ILONA BUNTON

• Review provider faxes and enter prior authorization requests, CSRs and attach requests to member accounts
• Generate letter for facilities to include clinical requests, eligibility status, prior authorization requirements
• Enter cases for DME, newborn, therapies, surgical/procedural services, pain management, behavioral health,
inpatient and any other facility request
• Communicate with facilities to answer any questions and assist with member cases
• Assist with PCC teams to provide support as needed
• Communicate with other team members to aid each other as needed
• Experienced with Marketplace, SNF, traditional Medicaid for inpatient and outpatient cases

• Enforced organizational rules and incorporated policy changes into departments' day-to-day activities.
• Promoted a positive work environment by fostering teamwork, open communication, and recognition of accomplishments among employees.
• Mentored junior team members, providing guidance and support to foster professional growth and success.
• Maintained organized inventory with accurate records through proper ordering, tracking and auditing procedures.
• Maintain accurate on-hand balances
• Attend company seminars

• Answered incoming phone calls and addressed questions from customers and healthcare providers.
• Stocked, labeled, and inventoried medication to keep accurate records.
• Enhanced pharmacy workflow by assisting pharmacists with medication dispensing, labeling, and packaging.
• Calculated dosage, filled prescriptions, and prepared prescription labels with absolute accuracy.
• Data Entry

• Verify other carrier information and update member’s benefits information on a daily basis in system to ensure accurate processing of claims
• Investigate, update and resolve potential data errors in the C.O.B. and member eligibility records as identified on department error reports including reports provided by external parties
• Perform department recovery investigations by establishing a recovery period and analyze paid/denied claims to identify overpayments for recovery
• Investigate other insurance companies, state agencies, providers, external parties and subscribers to obtain or validate C.O.B. information
• Identify and implement Financial Recovery Group resolutions for subrogation
• Made accurate C.O.B. determinations using No Fault, NAIC and Medicare Secondary Payer regulations
• Reviewed and processed Medicare Secondary Payer demands to validate C.O.B. order and repayment obligation
• Investigated subrogation cases associated to legal
• Investigated possible Medicare reimbursement