Nicole Johnson

***** ********* ***** ***

Colonial Heights, VA

718-***-****

ac33oe@r.postjobfree.com

Objective:

Looking for a career that will allow me to use the Customer Service skills I've gained to assist others and further develop my Skills.

Skills:

• Dynamic customer service professional experienced in both call-center settings.

• Excelled in listening to customer’s needs and articulating options

• Providing customers with available solutions.

• Hardworking, energetic and reliable

• Recognized for assuming additional responsibilities.

• Keyboarding, Microsoft Office including Word and excel.

• 60+ WPM

• Technical Support and performance measures.

• Knowledge of Medical Terminology.

• Filing, Scanning and Copying

Work Experience:

8/2016-1/2017

Part D Medicare CSR Magellan Healthcare Glen Allen, VA

Duties:

• Determines appropriateness for medications.

• Communicates decisions to physicians, medical management staff, pharmacists and members.

• Researches, resolves and documents prior authorization outcomes in pharmacy system, with members

Client inquiries and grievances and provides verbal or written results to client, prescriber and provider.

• Communicates selected prior authorization criteria, pharmacy benefit coverage and formulary to Physicians, physician, medical management staff, pharmacists and members.

• Escalates requests to Pharmacist when request requires extensive clinical review or denial.

• Enrolled Medicare Beneficiaries in Part D plans.

• Processed payments through Cyber source and Wells Fargo system.

• Provided general information and faxed documentation to physicians and members.

6/2013-3/2016

Customer Service Rep General Dynamics Inc. Chester, VA

Duties:

• Serves as customer service Representative enrolling eligible members in ACA, Medicare and Medicaid programs.

• Provides callers with information on premiums and copay's.

• Provide knowledgeable responses to news media inquiries.

• Research Claims for Medicare beneficiary.

• Provided information for community resources.

• Enrolling consumers into general health care.

• Accepts inbound calls to determine whether consumers are eligible for a Marketplace or Medicaid programs.

• Verified personal information.

• Handles incoming calls from policyholders and caseworkers.

• Provided responses to inquiries regarding incorrect information on issues with health insurance policies.

• Adhere to Privacy Act and Health Insurance laws.

• Provide knowledgeable responses to Medicare beneficiaries in regards to claims/coverage questions.

• Maintain a current understanding of the processing/procedures to respond to numerous phone inquiries.

• Report problems that occur and assist with the resolution.

• Utilize databases & written materials to look up and provide information to telephone inquiries.

• Maintain appropriate documentation.

• Aggressively worked during open enrollment period to ensure maximum enrollment of candidates prior to program

Deadline.

4/2015-8/2015

Eligibility Specialist Xerox Healthcare Services Richmond, VA

Duties:

• Processed Applicant Applications to see if they would qualify for a Medicaid covered group

• Verified personal Information and documents

• Sent out document verification letters

• Used several verifiable systems (vacms, oracle, spider, mmis)

• Made outbound calls and received inbound calls

• Calculated Household income

11/2012-01/2013

Customer Service Tech Teletech@Home Chesterfield, VA

Duties:

• Answered incoming calls

• Assisted customers with product support issues

• Updated customer information

• Verified personal information

4/2008-2/2012

Data Entry Operator NY Blood CTR Queens, NY

Duties:

• Entered blood results into the computer

• Entered medical codes & verified codes

• Answered incoming & outgoing calls

• Verified personal information

• filed, Copied and faxed papers

2/2007-12/2007

Customer Service Rep Apex Temps New York, NY

Duties:

• Answered incoming calls

• Entered inventory orders

• Verified personal information

• Copied and faxed papers

5/2006-8/2007

Data Entry Processing Source One Temps Queens, NY

Duties:

• Entered school information

• Entered students medical records & verified codes

• Answered incoming & outgoing calls

• Verified personal information

3/2005-10/2006

Payment Processor Volt Services New York, NY

Duties:

• Entered payment information

• Verified payment amount and type

• Answered incoming calls

• sorted mail, copied, filed & faxed papers

1/2004-12/2005

Reservationist First Transit Inc. New York, NY

Duties:

• Booked traveling trips for access-a-ride clients

• Answered incoming & outgoing calls

• Verified personal information

• Assisted customers

2/2001-9/2002

Data Entry Clerk MDS Labs Poughkeepsie, NY

Duties:

• Entered medical forms & lab results

• Entered patients Insurance Information

• Verified information

10/2000-5/2001

Data Entry Operator Fleet Processing Center Kingston, NY

Duties:

• Prepared taxpayer’s information & forms

• Faxed, Copied, Printed & filed papers

• Verified information

Education & training:

2004-2004 Career Blazers New York, NY

1992-1994 CTI computer New York, NY

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