Malcolm T Email & Phone Number

Baton Rouge, La, Us

Communicates to members and providers in a timely, courteous fashion to ensure positive interaction 100% of the time. Reviews medical claims and advises on processing for members and providers. Generates appropriate correspondence to ensure compliance of state and federal regulation policy and procedure. Performs data entry of all interactions to ensure documentation of service request 100% of the time. Responsible for meeting targets for staff and unit performance as required by company Examined patients' insurance coverage, deductibles, possible insurance carrier payments and remaining balances not covered under their policies when applicable. Precisely evaluated and verified benefits and eligibility. Interacted with providers and other medical professionals regarding billing and documentation policies, procedures and regulations. Actively maintained current working knowledge of CPT and ICD-9 coding principles, government regulation, protocols and third party requirements regarding billing. Accurately documented, researched and resolved customer service issues. Mastery of customer service management systems and databases.

Planned and coordinated logistics and materials for board meetings, committee meetings and staff events. Coordinated domestic and international travel arrangements, including booking airfare, hotel and transportation. Managed office supplies, vendors, organization and upkeep. Answered and managed incoming and outgoing calls while recording accurate messages. Completed data entry, tracked resumes and maintained the applicant tracking system. Compiled company information and related material and distributed it to candidates. Coordinated, scheduled and arranged meeting and travel calendars, including business and social events.

Blue Cross Blue Shield Of Louisiana

Gathered and verified all required customer information for tracking purposes. Accurately documented, researched and resolved customer service issues. Managed customer calls effectively and efficiently in a complex, fast-paced and challenging call center environment. Thoroughly researched newly identified diagnoses and/or medical procedures to expand skills and knowledge. Determined prior authorizations for medication and outpatient procedures. Pre-certified medical and radiology procedures, surgeries and echocardiograms. Researched questions and concerns from providers and provided detailed responses.

Bachelor Of Science (Bs), Health/Health Care Administration/Management

Healthcare Administration