Customer Service Home Health
Resume:
Carisa Thomas
Colonial Heights, VA. 23834
******.***********@*****.***
Summary of Qualifications:
• Possesses a broad knowledge of call center operations, very knowledgeable in customer service relations, dependable leadership skills, proficient in handling customer accounts processing Change gear requests, IDX systems and QNXT
• Uses effective telephone communication and receptionist skills/answering phones frequently as well as emails from outside departments
• Uses office equipment such as; computers, copiers, fax machines and calculators.
• Uses Microsoft Word applications and Internet Explorer
• A motivated team player who is ready to get the job done.
• Demonstrates initiative in problem solving and decision making
• highly organized, efficient and self-directed, and works as a team player
Work Experience:
2011-Present
CJ PLANS IT ALL - Wedding Planner
Colonial Heights, VA
Responsibilities
WEDDING COORDINATOR
Dedicated, meticulous event management professional with experience in coordinating 45 large scale events till date including 15 weddings. Highly skilled in designing and implementing innovative wedding themes. Well versed in developing and maintaining client database, negotiating with third party vendors and service providers.
SUMMARY OF QUALIFICATIONS
* Demonstrated ability to develop and suggest innovative wedding themes
* Adept at making negotiations with third party vendors and caterers
* Well versed in developing economical contracts with music DJs and flower providers
* Skilled in conducting wedding market surveys and incorporating emerging trends in wedding planning
*Experienced in accomplishing economical yet high quality lighting and photography deals
*Capable of handling correspondence and remain in constant contact with the customer, ensuring the whole event is planned as per customer preferences and desires
* Meet the clients, build rapport and develop a wedding plan with time frames
* Develop and suggest various wedding themes to the clients, venues searches
* Arrange tasting sessions with caterers and accompany the client in same
*Make flower purchases, help set up centerpieces, create programs, menus
*Communicate effectively with DJ and light providers
August 2012- Present
MER II Member Engagement with VPCC
Virginia Premier Health Plan (Dual Plan)
Richmond, Virginia 23219
*Answers & monitors calls routed through hunt groups to ensure that established monthly call standards are met.
*Assists management with addressing issues and concerns of the department and maintains professional relationships with team while also providing quality coaching and constructive feedback.
*Responds accurately and courteously to member and provider inquiries regarding benefit interpretation, eligibility, claims status, accessing care through plan providers, and other health plan related issues.
*Provides information, facilitate and/or coordinate appropriate resolution of member issues.
* Responsible for working with the Medical Management area to complete the Health Risk Assessment (HRA) for members.
*Assist members on how to properly use the medical services available to them. Builds and maintain relationships in order to retain members.
*Verifies member eligibility for physician offices, ancillary providers, and hospitals. *Documents member/provider inquiries, complaints, hospital notification, and other data in CRM in an accurate, clear, and timely manner.
* Conduct outbound telephone calls consistent with programs promoting health plan education, health and wellness for members.
*Mail member ID cards for new members and PCP changes
*Handle clients and update information in system
July 2010 to August 2012
Billing Specialist
Bostwick Laboratories, Glen Allen, VA.
*Prepares and submits clean claims to various insurance companies either
*Electronically or by paper.
* Answers questions from patients, clerical staff and insurance companies.
* Identifies and resolves patient billing complaints.
* Prepares, reviews and sends patient statements
* Evaluates patient's financial status and establishes budget payment plans. Follows
And reports status of delinquent accounts.
* Reviews accounts for possible assignment and makes recommendations to the
Billing Supervisor, also prepares information for the collection agency.
* Performs daily backups on office computer system
* Performs various collection actions including contacting patients by phone,
Correcting and resubmitting claims to third party payers.
* Processes payments from insurance companies and prepares a daily deposit.
* Participates in educational activities and attends monthly staff meetings.
APRIL 2005- SEPTEMBER 2010
Quality Assurance Coordinator/Dispatcher
Logisticare Solutions -Norfolk, VA
*Records and initiates investigation of complaints
*Initiates corrective actions
*Work closely with Regional Managers
*Collects and monitors driver and provider compliance information
*Sends out notices when updates are due.
*Manages the denial and appeal process
*Creates and disseminates exceptional distance report
*Perform occasional vehicle inspections
*Performs other duties as assigned
Knowledge, Skills and Abilities
* Expert listening skills and ability to identify customer need, appropriate issue resolution
* Strong verbal and written communication skills * Strong time management skills
* Problem-solving orientation to identify root cause, develops solutions, and implement in close collaboration with those doing the work
* Ability to remain calm and productive under pressure
* Ability to translate complex processes into simple standard work that staff can consistently perform with predictable outcomes
* Strong ability to assess member communication styles and personalities and match approach to those needs * * Excellent conflict management skills including:
* Professionally and adeptly resolve issues while under pressure
* Diffuse conflict and member distress * Demonstrate personal resilience * Strong attention to detail
Clinical Service Supervisor
CALVERY HEALTH PARTNERS, Newport News (company went out of Business)
September 2003 to February 2005
Assume administrative duties in the absence of the Director or QI Coordinator.
* Coordinate the patient admission process for home health/hospice with the Medical Director and the primary
Care physician.
*Care including scheduling oversight.
* Provide hospice benefit explanations and inpatient consultations to potential patients.
Fulfilled.
*Coordinate and assign new referrals.
* Perform daily rounds on hospitalized Home Health/Hospice patients and pending referrals.
* Assist Director with annual review and update clinical policies and procedures.
Development of staff competencies and assist with systematic assessments.
* Consult with staff regarding Home Health/Hospice nursing concerns and practices.
Volunteer: Position became Part time……
Bereavement Counselor
Care for you South- Hampton VA (company closed)
June 2005- April 2010
Coordinated patient care and treatment and counseled family members
Provided counseling training to intern, support staff, and volunteers
Offered bereavement support to family members and staff
Maintained clinical records of patients and responded to their requests
Maintained relationship with relatives of the deceases and ensured they have overcome with the loss
Arranged and coordinated special prayer and meetings for the families of deceased
Summary of Qualifications:
* Possesses a broad knowledge of call center operations, very knowledgeable in customer service relations, dependable leadership skills, proficient in handling customer accounts
• Has knowledge of processing Change gear requests, IDX systems and QNXT • Uses effective telephone communication and receptionist skills/answering phones frequently as well as emails from outside departments
• Uses office equipment such as; computers, copiers, fax machines and calculators.
• Uses Microsoft Word applications and Internet Explorer • A motivated team player who is ready to get the job done. • Demonstrates initiative in problem solving and decision making• highly organized, efficient and self-directed, and works as a team player
Education and Training:
Virginia State University Bachelor of Science 1995
High School Graduate, 1991 Lloyd C. Bird High School, Chesterfield VA.
Contact this candidate