Customer Service Representative
Resume:
NICOLE HARDING
Brockton, Massachusetts, 02301
**.********@******.***
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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