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Customer Service Representative

Location:
Puyallup, Washington, United States
Posted:
September 23, 2018

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Resume:

Gina Christensen

***** **** *** *. ******, WA ***38 253-***-**** ac65hq@r.postjobfree.com

Qualifications

Experienced health care professional with more than 10 years of leadership experience in training, motivating, interviewing and team building. Worked directly with upper management for implementation of new software and varied lines of service for business operations.

Professional History

Evergreen Eye Center

Sr. Referral Coordinator July 2017-Present

Responsible for expediting patient referrals from referring community doctors, ensuring that appropriate appointments are created after considering a patient’s needs. Hired to manage the team and create a rigorous referral program for this referral-based specialty practice that ensures the appropriate tracking and processes for all in-coming referrals.

Dramatically reduced the process time for referrals by half

Oversaw the growth of over 30% in referrals received by the practice with a >85% conversion to appointments for premium services

Assisted in the logistics, planning and execution community outreach events as well as continuing education events for referral optometrists (COPE-Approved events)

Created custom reports for tracking of all incoming referrals and conversions, reported regularly to senior management

Called on referral optometrists as part of our physician liaison and outreach program

Assisted with the onboarding of new physicians and the opening of new office locations

Concerto Health

Clinic Administrator 2014-December 2016

Plan, direct, develop and coordinate activities of the clinic to ensure attainment of clinic and corporate goals and objectives. Coordinate directly with the Medical Director to achieve the goals of the organization. Ensures proper implementation of policies and procedures related to Patient Experience, Finance, Utilization, Quality Assurance/ Risk Management, Marketing, and Human Resources at the clinic level.

Create a results oriented work environment; delegate responsibility to the staff; participate in the formulation of a workable operations plan, that is capable of providing effective organizational results; develop short term and long term goals for the clinic, identify and implement new methods, programs, policies, procedures and techniques, to enable the clinic to perform more effectively; identify and solve problems; prepare and determine capacity analysis for the clinic; participate and provide direction and leadership to the management team within the clinic; interact with other managers and groups internal and external to the organization; direct personnel in maintaining clinic standards; develops and maintains disaster preparedness and patient safety plans according to corporate guidelines; implements standards and guidelines for all physical plant and equipment, including preventive maintenance, repair and replacement.

Collaborate with the Medical Director in physician staffing and recruitment; determine and monitor the appropriate MD/Support staff ratios for each clinic; assist in maintaining standards of care for patients; monitor compliance of regulations and standards established by the Fidelis and various regulatory agencies; assist in obtaining and maintaining appropriate levels of licensure/certification/accreditation.

Provides guidance and leadership to the clinics; collaborate with Human Resources to establish relative and measurable criteria for evaluation of all staff members; develop subordinates by utilizing training, guidance and continuing education; provide performance feedback to direct reports; evaluate staff performance and career development; develop and maintain open lines of communication throughout the organization; apply clinic policies and procedures to all employees; including equal opportunity and affirmative action; conduct and

Attend staff meetings; develop staffing patterns for each department; provide an open door policy for all employees.

Allocate resources and focus work efforts on strategic objectives; develop and recommend clinic operating budget; ensure compliance with approved budgets; install and execute programs of cost control and cost reduction. Ensure clinic operations metrics are reported appropriately and goals are met.

Ensure timely and ongoing plan information is communicated throughout the clinic; work directly with the health plan in ensuring operational objectives are being met to support contractual agreements; provide for continued training and development in area of benefit plan structure and other requirements. ensure clinic compliance with all contractual agreements.

Participate in development and recommendation of Clinic operations and corporate policy and goals. Engage in operations process improvement initiatives to establish “best practices” in are relevant areas of clinic management and patient care.

TriWest Healthcare Alliance

Supervisor Contact Center, 2013 to 2014

Monitors Contact Center performance levels, identifies training needs, and develops action plans for staff development. Monitors telephone system's real-time reports to ensure department service levels and contract requirements are met.

Reviews medical management data entries for clarity of documentation and appropriate handling of encounters and inquiries.

Counsels individual employees on job performance issues. Develops and monitors progress on employee Performance Improvement Plans. Drafts performance evaluations for management review. Alerts management and consults with Human Capital on performance and behavior issues.

Ensures internal standards, guidelines and procedures are in place to achieve/maintain high customer service and performance levels. Ensures Patient Service Representative Team follows system protocols for data entry edits and corrections.

Provides for adequate coverage of Contact Center using Workforce Management system to plan and adjust employee work schedules.

Assists with the employee selection process, coordinates the training of new employees, and assists with Contact Center training initiatives.

Conducts staff meetings and provides clear communication regarding any changes/issues affecting the Contact Center or team members.

Assists Contact Center staff with customer contacts requiring supervisory intervention.

As needed performs all Team Lead and Patient Service Representative Duties, while providing contact center operational oversight and direction to staff.

Performs other duties as assigned.

Fidelis Secure Home

Clinic Manager 2011-2013

Oversees the daily operation of the Ambulatory Care Clinic.

Responsible for ensuring compliance with established clinical standards and reviewing and evaluating the work performance of office staff.

Training and development of Operations staff members,

Coaching of routine tasks relative to Care Coordinator, Patient Service Representative, Medical Assistant, and Medical Clerk.

Communicate and provides assistance to Fidelis members and staff.

Administer clinic policies, procedures and programs

Monitor/Implement quality improvement initiatives, promote teamwork and professionalism among team members

Tracking and handling of Caregiver documents specific to employment with Fidelis, documentation of Caregiver tracking information including risk status.

Receive and respond to written and verbal request from members and vendors.

Communicate policy and policy modifications to staff.

Communicate to employees any new policy or policy changes via memo and/or newsletter

Basic clerical duties as needed

Create/modify provider schedules via EMD Application

Perform billing task including collection of super bills; posting of charges via Navicare application; Create EDI file for submission to health plan.

Create monthly RAPS file.

Handle all insurance inquiries regarding prescription coverage.

Enumclaw Medical Center (FMG)

Medical records Lead 2010 to 2011

Supervised 10 employees, Responsible for oversight of medical records; ensuring records filing and that all medical records are up to date. Responsible for ensuring appropriate information is sent to other clinics; ordering supplies, answering phones, training, interviewing, and other duties as assigned.

Patient Service representative 2007 to 2010

As a patient Service Representative I was responsible for checking in patients, collecting co-pays, updating demographics, verify insurance, and other job duties as assigned.

Group Health Cooperative

Patient Care Representative 2006 to 2007

As a Patient Care Representative my responsibilities include setting appointments for family practice and pediatric providers. On top of those responsibilities I also assisted the Referral coordinator, make reminder calls, check in patients and work on the outreach project.

Healthcare Management Administrators

Customer Service Representative 2005 to 2006

My responsibilities as a Customer service representative were to assist healthcare professionals and members with healthcare benefits and claim status. I also worked on special projects including implementing new procedures to ensure superior customer service. As a customer service representative in my first three months I had the highest call volume in the contact center.

Shield Healthcare

Supervisor 2001 to 2005

Key Accomplishments:

-Involved in contact center implementation of Onyx/CRM system

-Consistently achieved recognition for the highest sales, order and call volume

-Employee of the year and best overall performer

-Led and mentored the least productive team and helped them become the most productive team in the contact center.

Ongoing: Managed a team of 10 customer service agents, handled escalated calls and resolved difficult compliance issues. Monitored phone calls to ensure superior customer service, and gave feedback to the team. Interviewed and trained new employees. Did performance reviews.

Education

AA degree in Business

BA in Health Care Administration

Affiliations

Spirit at Work Representative

Corner Stone Advisory Committee

EMR/Medical Software Applications Knowledge:

EPIC, eCW (E-clinical works) Practice Partner, EMD’s, CARE360 and All scripts EMR, MDHQ, Office Ally

Implementation of EMR in two health plan market

Implementation of 2 EPIC “Go Lives”

FACETS/TMG

STORAN- Medicare Risk Adjustment

MDX-Medicare Risk Adjustment

TruCare Care Management Platform

AristaMD (Referral Intelligence Platform Application)

Mod Med

References

Kristy Rooney-206-***-****

Stacey Zierath- 253-***-****

Korina Velasquez- 253-***-****



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