Customer Service Representative

Experience

Accenture/State of La Medicaid/UI Maryland Dept of Labor New

Customer Service Representative(Remote) 10/2023 - Present Responsible for providing customer service support according to the scope of work and service level requirements, including ensuring call quality and quantitative standards are observed in meeting customer care needs and resolving them in a timely fashion

Responsible for receiving all inbound calls and providing information relative to Medicaid programs. Responsible for promoting and facilitating enrollment and retention in the Louisiana Children’s Health Insurance Program

(LaChip) and Medicaid program through statewide MSD. Utilize multiple benefits verification tools using electronic healthcare record systems to locate benefits and run/adjudicate claims.

Make outbound calls to contact doctor’s offices, insurance, and the patient (customer) to help process the specialty crucial medications to be filled and shipped to arrive on or by the expected dates discussed/needed (medications will be for rare and complex conditions such as cancer, fertility, etc.) Complete 80% of cases through back-office work and 20% inbound/outbound calls, back-office work may decrease and inbound/outbound calls may increase to meet the needs of the business Effectively handle incoming and outgoing calls to patients, clients, and other customers while proactively gaining patient and order information

Empathize and converse with patients by building a rapport and discussing therapy changes on targeted medications. Navigate through multiple computer applications with speed & accuracy. Utilize and understand HIPPAA compliance, as well as ensuring that patients remain adherent to and compliant to their specific therapies.

Adapt to learn new call types when business needs change & flex support in those areas. Tulane Medical Center New Orleans, LA

Medical Records Coordinator 07/2018 - 10/2023

Completes release of information requests including retrieving patient’s medical chart and returning chart, scanning medical record accurately and correctly and transmitting daily, according to requests, established procedures, and established standards of quality and productivity. Date stamps all requests and highlights pertinent data to facilitate processing. Validates requests and authorizations for release of medical information according to established procedures. Performs quality checks on all work to assure accuracy of the release, confidentiality, and proper invoicing. Maintain equipment in excellent operating condition (inside and out). Provides excellent customer service by being attentive and respectful; insures understanding of customer request and follows-through as promised; and being proactive in identifying client concerns, or problems. May receive incoming requests including opening mail, telephone inquiries, and retrieving facsimile inquiries, depending on the needs to the client.

Maintains a neat, clean, and professional personal appearance and observes the dress code established. Maintains a clean and orderly work area, insures that records and files are properly stored before leaving area. Maintains working knowledge of the existing state laws and fee structure Works within scope of position and direction; willingly accepts assignments and is available to take on additional facilities or help out during backlogs

Carries out responsibilities in accordance with client/site policies and procedures, including HIPAA, state/federal regulations related to operations, and labor regulations. Maintains confidentiality, security and standards of ethics with all information. Work with privileged information in a conscientious manner while releasing medical records in an efficient, effective, and accurate manner.

Walmart Marrero, LA

OTC Pharmacy Department Manager 11/2014 - 12/2018 Ensures customer satisfaction by greeting and answering customer questions. Tours my department to ensure it meets our customers' expectations. Works hand-in-hand with sales associates to get the job done. Prepares and plans for upcoming events that will impact my department. Communicates, takes directions at all levels, and turns it into action. Daydriane Chirlow-Robins

504-***-**** ****************@*****.*** Gretna, LA Utilizing basic math skills in order to maintain accurate inventory levels. Earl K. Long Medical Center Baton Rouge, LA

Insurance Analyst II 12/2011 - 04/2013

Greeted patients and guest in a courteous manner whether via telephone contact or in person. Scheduled appointments or completed the check-in process/admission for patients; obtained and verified accurate identification and demographical data for the patient's permanent medical record. Verified insurance information and updated patient demographics as necessary. Collected co-payments and payments for services at the beginning and end of each patient visit. Tulane Medical Center New Orleans, LA

Customer Service Coordinator/Insurance Verification 12/2009 - 12/2011 Was responsible for ensuring that all phases of the clinic registration process (interviews, pre-admissions, verification of insurance coverage, pre-certification of insurance coverage, and collection of co-pays) are completed in an accurate and timely manner in order to guarantee that maximum collection is achieved. Verified patient diagnosis and procedure codes were assigned properly prior to claim submission. Informed customers about billing procedures, processed payments and provided payment option setup assistance. Consulted with customers to determine best methods to resolve service and billing issues. De-escalated problematic customer concerns, maintaining calm, friendly demeanor. Documented conversations with customers to track requests, problems and solutions. Delivered service and support to each customer, paving way for future business opportunities. Tulane Medical Center New Orleans, LA

Environmental Service Worker 12/2008 - 12/2010

Maintained environmental and infection control standards within the established policies and procedures of the healthcare center.

Performed a variety of general cleaning tasks to maintain patient rooms, offices, hallways and other assigned areas of the facility.

Skills

Customer service, Microsoft word, Microsoft excel, Communication skills, Leadership, Documentation review, Time management, centralized scheduling, Medicare, Medicaid, Salesforce, Teams, Prior Authorization, EOB, Inbound/Outbound Calls, Payor/HCP calls

Education

Unitech Training Academy Metairie, LA

Medical Billing and Coding/Administrative Medical Assistant 05/2018 Technical Diploma

Kenner Institute Kenner, LA

Coursework in Anatomy & Physiology and Cardiovascular 05/2014 Technical Diploma

West Jefferson High School Harvey, LA

College Prep Coursework 05/2008

High School Diploma

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