Nyasia Miller

• Manage the entire care process with a sense of urgency from benefit investigation/verification to medication delivery, ensuring an exceptional patient experience
• Conduct benefit verifications and collaborate with various healthcare providers, including physicians, specialty pharmacies, and insurance companies, to ensure seamless coordination of patient care and timely access to necessary services
• Assist in obtaining insurance, prior authorization, and appeal requirements and outcomes
• Help patients understand their insurance plan coverage, including out-of-pocket costs, and provide guidance on the appeals process if needed
• Resolve patient questions and represent their concerns regarding the status of their requests for assistance
• Demonstrate expertise in payer landscapes and insurance processes, remaining knowledgeable about changes in Medicare, Medicaid, Managed Care, and Commercial plans
• Process enrollments via fax, phone, and electronically
• Scrutinize forms and documentation thoroughly for missing or new information to update the database

• Reviewed all patient insurance information needed to complete the benefit verification process.

• Triaged cases with missing information to the appropriate program associate.

• Verified patient-specific benefits and documents specifics for various payer plans, including patient coverage, cost share, and access/provider options.

• Identifiesdany restrictions and details on how to expedite patient access.

• Documentedand initiated the prior authorization process, claims appeals, etc.

• Completed a quality review of work as part of finalizing the product.

• Reported any reimbursement trends/delays to management.

• Performed related duties and special projects as assigned.

• Greeted customers and answered any questions they had about the store's products and services.
• Verified that customers were of legal age to purchase alcohol or tobacco products.
• Operated cash register efficiently and accurately, processed payments by cash, check, credit card, gift card or automatic debit.
• Counted money in cash drawer at the beginning of shift to ensure that amounts were correct and have sufficient change.
• Issued receipts, refunds, credits or change due to customers.
• Balanced daily transactions on a computerized point-of-sale system.
• Organized promotional displays or arrange merchandise on counters or tables to promote sales.
• Conducted price checks for special orders or discounts as requested by customers.
• Maintained cleanliness of checkout area including countertops, registers, windowsills and floors.
• Ensured compliance with all safety regulations within the store environment.
• Provided excellent customer service while promoting loyalty programs to increase sales potential.
• Organized promotional displays or arrange merchandise on counters or tables to

• Navigated through multiple computer applications with speed and accuracy
• Accepted and implemented coaching/feedback in order to achieve individual and team performance goals
• Maintained expectations regarding call quality and resolution time
• Responded to 75-100 inbound calls per day in a high call volume environment.
• Answered customer inquiries and provided accurate information regarding products and services.
• Provided excellent customer service to resolve customer complaints in a timely manner.
• Gathered customer feedback through surveys and used the data to improve customer service.
• Assisted customers with product selection, ordering, billing, returns, exchanges and technical support.
• Answered incoming customer calls regarding product inquiries, orders, complaints and general customer service.
• Assessed customer needs and provided solutions to resolve their issues in a timely manner.
• Processed customers' orders over the phone and provided follow-up services to ensure satisfaction with products or services.
• Identified root cause of technical issues and developed solutions.
• Researched, analyzed and diagnosed complex system problems.
• Provided remote support to customers experiencing technical difficulties.
• Maintained records of troubleshooting activities and customer interactions.
• Performed maintenance tasks such as software patches and upgrades.
• Configured network hardware components such as routers, switches, firewalls.

• Helped patients with healthcare needs while under the supervision of RN/LPN
• Changed linens, made patients’ beds, and performed light cleaning to rooms
• Set up medical equipment and performed various procedures and treatments.
• Assisted patients with activities of daily living such as bathing, grooming, and dressing.
• Provided basic patient care by taking vital signs, measuring height and weight, and recording intake and output.
• Reported changes in patient condition to registered nurse or physician.
• Turned and repositioned bedridden patients on a regular schedule to prevent bedsores.
• Answered call lights promptly and responded to patient needs accordingly.
• Served meals to patients in their rooms and assisted with feeding when needed.
• Cleaned and sanitized patient rooms according to established protocols.
• Maintained accurate records of patient care, condition, progress, or problems for review by medical staff.

• Navigated through multiple computer applications with speed and accuracy
• Accepted and implemented coaching/feedback in to achieve individual and team performance goals
• Followed a call script to assure customer properly assisted
• Maintained expectations regarding call quality and resolution time.
• Reviewed prior authorization requests to ensure accuracy and completeness of required information.
• Coordinated with other departments to obtain additional information needed for prior authorization.
• Verified patient insurance coverage, including eligibility, benefits and authorizations for medical services.
• Provided guidance to providers regarding the prior authorization process.
• Researched clinical criteria and determined eligibility for requested services based on plan provisions.