Darrin Chapman

** ***** ********, ****** & Commercial Customer Service Experience

Philadelphia, PA 19120

acutyz@r.postjobfree.com - 267-***-****

Authorized to work in the US for any employer

WORK EXPERIENCE

Customer Service Representative Hedis Benefits Outreach Leader Aetna Better Health Insurance - Philadelphia, PA - January 2015 to April 2016 Salary-$16.50/hr. Full Time - 40hr week. H/R Verification of Employment Dept. 800-***-****. Employee ID# A750344

Customer service representative & HEDIS team leader of 10 outreach center associates. Improve Aetna membership enrollment in states of Pennsylvania, New Jersey, and Ohio via promotion of intervention plans, educational screenings, and preventive health assessments. Provide high level customer service, quality, and accuracy to Aetna's three lines of business: Medicaid

(Welfare/State), CHIP (Children Plan), and Health Pa (PCO Option). Plan, coordinate, and monitor HEDIS/ EQRO data collection and outreach activities. Identify medical records for gaps in care and advise ongoing improvement and maintenance. Coordinating the Road Map with the HEDIS team members. Review provider data to ensure accurate data for completeness in demographics, correct provider types, and review of provider specialty tables for roadmaps.

Add to, revise, and maintain service department Knowledge Hub for industry-specific terminology along with glossaries, training materials, and member service scripts. Answer and appropriately direct inbound calls from patients, physician offices, insurance companies, internal customers, etc., utilizing proper telephone etiquette. Maintain call center performance metrics including Average Handle Time, After Call Work, Quality, and Scheduled Adherence while actively listening to customers, probing for clarification, and providing consultative guidance based upon customers health needs.

Schedule/cancel/reschedule and confirm patient PCP and/or specialists appointments. Collect, verify, enter, and maintain medical record data in medical management databases. Review medical necessity/pre-certification checks/verification [in accordance with Centers for Medicare & Medicaid services] for medical procedures and prescription requests, verification of member eligibility & benefits, coverage & effective dates, COB, and preauthorization required services in hospitals or skilled nursing facilities.

Perform administrative tasks to compile, analyze, and process CHIP membership applications and payments, and with coordinating membership renewals.

Provide structured patient education on health coverage, engage in follow-up conversations and offer renewal assistance for enrolled individuals.

Process non-Clinical Claim Management complaints and grievances from members and providers via internal processes and reporting systems, and properly handle call escalations. Educate providers and medical/health facilities on self-service options. Assign members to PCP panel/practice, verify member plan eligibility, and enter and/or verify patient/guarantor demographic and insurance information.

Identify providers for ICD-9/10-CM coding, CPT coding, and claims form education. Review and educate member claim history, claim issues, claims payment, claim adjudication, and all claims issues related to accurate tracking of benefit maximums. Educate members rights and responsibilities in accordance with member handbook, issue ID cards, member welcome packet, privacy notice, and all associated correspondence. Respond to incoming e-mail support requests from member portal and reset passwords. Participate in HEDIS projects.

Customer Care Ambassador., Charter Member

Parkway Corporation - Philadelphia, PA - May 2014 to November 2014 Salary-$15.00/hr. Full Time - 40hr week. H/R Verification of Employment Dept. 215-***-**** Hired as "Charter Member" to help establish and pioneer Parkway's first call center for servicing customers across 40 facilities throughout North America & Canada. Coach, train, mentor, motivate and oversees 5 Customer Service Representatives. Act in role of “training instructor” to give reps regular feedback, help meet performance and work goals, monthly bonuses initiative, and constructive feedback to improve service levels. Audit inbound/outbound call records and volume on daily basis for quality scoring. Actively work on call center floor providing (OJT) and observe reps interacting on calls. Communicate to IT dept. call center phone issues, freezes, delays, or service interruptions. Tailor service driven manuals and methods to ensure market relevance and efficiency, enhance employee interpersonal skills, quality & process issues, and product knowledge. Report to senior management quarterly "emotional competency" programs for service center (self-awareness, self-regulation, empathy, social skills, and conflict management.). Give regular feedback to Customer Experience Manager, Customer Service Director, and V.P. of Service Operations the service team's progress, issues, and areas of excellence. Work with minimal supervision within high volume inbound / outbound customer call center. Ability to (multi-task) switch between several software programs while on client call. Successfully communicate with different customer, vendor, or client behavior types. Use of soft skills and proper telephone etiquette to satisfy various customer situations. Responsible for customer service assistance of money, education, and resources. Engage “quick response”, first-call resolution to inquiries and/or complaints via PBX system, email, intercom, video (PARCS) system, and solar-automated technology. Provide guidance to bring about “non-events" (no issue) experiences to each customer. Take ownership to assure customers begin/end with positive association of company brand. Log in to assist with calls when necessary throughout the majority of the shift (75% of shift). Professionally investigate and process customer complaints/grievances, diffuse irate callers and problems, identify solutions quickly, and bring rapid resolution to consumer issues. Assist customers with cash/debit/credit transactions, vendor coupons, and online payments. Provide financial account support for daily/monthly customers and new sign ups. Assist customers by remotely vending gates and directions for paying/voiding citations. Dispatch Philadelphia Police/Fire/Ambulance assistance for warranted customer emergency. Monitor surrounding areas associated with facilities (buildings, streets, lots, parks, business) via remote CCTV cameras, smart devices, and respond to any alarms (building, elevator, etc) associated with Parkway facilities in accordance with company protocols.

Work closely with Director of Loss Prevention to prevent/report theft and on-site violations. Ability to understand complex oral and written directions, define problems, collect data, establish facts, draw valid conclusions, interpret technical instructions, deal with abstract and concrete variables, read and interpret documents (procedural manuals), write routine reports and correspondence. Customer Service Professional., Behavioral Intake Department United Health Group - Philadelphia, PA - July 2013 to April 2014 Salary-$15.00/hr. Full Time - 40hr week. H/R Verification of Employment Dept 800-***-**** Safely resolve behavioral health crisis through intervention, assessment and stabilization. Provide psychiatric emergency services including crisis assessment, intervention, outreach and screening for commitment to promote the safety of the client in crisis. Communicate by way of "scripted tools" to validate all member identification: policy number, group number, claim number, or other information used to identify call, case, etc. Review and Interpret Patient Statements and Client Contractual Terms/Agreements. Ability to (multi-task) switch between several software programs while educating members on United Health Care programs, policy, and resources.

Assign/Refer members to appropriate care management staff member or behavioral health network provider for assessment and counseling. Work with utilization management to assure optimal use of clinical care for members with medical, and/or social concerns.

Service customer inquiries by phone, email, or fax from individual members and their eligible dependents, hospital/facilities, individual practice providers, and/or health insurance companies requesting services via a high call volume intake unit/call center.

Use soft skills and investigative technics to problem solve and make cross departmental connections for resolution of member issues within timely manner.

Research and initiate investigation, documentation, and preparation of member complaints, grievances, escalated and complicated cases, and appeals process. Educate members on In-network/Out-of-Network Mental health and Substance Abuse group plan benefits and 5 levels of care coverage, company policy and member rights, appeals and grievance complaints, HIPAA process/guidelines (if applicable), Medicare rates, specialist in-network referral assistance, and EOB letters to Optum health plan members.

Respond to telephonic and e-mail claims inquiries from members and providers. Research, explain, resolve, and/or re-processing of complex, high dollar paper and electronic claims issues submitted by members, provider offices, and facilities. Engage internal/external conference calls for any questions/issues from clients or providers. Assists providers and facilities with member Single Case Agreement inquiries. Determine correct authorization process (i.e. auto approve, refer to Pre-certification Nurse or Medical Director) based on company policy, member benefit coverage, and provider status. Log, update, and revise accurate member and clinician contact information/contract files. Successfully meet matrix goals (e.g., Quality, AHT, Average Speed to Answer, etc). Utility Collections Representative., Customer Affairs Unit Philadelphia Gas Works (PGW) - Philadelphia, PA - May 2003 to October 2009 Salary-$20.50/hr. Full time - 40hr week. H/R Verification of Employment Dept 215-***-**** Answer, educate, and service telephone inquiries from all City of Philadelphia gas bill members to bring fast resolution to their delinquent accounts ranging from 30 to 180 days overdue. Created new gas accounts for 1st time resident customers and transferred gas service from residential/ commercial properties.

Bring about resolution of customer complaints via email, phone, letter, or in-person. Technical troubleshooting and gathering information from customers to identify root causes of customer problems and/or dissatisfaction. Prepare collection/service letters, notices and answer correspondence related to collection. Perform collection/ service functions relating to liens, judgments, USTRA, bankruptcy, medical emergencies, theft cases, home heating appliances, etc.

Initiate, review and track customer residential/commercial orders relating to gas leaks/trouble orders, turn on/turn off of gas service, excavation orders, restoration of off-accounts in high bill delinquency, federally-funded grant assistance, meter testing, credit agency related matters, low- income assistance programs, payment/budget arrangements, and within the guidelines of the Public Utility Commission (PUC). Sr. Benefits Outreach and Enrollment Specialist., Team Leader Oak Tree Health Plan Insurance - Philadelphia, PA - October 2000 to May 2003 Salary-$15.75/hr., Full time - 40hr week. H/R Dept # 717-***-**** Oversee and assist outreach staff of 15 (BOS) specialists. Responsible for processing insurance enrollments, re-credentialing applications, and maintaining files. Answer customer questions related to Benefit Plans, including Medicare A, B, MediGap, Medicare Part D plans, Cobra, Flex Spending Accounts, Health Savings Accounts, and Health Reimbursement Accounts, and pharmacy benefits including injectable medications. Educate, assist, and service [within high volume inbound call center] physician coordination of care regarding interpretation of client benefits, claims processing, and patient care management services for all members enrolled in Pennsylvania's State Medical Assistance Program directed by the Department of Public Welfare (DPW). Participate in community and public events, such as health fairs, community days, and events held at key organizations that attract and serve community members. Direct outreach to organizations and businesses in targeted communities. Distribute outreach materials to patients, community members, partner organizations and businesses to build coverage option awareness.

Refer uninsured and underinsured individuals for insurance counseling and enrollment. Maintain ongoing knowledge of the rules and regulations of public federal and state-run programs along with patient assistance programs.

Maintain and track outreach data, including dates and types of events, number of individuals reached through group or one-on-one communication, and referrals made. Provide Data collection instruction to internal staff and prepare training materials for all staff. Member Services Representative

Independence Blue Cross (IBC) - Philadelphia, PA - March 1997 to July 2000 Salary-$13.50., Full time - 40hr week. H/R Dept # 215-***-**** Educate and answer inquires [within high-volume In-Bound Call Center] regarding plan benefits to Keystone Health Plan East members by phone/walk-in.

Respond to members and providers questions and problems regarding: eligibility, benefits, plan policies and procedures, complaints, grievances, claims, and hospital/physician participation. Evaluate medical necessity for High-risk patients and collates with in-area/out-of-area hospitals and Patient Care Management to set-up authorizations for in-patient/out-patient newborn deliveries, surgery, E.R. stay, etc. EDUCATION

Diploma in Biblical and Theological Studies

E.S.C.M. Palmer Theological Seminary - Wynnewood, PA 2009

High School Diploma

Olney High School - Philadelphia, PA

June 1985

SKILLS

Strong Soft Skills, effective listening, interpersonal skills, email, online individual/group chat, fax, instant message and telephone set/headset experience, Advanced Microsoft office, 10 Keypad, Data Entry, Advanced Soft Skills, knowledge of EOBs, CPT & ICD-9 codes, HCFAs, UB92s, HCPCS, DRGs and authorizations/referrals. Computer knowledge of QNXT, PROPAT, and DOCFIND. Type 40 wpm, high knowledge/familiarity with general office functions and procedures including ICD-9/10 codes, CPT coding, medical terminology and HIPAA regulations. (10+ years) ADDITIONAL INFORMATION

Self-Employed from October 2009 to present.

Non-Profit Founder of E.Y.I.C. (Educational Organization), Philadelphia Pa

"Christian relationship educator" - teaching across a range of social topics online, involving issues of conscience and ethics in family, workplace, community, and Church life.

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