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Customer Service Representative

Rockville, Maryland, 20852, United States
March 02, 2018

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John A. Chrisafis


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

Rockville, MD 20852


Highly skilled Customer Service/Medical Professional

Exceptional interpersonal and communication skills

Comprehensive understanding of handling conflicts with the ability to provide solutions that meet specific/individual needs


Centene Corporation 10/2017 – present

Envolve, Livehealthier, Bethesda, MD

Contractor with Graham Staffing Services, Bethesda, MD 20814

Customer Service Representative I

Receive and respond to all telephone inquiries from members or providers

Research and identify any processing inaccuracies and route to the appropriate team for adjustment

Research and provide information regarding member's eligibility, benefits, referrals and authorizations

Provide members with information on the Provider Network and how to contact and access providers

Educate providers on prior authorization requirements, how to access services and other routine, non-clinical issues

Educate providers on process of submitting outpatient treatment requests for outpatient therapy.

Initiate or fax necessary forms to providers for outpatient therapy services

Coordinate with Provider Relations regarding contracting and/or credentialing status

Create escalation tickets and update patient records


Shire, Vertex Guidance and Patient Support, Rockville MD 04/2015 - 04/2016

Contractor with A-Line Staffing Solutions, Sterling Heights, MI 48314

Senior Reimbursement Counselor

Researched, evaluated and secured insurance coverage verification

Assisted with prior authorizations

Performed claims testing and resolved rejections

Identified and determined alternatives for non-covered services and provided referrals

Proficient in Patient Plus, Copay Assistance and Microsoft Office Suite

Provided detailed investigation reports, reducing reverification requests that would have otherwise delayed patient access to medical service

Assisted with training and provided support to junior personnel

CVS Caremark Pharmaceuticals, Sandy, UT 20156 03/2015 – 04/2015

Member Advocate Representative

High volume customer interactions providing assistance and resolving impediments to medication access.

Specialized in Medicare Part D processing. Managed tracking and prepared reports of departmental procedures.

Presented management with procedures that resulted in improved efficiency.

Assisted with training and support to junior personnel.

Northeast Health Systems, Inc., East Greenbush, NY 12144 09/2011 – 06/2014

Medical Assistant

Evaluated health data and maintained electronic records. Provided patient care, performed medical tests, provided support services to Physicians and prepared specimens for pathology

Recognized for detailed and accurate statistics

Consistently exceeded standards of HIPAA compliance

East Carolina University, Greenville, NC 04/2005 – 12/2006

Administrative Support Specialist

Performed a variety of detail orientated managerial functions in the areas of budget; personnel; facilities management; student services; policy interpretation; and organization

Liaison between Chancellor’s office, University administrative office, and other departments and directly contacted State level official and University Honors Program study abroad affiliates, requiring a high standard of communication skills, both verbal and written

Reviewed work assignments and assisted in designing detailed positions requirement standards, and collected position classification reviews

Supervised staff personnel involved in operational activities such as records management, budget and personnel administration, utilities service ordering and billing and secretarial and clerical quality standards

Coordinated processes and procedures and resolved problems related to student services functions such as admissions, registration, and records management

Brody School of Medicine, Greenville, NC 05/2004 – 04/2005

Office Manager

Insurance coverage verification

Transcribed clinical notes and entered referrals in Logician

Posted and coordinated surgeries with the patient, hospital, OR and surgeon

Collaborated with patient insurance providers and obtained pre-certifications of insurance coverage/benefit

Coordinated the doctors daily schedule including meetings and monthly calendar

Successfully assisted in the writing of the Division’s Re-Organization Structure

Ordered supplies, maintained inventory, web and brochure development


Canopy at Hilton, Washington, DC 01/2017 – 10/2017

Restaurant Server

Leisure World, Rockville, MD

Restaurant/Catering Server

Mamma Lucia, Rockville, MD 20852

Restaurant Server

Smashburger, Rockville, MD 20852

Guest Services Expert


Colorado State University, Fort Collins, CO – Bachelors of Science in Wildlife Biology

Berkeley College, Dover, NJ – Medical Assisting

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