Joyce Bucher

• Answered phone calls from providers and provided authorization requirements by checking ICD-10 codes. If authorization was required I assisted with entering the authorization.
• I reviewed authorizations that were entered into the portal by the provider.
• I made outbound calls to providers if more information was needed to process the authorization request.
• I made outbound calls to providers and members to advise if an authorization was approved or denied.
• Answered phone calls from providers to check the status of authorization requests.
• Escalated any urgent requests to the correct team for review.
• I did all of these tasks while maintaining patient confidentiality and following all HIPAA guidelines.

• Answered inbound calls from members regarding premium payments, benefit information for medical and prescription drugs, provider information, claim inquiries, authorization requirements, authorization status and any other inquiries the member had.
• Actively listened to members, handled concerns quickly and escalated major issues to supervisor.
• Demonstrated excellent multitasking abilities by simultaneously handling multiple tasks such as navigating systems, taking notes on calls, answering the members inquiries and focusing on first call resolution while ensuring compliance with HIPAA regulations and company policies.
• Maintaining composure under pressure, a good attitude and showing empathy and compassion for members experiencing personal difficulties I was able to handle a high volume of calls daily while consistently meeting or exceeding call guidelines for service levels, handle time and productivity.
• Made calls out to members to provide updates if it was not able to be resolved on their first contact (if the issue was not resolved and there was no update I would also call out to advise that I did not have an update but it was still being looked into)
• Educated members about benefits and resources available to them effectively

• Answered inbound calls from members regarding benefit information for medical and prescription drugs, provider information, claim inquiries, authorization requirements, authorization status and any other inquiries the member had.
• Actively listened to members, handled concerns quickly and escalated major issues to supervisor.
• Demonstrated excellent multitasking abilities by simultaneously handling multiple tasks such as navigating systems, taking notes on calls, answering the members inquiries and focusing on first call resolution while ensuring compliance with HIPAA regulations and company policies.
• Maintaining composure under pressure, a good attitude and showing empathy and compassion for members experiencing personal difficulties I was able to handle a high volume of calls daily while consistently meeting or exceeding call guidelines for service levels, handle time and productivity.
• Made calls out to members to provide updates if it was not able to be resolved on their first contact (if the issue was not resolved and there was no update I would also call out to advise that I did not have an update but it was still being looked into)
• Educated members about benefits and resources available to them effectively

• Processed high-volume billing transactions accurately and efficiently, ensuring timely invoicing for clients.
• Resolved discrepancies in billing statements by investigating and correcting errors, enhancing customer satisfaction.
• Researched and resolved billing discrepancies to enable accurate billing.
• Worked with multiple departments to check proper billing information.
• Assisted colleagues in resolving complex billing issues, promoting teamwork and knowledge sharing within the department.
• Ensured compliance with industry regulations by staying up-to-date on changes in billing rules and guidelines.
• Assisted in transition to electronic billing, reducing paper waste and improving operational efficiency.

I was responsible for total claim processing. Providers would send in claims that had already been processed and needed to be adjusted. I had to strip the claim make the adjustments and reprocess the claim for payment.

I was responsible for total claim processing. Providers would send in claims that had already been processed and needed to be adjusted. I had to strip the claim, re-enter the claim making the adjustments and reprocess the claim for payment.

I was responsible for inventory of approximately ten thousand parts. When there were issues, such as defective parts, I was responsible to have quality control place the part on hold and do a thorough inspection. I also worked very closely with the purchasing team for orders and any issues causing back orders.

Members would call with benefit, billing, and authorization inquiries. I would also receive calls from potential members to get information about the different plans offered. I would provide all plan information over the phone to the potential members and also mail them any information we had in office (pamphlets, and books). All calls were thoroughly documented.