Customer Service Support Specialist

SHAWNTEL WILDER

601-***-**** *****************@*****.***

Jackson, MS

OBJECTIVE

Accommodating Customer Support Specialist with a history of exceeding customer and patron expectations. Looking to obtain a position that will enable me to use my strong communication skills.

KEY SKILLS

Communication

Prior Authorizations

Medicare

Medicaid

Icd 10

Cpt

Insurance Verification

Data Entry

Active Listening

Microsoft Office

HIPPA

CRM

Customer Service

Education-

HSD from McLaurin High school May 2018

EXPERIENCE

October 2021-March 2024

Benefit Verification Specialist MTM Remote

Conducted thorough reviews of patient insurance data essential for comprehensive benefit verification, ensuring accuracy and completeness.

Managed a high volume of approximately 70-80 calls daily, comprising both inbound and outbound communications, to validate patient-specific benefits. Accurately documented pertinent details for diverse payer plans, encompassing coverage, cost-sharing arrangements, and available access/provider options.

Identified cases with incomplete information and effectively triaged them to the appropriate program associate for resolution, ensuring seamless workflow and timely processing.

Orchestrated the necessary steps for prior authorization, when required, liaising with relevant stakeholders to expedite approval processes and minimize delays in patient care.

Proficiently administered electronic medical records (EMR), maintaining meticulous documentation, and facilitating efficient scanning procedures to uphold data integrity and compliance standards.

Engaged in continuous training and professional development to stay abreast of evolving industry regulations and best practices, optimizing service delivery and contributing to organizational excellence.

May 2019-September 2021

CSR Medicare (Xerox) Ridgeland MS

Initiated prior authorization requests for healthcare providers on behalf of patients, employing efficient communication channels such as phone or fax. Ensured timely processing to facilitate seamless access to necessary medical services.

Managed the preparation and submission of insurance claims to various providers, employing both electronic and paper-based methods. Handled a substantial volume of approximately 70-80 calls per day, ensuring accuracy, timeliness, and compliance with regulatory requirements.

Implemented and maintained customer relationship management (CRM) systems, devising, and monitoring key performance indicators (KPIs) to gauge customer service effectiveness and enhance operational efficiency.

Upheld strict confidentiality standards and meticulously adhered to all Health Insurance Portability and Accountability Act (HIPAA) guidelines and regulations, safeguarding patient privacy and data security.

Demonstrated unwavering commitment to compliance by diligently following established policies, processes, and departmental guidelines in executing assigned revenue cycle responsibilities, contributing to the overall integrity of financial operations.

Engaged in detailed discussions with clients or their healthcare providers, providing comprehensive explanations of benefits, pharmacy benefits, and Medicare Part B information, fostering informed decision-making and ensuring clarity regarding healthcare coverage and entitlements.

REFERENCES

[Available upon request.]

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