Bobbi-Lynn Furtado

• Perform claim verifications, desk and on-site audits.

• Communicate with providers to gather information for audits, to educate on claim

submission practices and to respond to queries in regards to audit results.

• Assess provider documentation to ensure compliance with the provider agreement,

benefit plan design and provincial legislation.

• Calculate the adjustments required to correct claim transactions.

• Prepare, coordinate and travel to conduct on-site audit at the provider’s location, and

complete the post on-site audit activities.

• Compile and produce audit reports that are detailed and unbiased.

• Perform self and peer-review to ensure accuracy and quality of claim reviews.

• Track audit activity and summarize results of claim analysis and recoveries on a daily.

and/or monthly basis for department statistics for presentation to customers.

• Identify trends observed from claim reviews and provide recommendations for risk criteria

changes and/or candidates for a desk or on-site audit.

• Respond to internal and external customer questions professionally, timely and accurately.

• Enhanced customer satisfaction by promptly addressing concerns and providing accurate information.
• Answer in-bound calls and emails from Plan Members, Plan Sponsors, Clients and Providers in dental and medical offices in a professional manner.
• Resolved customer complaints with empathy, resulting in increased loyalty and repeat business.
• Assisted customers in navigating company website and submitting claims, improving overall user experience.

• Assisted pharmacist by filling prescriptions for customers and responding to patient questions regarding prescription and medication-specific issues.
• Communicated instructions to patients or caregivers about proper use and storage of drugs.
• Organized client information into correct profiles while maintaining confidentiality.
• Completed and filed documentation for insurance, store and liability purposes.
• Trained new pharmacy staff on computer system and drug management protocols.
• Greeted customers and responded to questions with friendly, knowledgeable assistance.
• Prepared bills for clients and submitted required paperwork to insurance companies.

• Ordered stock to keep inventory maintained and received orders with accuracy
• Prepared, processed, and filled blister packs and prescriptions
• Prepared and billed medications to customers

• Oversaw home health care accounts and ensured transactions were properly managed
• Created a bi-weekly schedule for employees, managing time off requests
• Processed, prepared, filled, and billed prescriptions

• Gathered information for prescription refilling and filled with accuracy
• Prepared and billed medication to customers

• Receive prescriptions and communicate required medications to pharmacist
• Monitor medication inventory stock and place orders when needed

• Operate cash register to process cash, debit, and credit transations
• Prepared and filled prescription orders in a timely manner