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Click here or scroll down to respond to this candidateCandidate's Name
EMAIL AVAILABLE PHONE NUMBER AVAILABLE Glasgow, KY Street Address
Summary Authorized to work in the US for any employer. Highly-motivated employee with desire to take on new challenges. Strong work ethics, adaptability and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.Skills Customer SupportPatient AdvocacyHIPAAAuditingInsurance VerificationQuality AssuranceQuality AuditsCRM, Salesforce, Microsoft OfficeAccount MaintenanceCall Volume and Quality MetricsMS OfficeQuality Assurance ControlsNeeds AssessmentCredit Card Payment Processing72 Wpm Typing SpeedVerbal and Written CommunicationTechnologically SavvyDe-Escalation TechniquesCustomer Account ManagementCall DocumentationMultitasking and PrioritizationProduct KnowledgePolicies and Procedures AdherenceTeamwork and CollaborationOracle EnterpriseOneAdministrative and Office SupportMulti-Line Phone SystemsUnderstanding Customer NeedsComplaint InvestigationProblem ResolutionSales Quota AchievementSales and UpsellingData EntryOrder FulfillmentProfessional Telephone DemeanorBilling Adjustments and RefundsComputer SkillsRemote Office AvailabilityCustomer Service ExcellenceMember RelationsExperience Member Service Specialist 10/2022 - 02/2023 Molina HealthcareEffectively Communicate with customers to provide First Class Service Actively listen to ensure the members are helped with all appropriate information that is needed, for First Call Resolution.Gather all demographics and information needed and enter all information from start to end, with resolution and disposition used on call. Enter in to CRM Coding and Documenting with complete AccuracyCase Management and Service CoordinationUpdate iServe Tickets and follow up with membersRetro Terminations and Disenrollment Requests of members insurance ID Card Keys, requests and/or changeCritical Incidents and Grievances, AppealsEligibility and discrepancies, Out of Area Coverage Appropriately route calls to internal departments for assistance ie: Medical Records, Denial of Appeals, Provider Documents, Audits (after going over the research that I provided) MHSummary of Benefits (Molina Healthcare states that I covered are IL, MI, CA, NV, TX, OH, SC and ID) MMP Duals line (Medicare and/or Medicaid)Salesforce Auto ClaimsEscalationsBenefits with Type of Plan, to assist members in choosing the best plan for themselves/family's needsBilling payments and/or questions and resolve on same call Pegasus, Legacy, Salesforce, QNXTSearch Directory for Providers, Pharmacy, Specialist for IN and OON Language Line TransfersBehavioral Health IndicatorArrange TransportationWaiver Programs and/or Patient Assistance availability per Plan Home and Community Based Services locator and transfer Work with Drug Formularies, search for information as well as add/delete drugs for updated listingsAlert for Adverse EventsStrict HIPAAMember Services Representative 11/2018 - 03/2020ACAAssist members with their Insurance PortalsUnlocking, enable a disabled account, reset passwords, etc Recognizing Behavioral Health Issues and assisting further Assist members with Medical and Pharmacy ClaimsAssisting Brokers on behalf of membersAssisting Members with all Insurance benefits, including Out Of Pocket, Deductibles, Co-Pays Process payments for members Insurance PremiumsStrict HIPAA awarenessTeam Lead Inbound Patient Advocate 03/2007 - 04/2019 Abbvie, IncAct as a patient advocate for callers with questions or concerns about the medication, Humira Provide callers with financial options to make their pharmaceutical medication more affordableSupport patients' needs by providing complimentary services Completed outbound calls for clients, RN's, Pharmacies, and Providers' offices Product Quality Auditor for this recorded line with many legal compliance regulations, detailed HIPAA based workCustomer Service and Sales Supervisor 03/2006 - 03/2018 Liveops, IncHandle high volume of inbound/outbound calls daily and provide exceptional one call customer service by offering one point of contact for problem resolution for multiple companies Respond to customers inquires about products and services and attempt to complete the sale Process orders online and document every phone conversation into electronic databases Offer up-sells that compliment the main product, subscription services, and other add-ons Review and explain all contractual details of purchase and ensure customer understanding of it Maintain strict confidentiality for clients, customers, and partners, including their financial, medical, and demographic informationSurgical Scheduler 01/1995 - 01/1997Drs Margiotta and JoyPatient Communication to start process of surgeryInsurance verification and authorizationPre-op schedulingSurgery schedulingMaintain all medical records pertaining to pre-op and post-op Schedule post-op visitsEducation andTrainingHigh School Diploma 06/1988Atlantic High School Delray Beach, FL |
