Donna Hall, MA

Experience

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  United Health Care

  Nov 2011 - Feb 2013

  Claims Customer Service Representative

  Identified, researched, and resolved providers and member’s issues using the computer system.Delivered world class customer service and strived for one call resolution for providers and member’s issues.Responded to members and provider inquiries which included:  Benefit and Eligibility information  Billing and Payment issues  Authorization for treatment  Explanation of Benefits (EOB)

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  Sutherland Global Services

  Oct 2014 - Oct 2015

  Clinical Auditor/Quality Control Specialist

  Thoroughly reviewed medical records to determine correct usage of ICD-9/10 CM diagnostic and procedure codes.Analyzed the audit results and provided recommendations for corrective action.Communicated effectively the evaluation and recommendations to all levels of management.Created authorizations based on the patient’s needs.Scheduled, confirmed, and rescheduled patient appointments. Provided exceptional customer service to the patients and providers.Verified patient demographic and insurance information. Show less

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  MD Anderson Cancer Center

  Nov 2015 - Feb 2016

  Patient Services Coordinator

  Interpreted and coordinated physicians’ orders to schedule diagnostic tests, procedures, treatments, and physician appointments.Clearly and accurately convey appointment information to the patient’s in a timely manner in person, by telephone, or in writing.Transcribed the patient’s medications based on the doctor’s orders.Received multiple telephone calls from internal staff and external customers; directed the calls appropriately in an expedient, courteous and friendly manner.Registered the patients upon arrival to the floor.Provided superior customer service to the patient and the patient’s guests. Show less

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  AcariaHealth Specialty Pharmacy

  Feb 2016 - Nov 2019

  Insurance Verification Team Lead

  Lead and motivate team members by providing daily direction Assign work to team membersConduct individual training sessions with team membersDesign, develop, and deliver training material to team.Audit the employees’ calls and referrals.Interviewed potential internal and external employee candidates.Liaise with patients, physician offices, and insurance companies.Obtain and verify insurance eligibility for services provided and document complete information in system.Perform prior authorizations as required by payor source, including procurement of needed documentation by collaborating with physician offices and insurance companies.Collect clinical information such as lab values, diagnosis codes, and chart notes.Determine patient’s financial responsibilities as stated by insurance.Prepared, executed, and followed-up on appeals in a timely manner. Show less

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  Superior HealthPlan

  Nov 2019 - Jun 2022

  Behavioral Health Service Coordinator

  Communicate with Foster Care Members, Medical Consenters, Department of Family & ProtectiveServices & providers to meet the behavioral healthcare needs of the Foster Care members.Conduct comprehensive assessments to determine the Foster Care member's needs.Managed a caseload of Foster Care members with behavioral challenges.Monitor and implement plans for the Foster Care members.Coordinate the delivery of behavioral health services, including locating providers and schedulingappointments for therapy, psychiatry, psychological exams & much more.Act as a liaison and member advocate between the member, family, physician, treatment facilities, & agencies. Show less