Stephanie Perez
Claim Specialist
Vega Alta
Summary
Highly trained professional with a background in verifying insurance benefits and creating appropriate patient documentation. An established Insurance Verification Specialist known for handling various office tasks with undeniable ease.
Overview
6
6
years of professional experience
Work History
Claim Specialist
Paynela
11.2023 - Current
- Evaluated and settled complex insurance claims in strict timeframes.
- Followed up with customers on unresolved issues.
- Worked with claims adjusters and examiners to expedite processing in alignment with procedures.
- Modified, updated and processed existing policies.
- Prepared insurance claim forms or related documents and reviewed for completeness.
- Reviewed outstanding requests and redirected workloads to complete projects on time.
- Checked documentation for accuracy and validity on updated systems.
- Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
- Determined appropriateness of payers to protect organization and minimize risk.
- Communicated effectively with staff members of operations, finance and clinical departments.
- Verified client information by analyzing existing evidence on file.
- Calculated adjustments, premiums and refunds.
- Generated, posted and attached information to claim files.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Posted payments to accounts and maintained records.
- Maintained confidentiality of patient finances, records, and health statuses.
PHARMACY TECHNICIAN
MEDPLUS SOLUTIONS
08.2020 - 11.2023
- Counted, measured and compounded medications following standard procedures
- Performed wide range of pharmacy operations with strong commitment to accuracy, efficiency and service quality
- Stocked, labeled and inventoried medication to keep accurate records
- Counted and labeled prescriptions with correct item and quantity
- Maintained proper drug storage procedures, registries, and records for controlled drugs
- Maintaining synmed robotic by cleaning and working most errors alerts
- Changing filters and calibrating containers
- Coordinate, distribute and manage the necessary files for the manual production of drug packaging and maintain the drug database in 'SYNMED.'
PHARMACY TECH
APS HEALTHCARE
09.2018 - 01.2019
- Answers and manages telephone calls from pharmacies and providers in a timely, confidential and courteous manner
- Documents calls and/or drug requests with complete follow-up history of the patient through electronic records
- Provides orientation to pharmacies regarding pharmacy benefits
- Performs system overrides (e.g., prior authorization) on the PBM claims processing system to ensure that claims are correctly adjudicated
- Assists pharmacies with claim processing and assists in the training of pharmacy representatives
- Collaborate with client special projects such as and limited to analysis of specialty drug protocols and non-formulary drugs
- Assist with internal/external audit requests
- Identify possible errors in PA Hub protocols vs
- Written protocols to make recommendations to MC-21
- Complies with all guidelines established by the Centers for Medicare and Medicaid (CMS) and guidelines set forth by other regulatory agencies, where applicable.
Education
ASSOCIATE DEGREE - undefined
NATIONAL UNIVERSITY COLLEGE
05.2018
Skills
- Receiving Incoming Supplies
- Assist Pharmacist
- Team Leadership
- Claims processing accuracy
- Processing Payments
- Bilingual Spanish/English
- Data Entry
- Audits
- Computer Knowledge
- Synmed, PA Hub, Connexus and IPS Program Knowledge
- Attention to Detail
- Clerical Support
- Understanding of medical terms
- Data integrity
- Reporting skills
- Training and Development
- Great mathematical skills
- Prior authorization processing
- Documentation abilities
Quote
Wanderer, there is no path, the path is made by walking.
Antonio Machado
Timeline
Claim Specialist
Paynela
11.2023 - Current
PHARMACY TECHNICIAN
MEDPLUS SOLUTIONS
08.2020 - 11.2023
PHARMACY TECH
APS HEALTHCARE
09.2018 - 01.2019
ASSOCIATE DEGREE - undefined
NATIONAL UNIVERSITY COLLEGE
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