Customer Service Representative
Resume:
Krystal Hardie Cell: 347-***-****
Brooklyn, NY 11213
WORK HISTORY:
**/**** – 11/2023 MOMENTUM RESOURCE SOLUTIONS LLC NYC HEALTH + HOSPITALS
(BELLEVUE HOSPITAL) NEW YORK, NY
TEMPORARY ASSIGNMENT / CREDENTIALING SPECIALIST
• Responsible for the credentialing & re-credentialing of all Physicians & Allied Health Practitioners ensuring they have proper qualifications & credentials in caring for patients.
• Utilized MD Staff Database status, alerts, report functions & software tools & links to pdf documents
• Recorded assigned Physician & Allied Health Professional files, updating each item & action as processed
• Maintained working knowledge of Joint Commission & State Laws as well as Bellevue Hospital Bylaws to interpret & remain in compliance with appropriate accrediting & regulatory agencies 12/2021 – 05/2022 METROPLUS HEALTH PLAN, NEW YORK, NY CUSTOMER SERVICE REPRESENTATIVE I (RETURNED TO THIS ROLE) 05/2021 – 12/2021 NYC HEALTH HOSPITALS CORP. (QUEENS HOSPITAL) NEW YORK, NY CLERICAL ASSOCIATE LV III / ADMITTING REPRESENTATIVE
• Interview Patient /family to obtain/confirm accurate demographics and insurance information and enter in EPIC system
• Confirm insurance coverage inquiries from Insurance Companies in EPIC system
• Responsible for assigning beds for admitted / transfer patients eg: surgery, procedures etc.
• Collaborated with Doctors, Nurse Managers and Supervisors in facilitating admissions, transfers, discharges & appropriate bed assignments on 9 units eg: Medicine /Surgery/ ICU/ Stepdown/ Telemetry /Psych / Mother-Baby / NICU and MAU
• Notified appropriate personnel / Physician of admission or transfers from other hospitals via Cisco Jabber Chat or via phone
• Processed Death Certificates for decedents 3-5 times weekly or more in an EVITAL system from Clinical Summaries and Patient Charts
• Compiled Hospital Census Report, information including inpatient units & updated changes in Census Report on a Tour 1 shift 10/2020 – 04/2021 METROPLUS HEALTH PLAN, NEW YORK, NY CONTRACTING / CREDENTIALING COORDINATOR / ESR III
• Established qualifications of Licensed medical professionals and assessed their background & legitimacy to become an in-network provider with the plan in house and remotely on a fulltime basis
• Ensured CAQH and all licensers, background, schooling information, Malpractice, DEA and databank searches and all signatures are legible and up to date
• Reviewed Packet ensuring provider met standards set out by the Insurance Company
• Scanned Contracts of Agreements and Amendments for Groups and Facilities
• Updated Agreements of new and existing customers eg; Groups, Facilities, and or Solo Providers
10/2019–10/2020 CUSTOMER SERVICE REPRESENTATIVE I
• Handled up 40-60 calls per day from provider and member inquiries by line of business eg; Medicaid, Essential Plan 1,2,3 and 4, Silverprime, Harp, SNP, MLTC related to eligibility, benefits, services, claims, authorizations and appeals
• Researched and responded accurately to all customer and provider questions and concerns via in house and remote full time
• Utilized dual monitors to leverage computer-based resources to research answers to member / provider questions and inquiries
• Provided new member orientations for all new to the plan members and PCP term resign projects
• Classify and record all customer / provider encounters clearly and concisely in a Macess Database
• Researched Medicaid members in Epaces verifying eligibility 10/2005 – 10/2019 ENROLLMENT SALES REPRESENTATIVE I
• Review applications and documents from internal and external sources.
• Ensure quality and accuracy of documentation received for eligibility ensuring that applications are placed in the correct line of business.
• Assist and Respond to inquiries pertaining to new enrollments and recertification. Screen for Medicaid, Child Health Plus, and Family Health Plus.
• Enter correct Immigration codes for qualified Immigrants applying for health insurance into system database.
• Assist with data entry in Macess and Powerstepp for the Medicaid LOB Return Mail
• Collected payments from all walk-in clients and communicated due dates of premiums and discrepancies with Invoices with Clients
• Maintain daily productivity grid in Excel Spreadsheet EDUCATION: KATHARINE GIBBS SCHOOL INC., NEW YORK, NY 7/00 – 6/02 Course of Study: Computers Network Operations Associate Degree / Applied Science: June 2002
COURSEWORK: Network, Verbal Communication, Web Technology, Software Integration
SKILLS:
*TYPE 60 WPM *MICROSOFT OFFICE SUITE * OUTLOOK *MICROSOFT TEAMS* REFERENCES AVAILABLE UPON REQUEST
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