Mia Peterson Email & Phone Number

Winter Park, Fl, Us

Altamonte Springs, Florida, United States

o Assessed the financial needs of Medicare and commercial patients, coordinating and enrolling them in pharmaceutical manufacturer and foundation assistance programs.o o Identified the most appropriate assistance programs based on patients' insurance coverage, medical diagnoses, and prescribed therapies.o Communicated program eligibility criteria to patients and completed enrollment on their behalf, facilitating medication delivery.o o Processed claims and copay cards to ensure timely reimbursements.o Collaborated with patients, physicians, and payors to provide necessary information and supporting financial documentation.o Maintained clear communication with relevant parties regarding patients' financial requests and updates.o Researched and resolved discrepancies related to vendor billing.o Documented and communicated patients’ medical records and financial assistance information accurately.o Meet service level goals (AHT, Grade of Service, average speed to answer and abandonment rate.o Review authorization requests to determine the appropriate authorization process, including auto-approval or referral to the Utilization Management Nurse, ensuring compliance with established guidelines and protocols.o Served as a liaison between billing and collections departments to address financial assistance matters.o Stayed informed on federal, state, and contractual regulations related to copay assistance and manufacturer programs.

United States

o Managed and triaged beneficiary calls, providing comprehensive case intake support on the Medicare Helpline.o Assisted members and providers with oral and written coverage determinations and appeals.o Educated beneficiaries on their rights and responsibilities within the Medicare program.o Requested and obtained medical records and detailed bills to support case research.o Prepared clear and professional letters and responses to appeals and grievances.o Receive and process requests for authorization from hospitals, healthcare providers, customers, and vendors through multiple channels, including fax, phone, and online portals, ensuring timely and accurate handling of inquiries.o Contributed to the operations of the Beneficiary and Family Centered Care (BFCC) Quality Improvement Organization (QIO), serving beneficiaries across 19 states.o Communicated QIO activities to beneficiaries, providers, and stakeholders to enhance transparency.o Trained new hires and verified beneficiary eligibility in the Medicare database.o Handled inbound pharmacy calls, ensuring compliance with departmental and regulatory standards.o Maintained data integrity and operational efficiency through accurate updates of systems and logs.

Orlando, Florida, United States

o Prepared and reviewed claims meticulously to ensure billing accuracy in compliance with industry standards and company guidelines.o Gathered and inputted patient demographic information conducted insurance verification/authorization, and managed scheduling of diagnostic and interventional procedures efficiently.o Built strong rapport with customers through compassionate responses, consistently exceeding expectations in timely, accurate, and respectful interactions.o Handled a high volume of over 50 inbound calls daily from patients, addressing inquiries and aiding with professionalism and efficiency.o Engaged in collection activities to secure reimbursements from payers and patients, demonstrating a proactive approach to financial reconciliation.o Managed billing, collections, and copay processes effectively.o Communicated plan benefit information, including formulary details, copay amounts, pharmacy services, and prior authorization outcomes.o Resolved delinquent and complex claims, showcasing strong problem-solving skills and persistence while managing confidential information in alignment with HIPAA and data privacy regulations.o Reported all Adverse Events (AEs) in accordance with training and Standard Operating Procedures (SOP), ensuring compliance with regulatory requirements.o Demonstrated proficiency in systems such as Rx Home and Blue Zone, contributing to efficient workflows and accurate data management.o Assisted in scheduling patient’s Rx orders, ensuring timely and accurate fulfillment of prescription needs.

Orlando, Florida Area

o Orchestrated end-to-end processing of employee leaves, ensuring compliance with policies and regulatory requirements.o Integrated clinical resources effectively, incorporating medical information into decision-making processes.o Developed and maintained detailed leave trend reports, analyzing current leaves, returns, and intermittent leave implications to support strategic decision-making.o Analyzed FMLA and other paid leave claims to determine eligibility, payment calculations, and adjustments in accordance with client policies and federal regulations.o Executed precise claim decisions for FMLA cases while managing time-off records concurrently.o Served as the primary contact for leave-related inquiries, maintaining effective inbound and outbound communications with employees.o Efficiently prioritized caseloads, demonstrating strong organizational skills and providing timely interventions.o Identified action plans, determined benefits due, and made timely case decisions based on client service expectations.o Ensured confidentiality of records in compliance with ERISA regulations, demonstrating comprehensive knowledge of Benefits, FMLA, STD, ADA, and Long-Term Disability (LTD)

Orlando, Florida Area

o Initiated and managed employee benefits administration for multiple companies, ensuring seamless operations and compliance with benefit policies.o Handled over 60 inbound and outbound calls daily, maintaining a strong focus on quality customer service.o Conducted comprehensive research and analysis of healthcare plans, including medical, dental, vision, and disability insurance, to support informed decision-making for employees and employers.o Provided detailed explanations of benefits and associated costs, effectively resolving benefit-related issues for employees.o Utilized systems such as CSPro and Lotus Notes to streamline benefit administration processes and enhance operational efficiency.o Demonstrated expertise in navigating and leveraging these systems for effective benefits management.o Possessed in-depth knowledge of Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs), offering valuable insights to participants, and facilitating informed decision-making.

Orlando, Florida Area

o Committed to effective communication and issue resolution, fostering positive interactions with consumers.o Utilized various systems and applications, including Salesforce and Smart label, to deliver comprehensive and accurate product knowledge.o Specialized in de-escalating situations with irate callers through active listening, empathy, and strategic problem-solving.o Maintained professionalism and composure in handling challenging interactions, ensuring a respectful and constructive dialogue.o Demonstrated exceptional product knowledge, instilling consumer confidence and satisfaction.o Successfully resolved complex consumer issues, enhancing the overall customer experience, and upholding a positive brand image.o Received positive feedback for effectively de-escalating difficult calls, contributing to a collaborative and supportive team environment.

Fort Myers, Florida Area

• Diligently maintained and updated customer information to ensure accuracy and completeness.• Proficiently troubleshooted issues related to VIZIO Televisions, Sound Bars, and Blu-Ray Players, demonstrating a strong technical aptitude.• Calmly addressed and resolved customer issues, employing de-escalation techniques to ensure positive customer experiences.• Promptly escalated complex issues to supervisors when necessary and appropriate, ensuring efficient problem resolution.• Responded promptly to requests for assistance, including the processing of credit card authorizations, demonstrating a commitment to comprehensive customer support.• Tracked call-related information for auditing and reporting purposes, contributing to the overall improvement of support services.• Generated insightful feedback reports on call issues, specifically addressing downtime and training-related issues to contribute to continuous improvement.

Bachelor'S Degree, Digital Arts & Design

High School