Customer Service High School
Resume:
Dashanika K. Lawrence **** Windmill Parkway Henderson, NV 89074
************@*****.***
Objective
An interesting position in which I would be able to utilize my interpersonal and customer service skills. I am also
searching for a position in which there is an opportunity for recognition and advancement in the field of study in
which I am pursuing.
Experience
Numotion Cerritos, CA
Funding Coordinator 11/2014-Present
Reviews medical documentation for accuracy/medical necessity
Submits for prior authorization with all required documentation to appropriate funding source
Maintains consistent follow up on status of all prior authorization requests
Reviews authorizations from payer to determine approved/denied items
Calculates estimated copay based on current insurance benefits
Communicates with Supervisor in regards to issues/changes with Payer
Responds to all internal and external customers in a timely & professional manner
Full-time 40 Hours
Kelly Services-WellPoint Newbury Park, CA
Utilization Manager 06/2014-09/2014
Served as point of contact for other internal departments regarding provider issues that may impact provider satisfaction.
Researched and resolves the more complex provider issues and appeals for prompt resolution.
Coordinated prompt claims resolution through direct contact with providers and claims department.
Provided assistance with policy interpretation.
Researched, analyzed and recommended resolution of provider disputes as well as issues with billing and other practices.
Assisted providers with provider demographic changes as appropriate. Responded to provider issues related to billing, pricing,
policy, systems and reimbursements.
Determined if providers were paid according to contracted terms.
Provided explanations based on terms of contractual agreement and organization's protocols, procedures, policies.
Developed, maintained, and enhanced relations with providers to foster cooperative business relationships. Collects data and
compiles a variety of reports.
Performs other duties as assigned.
Processed 80-100 calls per day to provider and or members.
Full-time 40 hours
Conifer Health Solutions Anaheim, CA
Customer Service in Collections 03/2014 to 06/2014
Customer Service Collections/Eligibility Specialist
Maintains exceptional service and integrity with customers and client accounts through accurate, timely, relevant, and quality
work efforts of all inventory assigned to the self-pay billing revenue cycle and call center.
Drives inquiries from customers and clients towards resolution which includes the identification of the appropriate source of
payment or assistance program
Records and maintains complete and accurate documentation of all activity performed on appropriate medium.
Informs management of operational issues impeding performance or customer satisfaction including but not limited to those
impacting the customer, client, or the company
Runs Eligibility and determine plan information
100-120 calls per day
Full time 40 hours
United Health Group Cypress, CA
Appeals Representative 01/2012 to 03/2014
Ensured complaint has been categorized correctly
Determined and confirmed member eligibility and benefits
Obtained additional documentation required for case review
Placed relevant documents into image repository
Initiated outbound contacted to members or providers
Reviewed case to determine if review by Clinician is required
Researched and resolved written complaints submitted by member, physicians/providers
Rendered decision for non-clinical complaints using sound, fact-based decision making
Drafted verbiage for use in outbound correspondence
Prioritized and organized tasks to meet CMS compliance deadlines
Ability to meet established productivity, schedule adherence, and quality standards
Full time 40 hours
Automobile Club of Southern California Burbank, CA
Customer Service Rep/Emergency Roadside 04/2009 to 10/2011
Used automated systems and computers to deliver world-class
Customer service to Auto Club members and contacts
Recognized and diffuse escalated member situations in a patient,
professional and courteous manner
Provided effective and timely resolution of a range of member
Inquiries, placing appropriate levels of urgency on each contact
Actively listened, build rapport and display empathy
Built customer satisfaction and loyalty
Displayed a consistently positive, professional and cooperative
tone with members, contacts and coworkers
Thrived in a fast-paced, rapidly changing, high volume work
Environment
Provided punctual, regular and consistent attendance
Remained flexible to work holidays and weekends in order to meet
The constantly evolving customer service needs of our members
Micromanaged environment including schedule adherence, quality, and excellent customer surveys.
90-120 calls per day
Full time 40 hours
NetBilling Valencia, CA
Customer Service Represenative 01/2009 to 04/2009
Answer phones and respond to customer requests.
Sell product and place customer orders in computer system.
Provide customers with product and service information.
Upsold products and services.
Transfered customer calls to appropriate staff.
Identified, research, and resolved customer issues using the computer
system.
Followed-up on customer inquiries not immediately resolved.
Completed call logs and reports.
Researched billing issues.
Researched misapplied payments and billing issues.
Resolved complaints, issued refunds accordingly.
60-80 calls per day
Full time 40 hours
Education
CES College Burbank, CA
Vocational Nursing 2011 (In Progress)
Vocational Nursing Program
El Camino College Torrance, CA
General Education 2000-2003
David Starr Jordan High School Los Angeles, CA
Diploma 1999
High School
References
Available upon request
Contact this candidate