Postal Mail Service Representative
Resume:
Tamara Pelzer
Salisbury, NC
adute4@r.postjobfree.com
Willing to relocate: Anywhere
Authorized to work in the US for any employer
Work Experience
Sykes
Customer Service Agent - Sumter, SC
November 2021 to February 2022
• Service Adeptness: Comprehend and empathize with client needs, devote time and effort to satisfy the client’s request
• Problem Solving and Decision Making Skills: Ability to think analytically and effectively manage risk using strong research skills, applying best practices and leveraging past experiences to resolve problems
• Ability to handle escalated problems
• Initiative: Willingness and ability to play an active role in identifying and implementing process improvements as well as a willingness to help others Patient Recruitment
WAKE RESEARCH ASSOCIATES - Raleigh, NC
December 2018 to March 2020
Respond to calls and emails relating to specific research studies for sister sites of Wake Research Associates, LLC
• Contact participants via phone to explain research protocols, screen for eligibility, and schedule eligible participants by taking up to 50 to 80 calls and emails.
• Meet with the Clinical Research team to discuss recruitment plan and mitigate risks in study enrollment
• Weekly reports of scheduled patients for the sponsor
• Attend initiation visits with monitor and clinical research coordinator
• Maintain accurate daily tracking logs in mega and matrix for all incoming and outgoing calls and oversee the accurate data entry of all communications to the Merge database
• Attend annual health fairs to advertise approved ads for media (e.g., print ads, mailings) to recruit research participants
Appointment Scheduler
The Mair Agency - Cary, NC
October 2017 to June 2018
Handle outbound calls schedule in home consultations for our Medicare Agents. Calling customers to confirm appointments.
Follow up with online leads.
Entering data into our customer data base.
Processing lead information from the in-field sales representatives. Medical Office Administrator
Wake Spine & Pain Specialists - Garner, NC
April 2017 to October 2017
Greeted customers and visitors in-person and via telephone calls. Answered inquiries and addressed, resolved or escalated issues to management personnel to ensure client satisfaction.
Correspond with clients through email, telephone or postal mail. Audited new customer files to verify medical necessity and satisfaction of coverage criteria. Contacted patients regarding unpaid and underpaid accounts to resolve any issues. Improved timely paying of bills by developing flexible payment plans for patients. Located, checked in and pulled medical records for appointments and incomplete patient charts. Facilitated organized record retrieval and access by maintaining filing system for both in-house and discharged residents.
Schedule appointments for patients (review appointment date, time, provider, and location for accuracy). Obtain authorizations for procedures from all insurance plans and/or worker's compensation plans as needed.
Verify insurance benefits as needed utilizing online tools and phone. Check in to include collecting and posting payments, patient intake, and updating patient demographics. Check out to include scheduling procedures and follow-ups, generating receipts, patient statements, and ledgers.
Schedule appointments for patients (review appointment date, time, provider, and location for accuracy). Customer Service Representative II
CSRA - Raleigh, NC
May 2015 to April 2017
Answered an average of 55 calls per day by addressing customer inquiries, solving problems and providing new product information.
Investigated and resolved customer inquiries and complaints in a timely and empathetic manner. Managed a wide variety of customer service and administrative tasks to resolve customer issues quickly and efficiently.
Use decision support software programs such as Matrix and Pega Educate Provides that are enrollees of Medicaid portal NC Tracks on how to navigate and make changes within the NC Tracks portal.
Answer all enrollment questions on how to enroll as a provider into NC tracks to provide services for Medicaid recipients.
Maintain the timelines on enrollment/credentialing schedules, communicate with providers and other departments to update as needed, clarify carrier information requirements, and maintain a strict level of confidentiality for all matters pertaining to provider credentials Responsible for both verbal and written communication with external customers to obtain information regarding health conditions and eligibility in order to make a complete and accurate decision. Includes contacts with applicants, group leaders, providers, and provider office personnel Responsible for dispositions of re-review for Medicaid Supplemental applicants (i.e., why denied coverage). Must respond in writing, to the applicant's inquiry and request medical records for health conditions in question Go over adjustment and recoupment to previously paid claims along with denied claims Inform and educate providers on their claims and other billing invoice Ensure that all HIPAA and Government security requirements with regards to sharing and storage of Personal Health information are met at all times.
Customer Service Representative II
Florida Blue - Raleigh, NC
March 2011 to May 2016
Prepare complete and accurate work and update customer Medicare benefits plans Motivated at a high standard to achieve company set performance's goals for exceptional customer service satisfaction. Handle and settle insurance claims by evaluating the facts of a customer situation surrounding the claim, determining whether the loss is covered and what the compensation should be. Call the customers' doctors or employers for additional information if they discover that the filings are questionable. In such cases, these reps may consult legal counsel to determine the best course of action. Settlements and authorize payments, while keeping records of all actions for the customer's file Strong interpersonal communication skills, both written and verbal Education
Bachelor of Business Administration in Health Services Administration Strayer university
2018
High school diploma
Wake Technical Community College - Raleigh, NC
2015
Skills
• Customer Service
• Clinical Research
• Clinical Trials
• Recruiting
• HIPAA
• Microsoft Excel
• Accounting
• Office experience
• Medical terminology
• Documentation review
• Microsoft Access
• Computer networking
• Medical Office Experience
• Medical billing
Certifications and Licenses
CPR Certification
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