Email and Phone Number

⦁ Gain and maintain the understanding of the plan designs and effectively apply that knowledge.⦁ Maintain a comprehensive working knowledge of Policies, Procedures, Compliance Regulations, Schedule of Benefits and turnaround times across all product lines.⦁ Maintain an understanding of claims processing and an ability to research claims issues.⦁ Prepare acknowledgment and response letters to members and providers.⦁ Maintain case records on all complaints, grievances, and appeals.⦁ Identify, research and resolve claim disputes received from a variety of sources.⦁ Ability to multitask on multiple appeals simultaneously, prioritizing work and completing within stringent time frames.⦁ Prepare statistical analysis for required reporting.⦁ Analyze and track trends.

Medical Reviewer - Processing medical referrals, data entry and auditing of completion of the referrals. Credentialing data entry, verification of Providers credentials and certifications.

Minimized resource & time losses by addressing employee or production issues directly & implementing timely solutions. Managed schedules, accepted time of requests & found coverage for short shifts.Tracked receipts. employee hour & inventoried movements.Prepared detailed reports on updates to project specifications, progress & identified team activities. Trained new team members by relaying information on company procedures, policies & safety requirements. Audited team performance & compliance with industry standards.Partnered with Account Manager to support preparation of client materials to educate, train & inform on benefits services and self-administration toolsHandled troubleshooting tasks & brainstorming with manager.Supported Account Manager with incoming Inquiries from existing clients.Mentored newly hired employees on safety, developed training summaries & work guides to use for referenceDeveloped monthly & daily production output plans to deliver on customer serviceCoached team members in techniques necessary to complete job tasksParticipated in cross functional team building activities.Evaluated employee skills & knowledge regularly. Training & mentoring individuals with lagging to keep up with production.Worked different stations to provide optimal coverage & meet production goals.Established open & professional relationships with team members to achieve quick resolution for various issues.Instructed team members on protocols & procedures of each position to maximize workflowInteract professionally with clear, intentional communication & set appropriate expectations can timeline of tasks.Developed and maintained successful business partnerships to address & proactively manage serviceTraining instructor for new appeals team members. Regularly updated the appeals process training procedures to the onboarding of new employees. Updated the PowerPoint & other training materials while instructing the training class.

Promoted office efficiency coordinating charts, completing insurance forms and helping patients with diverse needsDocumented vital signs and health history for patients in clinic and hospital environments.Assisted with routine checks and diagnostic testing by collecting and processing specimens.Directed patients to exam rooms, fielded questions and prepared for physician examination.Sanitized, restocked and organized exam rooms and medical equipment. Instructed patients regarding medications and care plan instructions. Enhanced patient outcomes by providing knowledgeable education on procedures and physician instructions.Collected and documented patient medical information such blood pressure and weightPrepared and administered medication to alleviate patient symptomsCalled and faxed pharmacies to submit prescriptions and refills.Collaborated with medical and administrative personnel to maintain a patient focused engaging and compassionate environment.Prepared initial patient charts for admissionsObtained client medical history, medication symptoms and allergiesArranged ed surgeries with surgical center and hospitals, confirming times with patients and preparing admission and consent formsScheduled appointments, registered patients and distributed sample pharmaceuticals prescribedObtained all prescribed laboratory testing.Performed clerical duties such as word processing; data entry, answering phones and filing documents.Answered questions about eligibility determinations and plan optionsMaintained confidentiality of all patient informationVerified patient insurance and applied for medical prior authorizations within the insurance carrier.

Assisted with routine checks and diagnostic testing by collecting and processing specimens.Directed patients to exam rooms, fielded questions and prepared patients for physician examinations.Monitored patients responses to vaccinations and reported any unusual findings to nurse supervisorScheduled appointments, registered patients and distributed sample pharmaceuticals as prescribed.Obtained client medical history, medication information, symptoms and allergies.Obtained all prescribed laboratory testing.Kept medical supplies in sufficient stock by monitoring levels and submitting replenishment orders before depleted.Promoted efficiency. coordinating charts, completing insurance forms and helping patients with diverse needsTested and recorded blood glucose levelsPerformed clerical duties such as word processing, data entry, answering phones and filing. Obtained pre- and post-treatment vital signs, height and weightCalled and faxed pharmacies to submit prescriptions and refills. Taught patients about medications, procedures and care plan instructionsVerified appropriate lab couriers picked collected lab specimens. Documented vital signs and health history for patients in clinic and hospital environmentsPrepared and performed Injections, immunizations, ear lavages, suture removals and dressing changesSanitized, Restocked and Organized exam rooms and medical equipmentCollaborated with medical and administrative personnel to maintain a patient focused engaging and compassionate environment.On a special team to research and obtain information to submit documents for Patient Centered Medical Home. Assisted with Grant submissions. Safety Committee and Compliance Committee