Heather L. Raymond

**** ******** ******, *** **** 816-***-****

Kansas City, Missouri 64133 addn8i@r.postjobfree.com

Professional Profile

Effective Team Player, High Degree of Professionalism, Dedicated to Exceptional Quality

Willing to go the Extra Mile for the Customer

EXPERIENCE:

Cerner Corporation, Kansas City, Missouri April 2019 – Present

Senior Patient Account Specialist

Responsibility for various business office functions for physician practices and hospitals systems

These functions include reviewing, correcting and submitting claims to payers

This work will be accomplished by communicating with patients, government agencies and third-party payers to gather, process and record information needed for appropriate reimbursement

As a Senior Patient Account Specialist, you will also be responsible for initiating collection action for past due and denied claims and calculating write-off and debit/credit adjustments

As a Senior Patient Account Specialist, you will also be responsible for initiating collection action for past due and denied claims and calculating write-off and debit/credit adjustments

United Health Group, Overland Park, Kansas July 2014 – March 2018

Subject Matter Expert

•Respond to and resolve on the first call, customer service inquires and issues by identifying the topic and type of assistance the caller needs such as benefits, eligibility and claims, financial spending accounts and correspondence

•Help guide and educate customers about the fundamentals and benefits of consumer-driven health care topics to include managing their health and well-being by selecting the best benefit plan options, maximizing the value of their health plan benefits and choosing a quality care provider

•Intervene with care providers (doctor's offices) on behalf of the customer to assist with appointment scheduling or connections with internal specialists for assistance when needed

•Assist customers in navigating myuhc.com and other UnitedHealth Group websites and encourage and reassure them to become self-sufficient

•Follow problems through to resolution on behalf of the customer in real time or through comprehensive and timely follow-up with the member

•Research complex issues across multiple databases and work with support resources to resolve customer issues and/or partner with others to resolve escalated issues

•Provide education and status on previously submitted pre-authorizations or pre-determination requests

•Meet the performance goals established for the position in the areas of; efficiency, call quality, customer satisfaction, first call resolution and attendance

•Participate in design of call monitoring program and quality standards

•Performs call monitoring for a select number of representatives and provide call monitoring support to supervisors as needed.

•Delivers feedback to employees in timely manner

•Provides coaching on improvement opportunities and implements developments (when required)

•Ensures accurate communication and complete documentation on each call

•Assists in identifying top defects and develops solutions for common errors

•Assist in call calibration, quality assurance scoring with supervisors, trainers, WFM analysts, and other parties on a monthly basis

•Monitors electronic email customer contacts

•Participates in the ongoing improvement and re-engineering of contact center processes; continually examines opportunities for quality improvements and adherence

Settlement Solutions Inc., Kansas City, Missouri January 2001 – June 2014

Started general office work at a specialized insurance agency that placed annuities providing payments for survivors and injured parties involved in Federal and State tort litigation (Structured Settlements)

•Assembled, priced, and computed annuity proposals from multiple insurance companies

Drafted and wrote release documents, court approval proposals, and settlement documents

Attended national conferences, mediations and court hearings

Dealt with multiple insurance companies, plaintiff and defense attorneys, Federal court judges, State court judges, and self-insured companies on a national basis

Managed all office operations including answering phones, accounts payable, scheduling, all general and administrative office duties, payroll, maintenance and filing of all client files, handle all correspondence, and other duties as assigned

EDUCATION:

Dowling Catholic High School, West Des Moines, IA

NOTABLES:

Activities: Assist at sporting events. Distribute flowers and visit hospital patients. Active participant, providing dog therapy to various organizations and facilities.

Volunteerism: Animal Rescue League including walking shelter animals. Race for the Cure. Homeless shelter

Leadership: Educated and train co-workers. Provide and facilitate on the job training for new employees. Call monitoring and coaching sessions. Big Brothers & Big Sisters.

Awards: 6 Insurance license. Service Awards. Top Individual, Team and Site Performance.

References Provided Upon Request

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