Pamela Jade Soderling Email & Phone Number

Remote

As an Appeals Specialist my specific role was to review and process UnitedHealthcare denials of medical claims for organ transplants. Some of my duties included the review and analysis of denials, submitting reconsiderations via UHC portal, submitting supporting documents (Appeal letters, lab reports, and test requisition forms, UHC genetic testing guidelines, Allosure Packets, JMD Assay, and more) to payer for review, processing claims in remittance, documenting the process as it moves through the system using Telcor, verifying status of claims submitted to payer and providing reports for the posting team, providing all cases with the necessary documentation for final case determination.During my time in this position I developed a strong rapport with the client directly, which was CareDX, and was the only agent included in zoom meetings for progress reports and troubleshooting of issues in Telcor. I also facilitated the training of a group of new hires, created training materials to assist new hires, and managed the project for a brief stint while my manager was away on leave.

Remote

Fully remote customer support agent, proving services based on the client needs per project. Inbound and Outbound lead campaigns for Patient Engagement during Annual Enrollment Period of Medicare Health Insurance.

Bowling Green, Kentucky, United States

Provided front-line phone customer service to policyholders, beneficiaries, and other internal agents. Assist in determining eligibility, applying for coverage, enrolling, and managing insurance policies and status of coverage. Assisting members in reporting any household or life changes and redetermine eligibility. Developing and maintaining a solid working knowledge of the insurance industry and of all products, services and processes performed by the team to help the client compare policies and select the best option for each individual or family. Ability to handle eligibility and policy issues considered non-routine and diffuse escalated situations. In this position I would average around 60-70 calls daily with an average handle time of around 450-600 seconds. Also responsible for complying with HIPPA regulations and maintaining group metric standards.

Bowling Green, Kentucky, United States

In this role I was responsible for opening the surgery department in the morning at 5am. In this department we would handle patients arriving for either outpatient surgery, our Cardiac Cath Lab, or out Endo Clinic. Job details included taking patient demographic and financial information, verifying insurance, coordination of benefits, and maintaining excellent patient flow. As well as coordinating with doctor’s offices to obtain physician’s orders, verifying medical necessity, obtaining pre-authorization when needed, make calculations on patient accounts, and collecting payments in person and over the phone. Adhering to HIPPA policies and Code of Conduct ensuring to always protect the integrity of the patient and the hospital alike.