Customer Service Continuous Improvement

Darline Marcelle Washington, CPC, CCHW

904-***-**** Mobile

**********@*****.***

Professional Profile

Customer Service and Claims Operations with over 10 years’ experience in the insurance and healthcare industries. Quick study, conscientious, dedicated and dependable. Excellent oral and written communications skills. Active listening skill; Ability to proactively, research and resolve problems.

Florida Blue 06/2019--Present Quality Associate

Analyzes agent/consultant compliance and sales behaviors through the review of quality scorecards of the channels within Commercial Direct Sales.

Provide regular summary reports of information as needed to support business decisions and continuous improvement. Conducts audits/completes audit form

Research guidelines to determine if an action is in compliance.

Performs quality testing calls to new agents before graduation.

Florida Blue ( Spectraforce) Contractor 06/2018-6/2019 Wellness Concierge

Drive meaningful conversations that result in client-centered engagement practices to schedule the preventive screening. Self-motivated team player with multitasking skills.

Provide support and case management to 170 plus Florida Blue Medicare Providers

Communicate with Providers via phone, fax and email to ensure Medicare members care gaps are filled, and email weekly reports to point of contact to identify Medicare members who have specific care needs/gaps.

Assist Providers in improving their Hedis rating with CMS/Florida Blue and follow up with Providers to address concerns/challenges with member compliance.

Baptist Primary Care-Reedy Branch 03/2014-9/2017 Referral Coordinator:

Provides referral assistance to physicians, patients, and insurance companies.

Schedule appointments, obtain authorizations, and collect patient responsibilities at the time of scheduling.

Provides business services for patients and the healthcare system.

Complete patient registration prior to scheduled appointment also post charges, and payments and assisting patients as needed.

MCCI Medical Group 12/2011-07/2013 Travel Referral Coordinator:

Process referral requests for the varies MCCI primary care centers in the Jacksonville/Callahan area for all providers practicing within the clinic module and ensuring that when the needed referral/precertification/authorization numbers are obtained for specialty visit and outpatient, and inpatient services.

Schedule routine and follow up appointments for patients; Update patients demographics & insurance prior to appointment, and schedule procedures for surgeries or any services requested; Medical coded physician visits; labs as needed or requested.

Education

Certified Community Health Worker Florida Board of Certification

Health Insurance License 240 Florida Department of Financial Services

Certified Professional Coder American Academy of Professional Coder

Certified Medical Assistant Florida College of Medical Careers Jacksonville

Certified Home Health Aide Florida Community of College of Jacksonville

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