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Customer Service Representative

Location:
Brockton, Massachusetts, United States
Posted:
January 22, 2017

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NICOLE HARDING

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

Brockton, Massachusetts, 02301

(508) ***-****

acyeur@r.postjobfree.com

PROFESSIONAL EXPERIENCE

CELTICARE HEALTH, WALTHAM, MA UNITED STATES

Senior Customer Service Representative, April 2015 to Present

Provide assistance to plan members and providers

Answer inbound calls for the member and provider service departments

Respond to telephone and written inquiries regarding claims, eligibility, benefits, authorizations and pharmacy related matters

Provide assistance to members and providers regarding website registration and navigation

Process Internal Fulfillment requests such as coverage letters and PIP Exhaust Letters

Work with other departments to ensure quality and first call resolution

Document all activities through CRM

Initiate Member Appeals and Provider Appeals

Coordinate member transportation through the Transportation Vendor

Research and identify processing inaccuracies in claim payments

Route activities to the appropriate site operations team for adjustment and/or resolution

APEX SYSTEMS, INC, BURLINGTON, MA UNITED STATES

Contract Project Coordinator, August 2013 – April 2015

Coordinate InterQual training for clinicians

Client communication by phone and email

Participant registration and enrollment in Learning Management System

Curriculum assignment

Create WebEx Sessions

Create and Process Orders for training materials

Collaborate with Account Management and Project Management Teams to ensure contract fulfillment

Verify contracted services and pricing

Create, publish, and assign training courses.

Maintain spreadsheets for education

Prepare, track, and process learner assignment modifications

Run various reports and export to Excel

Create meetings through Outlook

Update and maintain Process Documents

Update and maintain Operation and Training Calendars

Update and maintain inventory of training/education materials

U.S. LABORATORIES, BROCKTON, MA UNITED STATES

Client Services Representative, Aug 2012 – Apr 2013

Answer inbound calls

Provide service to long term care facilities

Schedule Mobile Phlebotomists to Long Term Care and Skilled Nursing Facilities

Direct communication with physicians and other health care professionals

Analyze and report specimen results

Requisition Filing

Document Scanning

Data Entry to document results and inquiries.

Assist lab technicians with specimen processing

Create and process medical supply orders

HEALTH CARE SUPPORT STAFFING, BRIDGEWATER, MA UNITED STATES

Customer Service Representative, May 2012 – Aug 2012

3 Month assignment to Orion Home Health Care

Provide direct service to patients and organizations by phone and face to face

Process client paperwork

Create and process tickets for DME and medical supply orders

Confirm tickets for supply delivery

New patient set-ups to include new Oxygen RX orders, hospital bed set up, and CPAP set up

Chart assembly and filing

Data entry to update customer information and orders

PRIMARY CARE PHYSICIANS OF HOLLYWOOD, PEMBROKE PINES, FL UNITED STATES

Front Desk, Oct 2009 – Feb 2012

Answer telephones and direct calls to appropriate staff.

Schedule and confirm patient diagnostic appointments, surgeries, and medical consultations.

Receive and route messages or documents, such as laboratory results, to appropriate staff.

Compile and maintain medical charts, reports, and correspondence, by use of electronic record software.

Transmit correspondence or medical records by mail, e-mail, or fax.

Maintain medical records, technical library, and correspondence files.

Verify patient insurance

Check-in and check-out procedures

Document scanning

J.M. FIELD MARKETING, FORT LAUDERDALE, FL UNITED STATES

Call Center Manager, May 2007 – May 2008

Oversee 30 agents and 3 supervisors

Manage assigned marketing functions

Quality assurance monitoring

Create and maintain staff accounts

Employee Scheduling

Develop, implement, and maintain policies and procedures

Department Payroll

Recruiting via online job boards

Pre-hire reference checks

Hire, motivate, and coach

Account progression reports

Employee training and coaching

EDUCATION

QUINCY COLLEGE, QUINCY, MA UNITED STATES

Healthcare Administration/A.S. Candidate

BROCKTON HIGH, BROCKTON, MA UNITED STATES

ADDITIONAL SKILLS

MS Office

LMS

Pivotal

SharePoint

eClinical Works

Medical Terminology

Health Insurance Verification

CRM



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