Customer Service Health Care

Location:

Pittsburgh, PA

Salary:

20.00 hourly

Posted:

August 09, 2023

Contact this candidate

Resume:

Dedicated healthcare administration and customer service provider

with exceeding proficient knowledge and skills in the health insurance verification field with a strong background in the medical field obtaining EMT certification, and knowledge in the medical field having experience with learning medical benefits of alternative medications, trained in the medical assistance field, insurance verification, and inbound/outbound calls. Exceeding proficient knowledge in medical billing and coding along with insurance claims and authorizations. Proven ability to establish a rapport with patients and exceed call volume, quotas, and sales. Reliable and driven with an ability to mulit-task and prioritize projects and time management. Excellent customer service skills, experienced in short term and long-term priority projects, adaptable to changes in the work tasks and jobs. Highly knowledgeable with policy account changes and claims with insurance questions. Team player with superb problem-solving skills. Conflict resolution specialist with enthusiastic work attitude.

Computer Skills: Microsoft Office (Excel, Power Point, Outlooks, Publisher, SharePoint) Data Sheets, Citrix Receiver, NaviNet, McKesson, Adobe, CareCentral, IDX, SIR, CAPS, Five9 Phone, MARX, MyAvility, and have the typing skills of 120 Words per minute. In addition, I have MJ Database skills as well as ordering systems for patient requesting medication.

Juliet Bogle

1818 Grant Street, Apt #1

Aliquippa, PA 15001

Phone: 724-***-****

Email: **************@*****.***

Juliet Bogle

Skills:

ConnectiveRX / Benefits Investigation Specialist

September 2022 – Current

(North Fayette, PA)

Responsible for obtaining insurance benefits for the new start forms that are faxed in from health care providers to obtain patient’s pharmacy benefit information for medication Otezla. Responsible for following up if patient meets criteria to be on Otezla. Responsible for following up on ongoing prior authorization requests, placing outbound calls to providers, health care provider offices, and pharmacy benefit managers to determine patient’s coverage. Responsible for determining if a prior authorization is needed for the specialty medication to be covered. Responsible for verifying the patient’s insurance and pharmacy benefits with various insurance companies and specialty pharmacies. Responsible for investigating the patient’s insurance benefits if minimal information is provided. Responsible for faxing out verification of benefits, triaging prescriptions to specialty pharmacies, and responsible for ensuring the patient has no adverse events before faxing out verification to the patient’s health care provider. Verifying patient’s policies whether they are maximizer policies and if they are accumulator plans are one of many tasks in the Benefits Verification department. Responsible for inbound calls from HCP offices, Providers, & FRS Field Representatives. Responsible to keep up a quota of above 98% accuracy on Quality Control scores, while assisting with Data Entry, PA Support and PA Appeal follow ups. Completed over 75 Linked- In Learnings to ensure training and knowledge is kept up to date to be the best employee, and a great team player.

In the amount of time being at ConnectiveRX, joined three separate ERGS, Women Connect, C.O.R.E. and PRIDE.

- Aided in creating a new work instruction for Escalations to PSS WINN Documentation for the Otezla/Amgen Team with the assistance of Aaron Arthurs.

- Trained on CSM/Bridge Cases with Eric Goldman.

- Trained new agents on the Otezla Team on how to complete a BV case from beginning to end with BV Shadowing and answered the questions of why BV agents do what they do.

Work

Experience:

- Created templates for BV agents to use as a tool that is like the EBIF, just more condensed on a word document while BV representatives are doing calls. The created template for BV agents can be used as a quick sheet reference.

Holistic Industries / Wellness Guide

August 2020 – September 2022

(Aliquippa, PA)

Responsible for patient consultations regarding the medical cannabis they need for the ailment they are treating. Knowledgeable in the varieties of terpenes and cannabinoids for those with terminal illnesses. Responsible for cash transactions, collecting money, and giving change. Verifying patients with their medical marijuana cards and ensuring they are active. Knowledgeable with the PA Department of Health website portal to help navigate certificate fees and updates for patients. Wellness Guides can spend anywhere form 5 minutes to 50 minutes with any patient that comes into the dispensary depending upon if they know what they need. The variety of those with mental and physical disabilities ranges and learning how these patients deal with the ailments they do, its rewarding to know what we do and teach helps them. Consulting with patients of all varieties of life, has allowed one to have a view of what it’s like in the “patients shoes”. This role allowed one to obtain the knowledge of holistic medications, as well as being an advocate for people who do not have a voice. The wide range of healthcare and treating each patient as if it were your own family member, allows one to have a satisfaction of knowing a difference is being made in someone’s life.

Mortgage Connect / Title & Closing Coordinator

December 2018 – August 2020

(Moon Township, PA)

Responsible for inbound and outbound calls to borrowers in the Wells Fargo Bank Department, attending to closings occurring with refinances and going through the process of obtaining necessary signatures from borrowers, notary information, and collectively setting up the documents necessary for notaries to do the closings for the borrower. In addition, I was also involved in the process during the COVID 19 Pandemic which involved us taking inbound calls at a high rate when we were sent home to ensure accurate information and closing time information for both the borrower and the notary.

The Monaca DraftHouse / Bartender

September 2017 – January 2020

(Monaca, PA)

Obtained my RAMP certification. Responsible for cash transactions, collecting money, and giving change and counting the register and tip money at the end of the night. Responsible for opening and closing the bar, making, and serving drinks, beers, and nonalcoholic beverages. Keep the bar top and tables clean, and stock for the day shift. Very fast paced environment with many holiday parties and events bringing a lot of customers of all varieties. Shutting down the building, locking up the building and counting the register and making sure the safety of the building by locking up after cleaning the bar at the end of the night. Beaver County Rehabilitation Center/ Therapeutic Support Staff March 2014 – January 2020

(Monaca, PA)

Responsible for doing activities with children and young children with special needs as well as maintaining up to date child clearances to be able to work with these individuals. Understanding the wide range of the Autism spectrum and learning how those with disabilities can engage in the community, and helping those in the Autism Support Community.

Concordia Visiting Nurses / Insurance Verification Coordinator March 2014 – May 2018

(Baden, PA)

Verified insurance upon obtaining referrals for home care services from doctor’s offices, hospitals, skilled nursing facilities and other rehabilitation units. Answering member inbound calls regarding existing services with our agency. Data entered information into our data base system for patient scheduling. Made outbound calls to providers and insurance companies for information in regard to the deductibles, out of pockets, co insurances, authorizations, copayments, and visit limits. Had to obtain the correct billing codes for existing diagnosis for insurances to pay out claims and services. Outbound calls to patients regarding any out-of-pocket responsibility or copayment to obtain the necessary ordered therapy services. Obtained the verbal acceptance of charges. Home Health Care Facility operated 365 days a year, so the Insurance Department of four individuals rotated all holidays and weekends. Investigated claims such as workers compensation claims and auto insurance claims for patients who needed home health care therapy. Responsible for verifying existing Medicare and Medicaid patients to ensure active coverage. Maintained mandatory overtime of 2 hours each week for 2 years. Made additional calls to ensure the patient whose care we were in charge of, were aware of the nurses coming into the home and had a clear concise of their insurance and what covered services they had. Taking the extra step to help those in the elderly community or with disabilities, made a big impact in our patients choosing Concordia moving forward, as they not only loved the nursing staff, but were pleased to know if they had billing questions or issues they could call into the Insurance Verification Department to speak with one of the agents in the office who would take the time to talk them through their care.

Coventry Health Care / Enrollment Verification Specialist June 2012 – February 2014

(Coraopolis, PA)

Processed enrollment applications for Part D prescription drug coverage. Answered customer telephone calls regarding existing accounts. Made requested policy and account changes. Responded to questions and concerns about the enrollment periods and the special election periods which allowed certain patients to enroll outside of the enrollment period if they fell under the criteria of having a Special Election Reason. Counseled customers on options for service and coverage. Outbound calls to individuals with any issues regarding their applications in the enrollment department. Cross trained and provided back up for the other customer service representatives.

Mortgage Connect / Title Typist

February 2012 – May 2012

(Coraopolis, PA)

Data entered titles of house deeds and HUDS. Maintained up to date knowledge of titles submitted to the company. Excelled in exceeding daily work quota. Prompt responded to general inquiries from staff members, mail, email and fax.

JT’s Affordable Flooring / Secretary

September 2011 – January 2012

(Aliquippa, PA)

Opened and closed the office daily. Scheduled appointments for flooring purchased at the store to be installed with the customers on specific days. Ordered carpet and flooring supplies from companies. Balanced billing information. Inbound/outbound calls from customers and supplies. Made deliveries to clients. Subway / Sandwich Artist

February 2011 – August 2011

(Aliquippa, PA)

Opened and closed store. Handled money transactions, collected money, and gave change. Took orders in addition to the money transactions. Managed cleaning of the dining room and kitchen. Made sandwiches as well as keeping up to date information for regulation of food products. Trained new employees. Yankee Candle / Cashier

August 2010 – December 2010

(Monaca, PA)

Seasonal worker for the holiday. Opened and closed the store. Worked at the cash register, handled transactions, collected money and gave change in addition to counting the drawer every night. Learned the varieties of customers in the retail world. Wendy’s / Cashier, Drive Through Operator, Sandwich Artist June 2008 – June 2010

(Monaca, PA)

Took orders on the front register and in the drive through hole. Collected money and gave change and handled all transactions. Made sandwiches, cleaned the dining room and stayed with the company throughout my high school career.

Panera Bread / Cashier

February 2007 – February 2008

(Monaca, PA)

Took orders, worked the cash register and learned how to do money transactions. Collected money and gave change and counted drawer daily. Worked behind the pastry counter, organizing the display window. Ran the dining room by cleaning, brewing fresh coffee every hour, cleaning up after the guests, and cleaning the bathrooms and dining room every night. CCBC / EMT Certification

April 2017; Monaca PA

Certified in Emergency Services.

Certified in CPR as well as Fire Safety.

Lincoln Park Performing Arts / Highschool Diploma

September 2007 – June 2009

(Midland, PA)

Education:

Christina Trimble – Former Coworker

Fed Ex Package Coordinator

Zelienople, PA

Phone: 724-***-****

Alex Haas – Former Coworker