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Customer Service Eligibility Specialist

Location:
Stone Mountain, GA
Posted:
July 22, 2022

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Resume:

Dawonna C Anderson

678-***-**** adruc2@r.postjobfree.com 2047 Redwater Drive, Decatur, GA 30035 Professional Summary

A professional with 17 years of experience within a variety of roles in customer service and a healthcare provider sector. Outstanding interpersonal, customer service and communication skills, including written, verbal, presentation and listening skills in addition to establishing positive relationships with internal and external stakeholders. Extensive staff supervision experience and facilitating employee training in HIM applications, electronic medical records, call center scheduling and appointment setting. Exceptional time- management capabilities, successfully managing multiple projects and prioritizing work responsibilities to meet project expectations within target deadlines Experience

Tax Preparer

Cheron and Cherica Tax Professionals, Decatur, GA

December 2010 -

Current

Assist over 50 clients per day with issue resolution through proactive communication with IRS personnel.

Supported individual and business tax clients and prepared simple to complex tax returns.

Mitigated risks, maintaining consistent and updated knowledge of current federal and state regulations.

Educated taxpayers on liability, processing requirements, and liabilities.

Assisted taxpayers with completing forms by furnishing sufficient and accurate information.

Served client needs by staying on top of changing laws and processes.

Completed accurate returns based on client documentation and additional information.

Reduced tax liability with correct use of appropriate adjustments, deductions, and credits.

Eligibility Specialist

UNUM, Decatur, GA

February 2019 - January

2021

Completed and processed 80-100 new disability leave request daily.

Determined eligibility and availability of leave time for each employee requesting leave for FMLA, State, and applicable corporate protections.

Determined and generate appropriate communications to comply with FMLA and State regulations and customer procedures.

Independently determined the appropriate status of leave under FMLA and state leave regulations taking into consideration regulatory requirements, company-specific requirements.

Determined and provided initial Short-Term Disability eligibility evaluation.

Systematically initiation of new claims in support of various Unum product types utilizing the appropriate claim adjudication system.

Performed a policy coverage search to determine claim filing eligibility and process/triage based on standard and/or customized policy instructions.

Managed pending/incomplete prior to triage/assignment to the corresponding claims organization/team.

Contributed to individual quality/production expectations to ensure the achievement of organizational turnaround time expectations.

Promoted a positive customer service experience through prompt, accurate, and courteous responses to internal and external customers' expectations. Office Manager

DreamStar Motors Inc, Decatur, GA

January 2013 -

Current

Effectively managed leasing, insurance coverage, vehicle, registration, and fleet transfers.

Monitored fleet utilization for the region.

Informed insurance carrier of vehicle accidents and administered certificates of insurance.

Obtained core data for damages and repairs.

Developed solutions to reduce expenses within the distribution network.

Organized incoming and outgoing mail in a clear and concise manner.

Tracked and logged all carrier and courier packages.

Distributed receipt of individual packages and mail.

Prepared and processed all outgoing parcels, from Domestic, International, and third- party carriers.

Efficiently ensured acknowledgment of packages.

Maintaining an operational fleet of 5 vehicles and ensuring implementation of business strategy.

Collaborating with team leaders to develop the most cost-effective transportation model.

Conducting repair audits by visually inspecting vendors' facilities and records to ensure high quality repairs and accurate billing of costs.

Ensured contracts are fulfilled.

Served as the liaison between auto-body shops, towing companies, and upper management.

Transplant Coordinator

Emory Healthcare, Atlanta, GA

January 2008 - January

2013

Obtained detailed transplant benefits; ensure authorizations are secured for each transplant phase.

Acted as liaison on behalf of physicians and nurses and provide clinical updates to case managers.

Counseled patients regarding state and federal assistance programs, educate patients and families on insurance issues, and communicate patient fiscal responsibility.

Ensured highest benefit level of reimbursement for the department.

Identified special policy clauses or pre-existing conditions and verify effective dates and co-pay information.

Ensured claims are entered and submitted within 48 hours of receipt, data entry and charge entry.

Accurately apply payments to patient accounts.

Posted and reconciled insurance and patient payments.

Research and resolve incorrect payments, EOB rejections and other issues with outstanding accounts.

Patient Account Representative II

Emory Healthcare, Atlanta, GA

January 2006 - January

2008

Processed an average of 50 patients per day by verifying insurance benefits for new and returning patients.

Ensured all insurance information was complete and accurately obtained.

Documented information given or received to support action taken on insurance charges and referral issues.

Recommend processes that need to be changed, automated, or left in place in line with stated goals.

Trained and educated users on Cerner and scheduling system functionality and capability.

Medical Secretary

Emory Healthcare, Atlanta, GA

January 2005 - January

2008

Reviewed and mailed physician dictations and typed letters while ensuring accuracy and completeness.

Assisted with billing by acquiring insurance authorizations for procedures and tests ordered by attending physicians.

Maintained physician's patient schedule and prepared materials and documents for clinic.

Screened and triaged multi-line phones, responded to questions, and took messages according to physician's instructions.

Entered new directives into EMR and prepared orders for refills and referrals.

Facilitated communications by taking detailed clinical phone messages for physicians and staff.

Patient Care Coordinator

Emory Healthcare, Atlanta, GA

October 2000 - January

2005

Initiated outbound administrative requests for medical record requests and specialty appointment booking.

Received incoming calls and triaged phone requests, including requests for appointments, form completion, and medication refills.

Welcomed patients upon arrival, communicated patient arrivals to team, and managed patient visit expectations.

Distributed patient forms and explained or clarified details of required paperwork or digital documentation.

Attempted to maintain continuity of care when scheduling patient appointments.

Supported patient service needs by coordinating efficient referrals for additional resources.

Affiliations

American Academy of Professional Coders (AAPC), Member Medical Terminology. Skills

Tax return preparation Regulatory compliance Correspondence

Account reconciliations

Microsoft Office Proficient Accounts and Operations Management Avaya CMS Call Monitoring Tax Preparation Healthcare systems – Cerner Scheduling, Cerner Registration, Cerner Global Patient Registration, IDX Scheduling, Health Quest, Pre-Arrival Database (PADB), Emory Electronic Medical Records (EeMR) applications, Powerchart, Surginet, GE Centricity, Kronos Time System, Avaya CMS Call Monitoring, NaviLink and Lotus Notes.



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