Demonstrate knowledge of HIPAA by appropriately managing patient confidentiality.Utilize CMS and InterQual criteria to establish authorizations for members requiring medical services for a Medicare advantage insurance company.Build authorization, match ICD-10 codes with there procedure.Obtain verification of insurance coverage and authorizations for clinical visits and surgical procedures for patients.Perform all components of the office registration including arrival, check-in and future appointments.Assign appropriate ICD-9 codes to all identify diagnoses, research and enter prescriptions as instructed.Verify daily billing submission report for insurances, including HCPCS codes, ICD-9 codes and modifiers.Enter in ICD-10 codes for quotes and authorizations on inpatient outpatient procedures and referrals to outside providers.Check clinical records for diagnosis, and obtain additional clinical information as needed to ensure the prescription authorization meets CMS guidelines.Document authorization in EMR system.Maintain HIPAA standards and ensure confidentiality of protect health information.Coordinate with insurance company authorization department to resolve CPT code discrepancies.

· Provide subject matter expertise and best-in-class customer service for all inbound and outbound customer calls to drive first call resolution. Provide insurance coverage, verification details prior authorization statues and alternate funding options for existing and newly launched products. Provide offices with current plan forms, portals, and websites for prior authorizations and appeal submissions. Clearly communicate and educate customers on results of the investigation.· Investigate and problem solve for patients experiencing escalated issues such as disadvantaged or complex access, savings card/copay card challenges or non-preferred formulary issues. Where necessary, complete a benefit investigation, contact the HCP and/or patient or potentially the filling pharmacy or payor.· Quickly learn and execute business process and system changes for all drugs and channel sources as applicable. Maintain an understanding of current business procedures, deviations, and case processing for all brands and channel sources for Insurance Specialist I role to support as needed.· Documents information in the appropriate system of record and formats. Accurately communicate insurance details to HCP and patients via phone, other electronic communication methods and fax, as per established policies and procedures.· Identify potential Adverse Event situations for reporting to Pharmacovigilance ensuring AbbVie meets FDA regulations

Verify patient insurance and benefit details regarding copayments, referrals, and authorizations.· Update patient demographics and insurance data· Answer multiple telephone lines on inquiries regarding providers, insurance coverage, and appointments· Responsible for admin duties such as scheduling, confirming appointments, and escorting patients to exam rooms· Obtained prior authorizations from various insurance companies by submitting clinical information via fax or speaking directly to a case management representative.· Worked with insurance companies for medication authorization approvals as well as submitting appeals for denied medications.· Communicated regularly with physicians, nurses, insurance companies, and managed care organizations

Obtained all Prior AUTHORIZATIONS for (echocardiograms, carotid duplex ultrasound, Stress echo, Lower extremities ultrasound, abdominal aortic ultrasound, renal ultrasound, ) in office.· Scheduled and obtained authorization for Nuclear stress test at hospitals.· Responsible for admin duties such as scheduling, confirming appointments, and escorting patients to exam rooms· Preformed Phlebotomy to 20-30 patients per day;· Preformed EKG to 40-50 patients per day· Obtained prior authorizations from various insurance companies by submitting clinical information via fax or speaking directly to a case management representative.· Worked with insurance companies for medication approval.· Contacted insurance companies regarding medical benefits.· Communicated regularly with physicians, nurses, insurance companies, and managed care organizations

Manage and train Medical Assistants to improve performance and skill level· Oversaw and managed clinical flow, the interaction of clinical staff, and all daily functions· In charge of making all Medical Assistants Schedules· Effectively oversaw all activities within lab in order to ensure that all duties preformed are recorded accurately and efficiently· Take necessary disciplinary measures with direction from office manager· Responsible for inventory and ordering medical supplies and materials· Responsible for implementing Proper Clinical instructions to all Medical Assistants· Triaged a Patient Flow of 40-50 patients per day· Checked in patient, collected copayments, and rescheduled patients’ appointments· Scanned in patient test results (MRI, X-rays, Med List etc)· Preformed Phlebotomy on patients per day· Take messages from patients and page Physician depending on urgency of message· Drug tested patient and prepared specimen to be picked up· Cleaned exam rooms after every patient