EXPERIENCED PROFESSIONAL

Self-motivated individual who offers a strong background in providing client/customer service support. Ability to set work priorities and complete work promptly and accurately with little or no supervision. Communicate effectively, both verbally and written. Goal oriented individual who is recognized as a team player, decision maker and problem solving.

AREAS OF EXPERTISE

Communicate and coordinate work with others.

Ability to meet deadlines in a timely matter.

Proficient in MS Office Suite – Word, Excel & PowerPoint

Outlook – Teams – Skype for Business

Excellent at Customer/Provider Service

Call Center, Office setting and Remote

Allscript / Epic / Forte

Mednet

Mitel (phone system)

PROFESSIONAL EXPERIENCE

Dec. 2020 – current Logistic Health Inc.– Events Operation

Wipro (LHI / OptumServe) – Remote

1.Vendor Appeal Processor

Respond timely to written appeals from Vendors.

Review and complete payment corrections and conducts payment error research.

Identify root cause denial trends, communicate trends with team and prepare appropriate appeals as required.

Review appeals based on the states guideline, specialty and fee schedule while resolving appeal as applicable, adhering to Company policies and regulatory requirements.

2.One Coordinator / MyTurn Clinic coordinator

Use information given to set-up clinics for Covid Vaccine shots / Testing clinics.

July 2020 – Nov. 2020 Customer Service / Provider Service Representative (Contract)

Ultimate Staffing (Luminer) – Remote

Took calls from Medicare members and Providers regarding coverage and benefits.

Helped Members understand their benefits.

Assist Medicare plan members in accessing providers or facilities within their network.

Managed a large number of inbound calls.

Handled complaints, provided appropriate solutions and alternative within a timely matter.

Aug. 2019 – May. 2020 Car Shield, St. Peters, MO.

Pre-Sales / Screening Representative (CSR)

I reconnect with existing leads to qualify potential customers, gather key information. I maintain a consistently positive attitude and deliver stellar service to all customers while maintaining current knowledge of products and services offered.

Sept. 2017- April 2019 Ciox Health, Saint Ann, MO.

Client Service Representative (CRS)

I am responsible for the processing of release of information (ROI) specifically medical record requests for onsite patient, lawyer, family members etc. I validate requests and authorizations for release of medical information according to established procedures and HIPAA guidelines.

May 2016- Oct. 2017 Express Protect, St. Louis, MO.

Customer Service Representative (CSR)

I’m the first point of contact with customers interested in continuing their Mechanical Protector Plan/ Warranty on their vehicle.

Dec. 2015- May 2016 The Pisa Group, Crestwood, MO.

Telemarketing Service Representative (TSR)

I take and process subscriber’s calls and provide excellent customer service for areas such as service failures, payment processing, general account maintenance, upgrading service option, and retaining subscribers.

Oct. 2015- May 2016 GSI Investment/DBA Posh Limousine Services, University City, MO.

Oct. 2013- Dec. 2014

Administrative Assistance

Overseeing the day to day running of the business which included but not limited to answering the phone, greeting visitors, filing, setting appointments, scheduling/booking reservations and driving when needed.

Apr. 2009- Aug. 2013 Magellan Health Service, Earth City, MO.

Member Correspondence Specialist (Promoted March 2011 to Aug. 2013)

Customized correspondence according to state regulatory requirements and contractual requirements; coordinated legal approval. Provided education and explain the use of appropriate correspondence for each NIA client on the Magellan CorPub or NIA letter systems. Reviewed NIA client requests for modifications to the correspondence. Developed and maintained correspondence templates that met the minimum standards for NCQA, AAHC/URAC, ERISA and Magellan/ NIA Policy in regards to authorization, non-authorization, extension, and appeal letters. In coordination with the compliance team, assisted in researching state regulatory requirements for correspondence. Assisted with NIA UR license renewal, with a focus on correspondence requirement. Assisted with monitoring, creating, and implementing best practices related to the timely and consistent generation of member correspondence.

Customer Care Advocate II (Apr.2009 to March 2011)

Contacted referring physician’s offices, members and imaging providers via telephone in order to communicate authorization approvals. Contacted referring physician’s offices via telephone in order to communicate denied authorizations due to lack of health plan eligibility. Verified all member information for accuracy. Triaged and directed cases and/or calls requiring additional action to the appropriate department for follow up. Participated in Utilization Management and Quality Management programs as directed. Perform special assignments as directed.

Education

East St. Louis Senior High - 9/1979 – 6/1982 Diploma received

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