Esther Roman

Goshen, NY

acbnab@r.postjobfree.com - 845-***-****

WORK EXPERIENCE

Clinical Appeals Coordinator

Mcbee Associates - New York, NY - 2011 to Present

Senior Customer Service Team Lead

Patient Account Services - Houston, TX - 2007 to Present

* Active managerial role in the day-to-day operational functions in achieving daily call center service levels

and performance guidelines.

* Delivered on the job training and classroom instruction in technical subject matter, system applications,

corporate initiatives and professional development. Designed training materials and job aides.

* Assigned multiple projects and department initiatives, responsible for resolving Hospital inquiry escalations,

facilitated resolution of issues between staff liaisons and the client. Managed and ensured timely responses

from the client.

* Managed Email Billing Solutions application. Responded to complex billing cases via email within at two-day

business timeframe in a professional and efficient manner.

* Assisted in the redesign and development of department workflows and policy & procedures - conducted

training to team on new processes.

* Handle inbound and outbound calls in a blended environment with excellent proficiency.

* Effectively use all supporting applications for call tracking and history.

* Assess customer complaints, handle billing inquiries and provide adequate resolution.

* Proficient in overcoming customer dissatisfaction, providing exceptional follow-up and customer service

retention.

* Persuasive communicator with well-developed presentation and negotiation skills. Able to develop productive

relationships with colleagues, customers, direct reports and staff at all levels.

* Oversee daily operations and responsibilities of Customer Service department - attendance tracking and

monitoring.

* Training, monitoring, educating and accessing competency of staff.

* Provided consistent floor supervision of staff.

* Assist staff in achieving personal mastery of their job responsibilities, ensuring they meet all performance

standards.

* Provided timely and consistent feedback to staff.

* Ensured staff met and or exceeded the department monitoring program goals - by conducting remote

monitoring, side by side monitoring, and calibration sessions.

* Provided daily, monthly, quarterly and annual analysis to management.

* Analyze data and report to management agent performance, areas for improvement and trends.

* Assisted management team with staffing decisions.

* Demonstrated strong leadership, analytical, and management skills that always remained in line with the

goals and mission of the department and Client

* Ability to research, document and resolve in-depth customer complaints and grievances

* Exhibit expert ability to understand, explain, update and initiate resolution for all types of billing inquires.

* Provide leadership in supervisor's absence.

* Exceeded productivity levels as it relates to lines of business and operational objectives

* Maintain quality, abandon rate, maximum talk time, and other service level standards

Customer Service Rep

Patient Accounts Services, LLC - Houston, TX - 2007 to Present

Team Lead

Customer Service - Call Center

- 2007 to 2008

* Answer and handle member calls with proficiency in all areas of benefit resources

* Consistently provide accurate information to members

* Effectively mode and make decisions consistent with the department's framework.

* Answer phone calls from members, and service providers regarding a variety of Ability benefit and coverage

related questions in a courteous, professional manner

Customer Service

United Healthcare - Houston, TX - 2006 to 2007

Customer Service Liaison

- 1994 to 2006

* Assist sales associates with all phase of orders

* Order Entry

* Set up appointments for Sales Associates

* Maintain patient files

* Verify insurance coverage, obtain referral, and pre authorizations

* Pre qualify patients for service to be rendered.

* Obtain supporting documentation from therapist, doctors need for processing orders

* Process service for the Handicapped

* to research, document and resolve in-depth customer complaints and grievances

* Exhibit expert ability to understand, explain, update and initiate resolution for all types of billing inquires.

* Transfer calls to appropriate staff as required

* Identify, research and resolve customer issues

* Follow-up on customer inquiries not immediately resolved

* Maintain up-to-date documentation for use during calls

* Schedule equipment delivery to patients and hospitals

* Obtain claim status via phone, internet and or/ fax

* Obtain supporting documents regarding insurance follow up.

Customer Service

Landaulet Metropolitan - Mount Vernon, NY - 1999 to 2005

Customer Service

Homecare Supply - Hicksville, NY - 1994 to 1999

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