Terri Housen

Process high volumes of insurance claims, verify documentation and coding, and collaborate with payers to resolve denials, ensuring timely resolution and compliance with payer timelines.

Resolve 40+ pharmacy benefit and insurance coverage issues daily with a 95% first-contact resolution rate and process prior authorizations/appeals with 98% accuracy to reduce claim denials and improve patient outcomes.

Reviewed and processed insurance claims for completeness and compliance, coordinated with payers and internal teams to resolve missing data or authorization requirements, and maintained timely claim submissions.

Managed 60+ insurance and provider inquiries per shift, providing accurate benefit explanations and eligibility verification while meeting performance KPIs in a high-volume virtual environment.

Processed Medicare Part D prior authorizations and appeals, documented 100% of member interactions to CMS standards, and resolved escalations to prevent medication delays and ensure continuity of care.

Investigated and resolved complex medical claims by analyzing records and billing information, collaborated with providers for documentation, and maintained high productivity while meeting quality standards.

Handled 70+ inbound calls daily, educated customers on services to reduce repeat calls, and maintained professionalism and efficiency in a high-pressure remote environment.

Processed healthcare insurance claims for accuracy and compliance, verified patient information and medical documentation, and communicated with providers and policyholders to resolve discrepancies.

Medical records certification or license held since 2017; specific credential and issuing body not provided.

Pursuing an Associate Degree in Medical Records with expected completion in November 2025.

High school diploma awarded; details on institution and graduation date not provided.

Completed High School diploma at Wyandotte High School in Kansas City, KS.