Customer Service Associate
Resume:
Stacey Miskell
**** ************ ****** *** ***
Louisville Kentucky 40222
EMAIL: ************@*****.***
Professional Summary:
Exceptional leader talented at promoting and leading, management and team building. Technically savvy with outstanding relationship building, training and presentation skills. Motivated manager with solid experience managing all levels of large scale projects, including budgeting and administration. Manager with 5 years experience. Areas of expertise include hospitality, customer service, sales, medical care, and an all around people person! WORK HISTORY:
Anthem Inc
OCTOBER 2018- Present
Manager: Tawn Calvin
Provider Services & Member Services
Incoming call center rep started off answering provider calls, after doing the provider services we were becoming nationally recognized and were offered many more accounts that allowed me to move into member calls and inquiries. I handle claims, advancing into claims adjusting with our new accounts. Benefits, provider issues, any inquiry you can imagine a provider or member may have. Currently in a promoted position as Customer service associate in chat with providers and members handling multiple inquiries at once, up to three.
McKesson: RX CROSSROADS
MANAGER: Brian Gangley
Trainer: Nikki Kniffley
Job Title: Case Manager
Job Duties: Contact payers to verify patient eligibility and product specific coverage information. Interface with physicians, advocates, patients, and manufacturer representatives to obtain and provide drug specific coverage. Provide prior authorization assistance as well as claims assistance, including billing and coding instructions to physicians and/or office staff. Provide accurate and timely flow up to all reimbursement inquiries. Ensure the intake information is accurate and complete in order to perform all reimbursement research. Research and complete payer specific information for reimbursement database. Utilize resources to identify and provide alternative funding sources for patients without insurance or adequate coverage through their insurer.
Humana Inc/ Humana Military
From Sept 2017- June 2018
Manager: Haley Eddington/ Nikki Gregory
Job Title: Agent Support/ Beneficiary Service Rep
Job Duties: Incoming call center environment answering incoming calls from Humana's agents who sold Medicare products all over the United States to eligible beneficiaries. Provided assistance to the agent with inquiries on the application status, details including denial information, penalty information, or missing information including election periods, medicare information, and eligibility information. Advised agents on the status of their certification with Humana and with the entity that licenses them. Assisted agents with the AHIP testing portion of their certification form technical issues to the test itself. Assured all agents were in compliance with the CMS guidelines and assisted them with pulling and correcting any applications that were submitted but needed corrections.
With Humana Military I answered incoming calls from beneficiaries that had Tricare coverage, our military and their families were the bene's and the information I assisted with could include the benefit information such as the deductible for the year, the cat cap, the amount of the ded or copay that had been met. Also assisted with the referral process in which the insurance may require more information or prior auth beofore a specific benefit could be covered and reimbursed. Assisted in explaining coverage or lack of coverage that may be in question such as denied claims or claims that were not covered due to specific qualification guidelines. Assisted with creating the referral for the client and submitting or auto approving in some cases as well. Also provided assistance to providers regarding the same information, claims, benefits, and referrals to obtain coverage for specific benefits provided or to be provided. Provided assistance with claims as well for the providers who may question the amount the plan reimbursed or for benfits provided but not yet reimbursed. Also provided assistance with coding with CPT and J codes.
Education:
2003 Henry County High School
New Castle KY
High Schoo Diploma not obtained
GED obtained from the Thorn Hill Testing Center
Frankfort Ky in 2003
Most Recent Education: Jefferson Community College Associate of Applied Science in Nursing
Degree not obtained
Category Certificate obtained in: Applied Sciences, Communications, Phlebotomy, CNA and CPR. All of these were obtained while in school working towrad my RN at Jefferson Community College.
Gaps in employment can be explained due my enrollment in the nursing program. Employed by private parties that were not taxed through the federal or state governments. Some of the employers provided housing and assistance in my education as opposed to a regular hourly income.
SKILLS:
Budgeting and Finance
Team Liaison
Strong Verbal communication
Powerful negotiator
Team Leadership
Process Implementation
Risk Management processes and analysis
Staff development
Project management
Self Motivated
Conflict resolution
Extremely Organized
Time Management and Data Management
Client Assessment and analysis
Contact this candidate