Customer Service Call Center
Resume:
Whitteney Chaney
ad4e6r@r.postjobfree.com
Summary
Motivated, loyal, and success-driven collections professional with a proven career history in developing customer relationships. Looking to join an established company such as JPMorgan where she can advance and utilize her customer service and relationship-building skills.
Skills
●Relationship Building
●Negotiation Skills
●Collections
●Excellent Communication Skills
●Research Skills
●Inbound and outbound call center experience
●Proficient with Microsoft Office Suite
Relevant Experience
Alignment Health Care (Remote) May 2023- Current
Resolution Specialist
Answering inbound calls and resolving patient and family concerns or requests efficiently and effectively
Acting as a liaison between patients and admissions, billing, utilization review, outreach, and clinical teams
Supporting clinical care team requests to improve the patient's experience.
Identifying gaps in treatment attendance and reaching out to clients to resolve treatment issues that may be leading to non-attendance proactively.
Managing client schedule, scheduling, and rescheduling appointments
Assist with initial client scheduling on an as needed basis
Complete all documentation in a timely and accurate manner.
Adapt to organizational change and departmental restructuring to fit the needs of our clients, families, and referral sources.
Meet determined KPIs including task request volume, daily talk time, daily call volume, issue resolution rate, time to resolution, and customer satisfaction scores.
State serv, January 2022 – April 2023
Specialty Billing Manager, SNF (Remote)
• Searching each financial statement for any payment inconsistencies or errors
• Collaborating with patients or customers, third-party institutions, and other team members to resolve billing inconsistencies and errors
• Creating invoices and billing materials to be sent directly to a customer or patient
• Inputting payment history, upcoming payment information, or other financial data into an individual account
• Finding financial solutions for patients or customers who may need payment assistance
• Informing patients or customers of any missed or upcoming payment deadlines
• Calculating and tracking various company financial statements
• Translating medical code if working in a medical setting
Century January 2020 – March 2022
Workers comp claims specialist
Aggressively investigated workers’ compensation claims for over 20 clients.
Actively managed over 180 open workers’ compensation claims, including directing medical treatment and distributing compensation benefits.
Successfully conducted quarterly claims reviews with all clients to keep them abreast of their open claims and claim strategies.
Maintained a high level of confidentiality in handling clients' medical claims, including knowledge of HIPPA.
investigated claims to determine compensability; Demonstrated proper claim handling within the authority.
Authorized changes in medical providers, medical management, rehabilitative services, vocational training, or other procedures or services.
Provided temporary disability payments and monitored cases for the continuation of benefits; terminated payments when appropriate; Returned to work.
Conducted negotiations for settlement of claims with claimants and attorneys; ensured preparation and filing of necessary legal documents.
Prepared reports on claims and loss statistics and other information as required.
Apogee Mental Health Phoenix, AZ January 2020- September 2022
Claims Processor-COB Specialist/In-Billing Specialist
●Performed medical billing and adjustments for claims.
●Assisted members, physicians, and hospitals with queries and concerns on accounts.
●Navigated through various databases and programs for updating and maintenance daily.
●Daily follow-up on claims and correspondence.
●Provided information to members on various benefit insurance packages offered.
●Provided ICD-9 and diagnostic codes for claims and medical procedures.
●Maintained, correlated, and prepared medical records and files of members.
Effectively communicated with and supported sales, marketing, and administrative teams.
●Investigated and resolved customer inquiries and concerns in a timely and empathetic manner.
●Managed a wide variety of customer service and administrative tasks to resolve customer issues quickly and efficiently.
●Learned, referenced, and applied product processing information.
Humana- Tempe, AZ August 2019 – March 2021
Claims Processor-COB Specialist
Assist in the streamlining of the EDI process to manage the workflow of EDI claims.
Manage claims on desk, route/queues, and ECHS within specific turn-around-time parameters.
Manage claims, route/queues, and ECHS, within specified turn-around time parameters.
Investigate, manage, negotiate, and resolve claims arising out of accidents involving automobile and homeowner policies.
Upgrade CPT-4 and ICD-9 coding procedures, staying in step with many managed care plans changing reimbursement schedules.
Manage expedition of appeals via problem-solving and collaboration with other departments.
Provide administrative assistance taking dictation, handling telephone calls, set up meetings.
Train on both ACAS and HMO platforms.
Coordinate with insurance companies on insurance claims; and resolve millions of dollars in balances - Sr.
Handle and dispose of claims in litigation by preparing and developing strategy with defense counsel and consensus relative to litigation handling.
Present evaluations and status report to Sr.
Verify all member and provider information is correct and also make sure all HCPCS codes are correct.
Process all inpatient and skilled nursing claims with the correct DRG and CSM codes to pay the allowable amount.
Used Windows base system to access client information for loss assessments, and post and reassign claims to adjusters.
Verify post-billing edits to ensure correct coding bill unit amounts and CPT codes to ensure clean claim submission.
CARVANA - Phoenix, AZ November 2018 to July 2020
Underwriter II
●Review insurance applications for compliance and adherence
●Assess clients’ background information and financial status.
●Liaise with specialists to gather information and opinions.
●Draw up a quote for competitive insurance premiums.
●Negotiate and define the specific terms of insurance policies with brokers or policyholders.
●Keep detailed records of policies underwritten and decisions made.
●Develop and maintain a profitable book of business for the insurer.
●Follow applicable insurance laws.
Horizon Blue Cross March 2017 to November 2018
Claims Processor-COB Specialist
Assist in streamlining the EDI process to manage the workflow of EDI claims.
Manage claims on desk, route/queues, and ECHS within specific turn-around-time parameters.
Manage claims, route/queues, and ECHS, within specified turn-around time parameters.
Investigate, manage, negotiate, and resolve claims arising out of accidents involving automobile and homeowner policies.
Upgrade CPT-4 and ICD-9 coding procedures, staying in step with many managed care plans changing reimbursement schedules.
Manage expedition of appeals via problem-solving and collaboration with other departments.
Provide administrative assistance taking dictation, handling telephone calls, set up meetings.
Train on both ACAS and HMO platforms.
Coordinate with insurance companies on insurance claims; and resolve millions of dollars in balances - Sr.
Handle and dispose of claims in litigation by preparing and developing strategy with defense counsel and consensus relative to litigation handling.
Present evaluations and status reports to Sr.
Verify all member and provider information is correct and make sure all HCPCS codes are correct.
Process all inpatient and skilled nursing claims with the correct DRG and CSM codes to pay the allowable amount.
Used Windows base system to access client information for loss assessments, and post and reassign claims to adjusters.
Verify post-billing edits to ensure correct coding bill unit amounts and CPT codes to ensure clean claim submission.
Aetna February 2015 to March 2017
Customer Service Representative
Responsible for initial review and triage of Care Team tasks
Identifies the principal reason for admission, facility, and member product to correctly apply intervention assessment tools.
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Screens patients using targeted intervention business rules and processes to identify needed medical services, make appropriate referrals to medical services staff, and coordinate the required services by the benefit plan.
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Monitors non-targeted cases for entry of appropriate discharge date and disposition.
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Identifies and refers outlier cases (e.g., Length of Stay) to clinical staff.
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Identifies triggers for referral into Aetna's Case Management, Disease Management, Mixed Services, and other Specialty Programs
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Utilizes eTUMS and other Aetna systems to build, research, and enter member information.
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Support the Development and Implementation of Care Plans
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Performs non-medical research pertinent to the establishment, maintenance, and closure of open cases.
McKesson Specialty Pharmacy October 2014 to February 2016
Insurance Specialist
Enroll new patients in the drug program.
Intake of insurance, verification benefits, determining what the patient's out pocket is going to be
Responsible for assisting current patients with the refill process.
Must be comfortable with MS Office
Education
GRAND CANYON UNIVERSITY
B.S PSYCHOLOGY
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