Alicia Metcalf

Processed and adjudicated medical insurance claims for multiple third-party administrator (TPA) clients. Interpreted policy guidelines, navigated claims platforms, and applied contract terms to ensure accurate and timely claim resolution.

Oversaw day-to-day responsibilities including patient support, client engagement, scheduling appointments, and verifying demographic and insurance information. Delivered high-quality patient care services in the Neurology department, sending appointment reminders and recording check-ins/outs.

Provided best-in-class front-desk and customer support services, greeting patients and transferring them to relevant departments. Oversaw all facets of collecting patient demographic information, validating insurance eligibility, and calculating out-of-pocket expenses.

Analyzed and verified insurance claims, collecting and recording pre-certifications for in-patient/out-patient accounts. Utilized advanced Navinet/Passport systems to attain pre-certifications from multiple insurance providers.

Processed and audited medical insurance claims, cultivating statistical reports for senior leadership. Managed all aspects of analyzing and processing high-amount medical claims while reviewing medical records and conducting detailed investigations.

Completed high school education, providing a foundational academic background. Developed essential skills for further professional and personal growth.