MELISSA HARRIS

ad2b1v@r.postjobfree.com 270-***-**** Glasgow, KY 42141

Summary Authorized to work in the US for any employer. Highly-motivated employee with desire to take on new challenges. Strong work ethics, adaptability and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.

Skills Customer Support

Patient Advocacy

HIPAA

Auditing

Insurance Verification

Quality Assurance

Quality Audits

CRM, Salesforce, Microsoft Office

Account Maintenance

Call Volume and Quality Metrics

MS Office

Quality Assurance Controls

Needs Assessment

Credit Card Payment Processing

72 Wpm Typing Speed

Verbal and Written Communication

Technologically Savvy

De-Escalation Techniques

Customer Account Management

Call Documentation

Multitasking and Prioritization

Product Knowledge

Policies and Procedures Adherence

Teamwork and Collaboration

Oracle EnterpriseOne

Administrative and Office Support

Multi-Line Phone Systems

Understanding Customer Needs

Complaint Investigation

Problem Resolution

Sales Quota Achievement

Sales and Upselling

Data Entry

Order Fulfillment

Professional Telephone Demeanor

Billing Adjustments and Refunds

Computer Skills

Remote Office Availability

Customer Service Excellence

Member Relations

Experience Member Service Specialist 10/2022 - 02/2023 Molina Healthcare

Effectively Communicate with customers to provide First Class Service Actively listen to ensure the members are helped with all appropriate information that is needed, for First Call Resolution.

Gather all demographics and information needed and enter all information from start to end, with resolution and disposition used on call. Enter in to CRM Coding and Documenting with complete Accuracy

Case Management and Service Coordination

Update iServe Tickets and follow up with members

Retro Terminations and Disenrollment Requests of members insurance ID Card Keys, requests and/or change

Critical Incidents and Grievances, Appeals

Eligibility and discrepancies, Out of Area Coverage Appropriately route calls to internal departments for assistance ie: Medical Records, Denial of Appeals, Provider Documents, Audits (after going over the research that I provided) M

H

Summary of Benefits (Molina Healthcare states that I covered are IL, MI, CA, NV, TX, OH, SC and ID) MMP Duals line (Medicare and/or Medicaid)

Salesforce Auto Claims

Escalations

Benefits with Type of Plan, to assist members in choosing the best plan for themselves/family's needs

Billing payments and/or questions and resolve on same call Pegasus, Legacy, Salesforce, QNXT

Search Directory for Providers, Pharmacy, Specialist for IN and OON Language Line Transfers

Behavioral Health Indicator

Arrange Transportation

Waiver Programs and/or Patient Assistance availability per Plan Home and Community Based Services locator and transfer Work with Drug Formularies, search for information as well as add/delete drugs for updated listings

Alert for Adverse Events

Strict HIPAA

Member Services Representative 11/2018 - 03/2020

ACA

Assist members with their Insurance Portals

Unlocking, enable a disabled account, reset passwords, etc Recognizing Behavioral Health Issues and assisting further Assist members with Medical and Pharmacy Claims

Assisting Brokers on behalf of members

Assisting Members with all Insurance benefits, including Out Of Pocket, Deductibles, Co-Pays Process payments for members Insurance Premiums

Strict HIPAA awareness

Team Lead Inbound Patient Advocate 03/2007 - 04/2019 Abbvie, Inc

Act as a patient advocate for callers with questions or concerns about the medication, Humira Provide callers with financial options to make their pharmaceutical medication more affordable

Support patients' needs by providing complimentary services Completed outbound calls for clients, RN's, Pharmacies, and Providers' offices Product Quality Auditor for this recorded line with many legal compliance regulations, detailed HIPAA based work

Customer Service and Sales Supervisor 03/2006 - 03/2018 Liveops, Inc

Handle high volume of inbound/outbound calls daily and provide exceptional one call customer service by offering one point of contact for problem resolution for multiple companies Respond to customers inquires about products and services and attempt to complete the sale Process orders online and document every phone conversation into electronic databases Offer up-sells that compliment the main product, subscription services, and other add-ons Review and explain all contractual details of purchase and ensure customer understanding of it Maintain strict confidentiality for clients, customers, and partners, including their financial, medical, and demographic information

Surgical Scheduler 01/1995 - 01/1997

Drs Margiotta and Joy

Patient Communication to start process of surgery

Insurance verification and authorization

Pre-op scheduling

Surgery scheduling

Maintain all medical records pertaining to pre-op and post-op Schedule post-op visits

Education and

Training

High School Diploma 06/1988

Atlantic High School Delray Beach, FL

Contact this candidate