Customer Service Medical Billing
Resume:
LATISHA
SHAFER
*******.********@*****.***
Fort Worth, TX 76104
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SKILLS
Customer service
Active listening
Critical thinking
Problem resolution
Call center experience
Complaint handling
Complaint resolution
Microsoft outlook
De-escalation techniques
Product and service solutions
Shipping and logistics
CRM software
PROFESSIONAL PROFILE
Certificates: CMS Form 1500, Medicare Billing: 8371 & Form 1450, Medicare Fraud and Abuse: Prevention, HIPAA Certification, Detection & Reporting, and World of Medicine.
EDUCATION
Ultimate Medical Academy
01/2016
Associate of Science Degree: Medical Billing and Coding
Ultimate Medical Academy
01/2015
Diploma: Medical Billing and Coding
PROFESSIONAL SUMMARY
Dedicated professional with a keen understanding of upholding company values and driving profitability. Proficient in navigating intricate scenarios through a combination of product expertise, customer-centric solutions, and innovative problem-solving approaches. Meticulous attention to detail ensures thorough review processes and sustained accuracy levels. Committed to adhering to established policies, guidelines, and procedures to ensure unwavering quality standards.
WORK HISTORY
Signet Jewelers Inc. - Peer Coach/Trainer at the Customer Connection Center
10/2018 - Current
Resolve customer complaints, online order problems, merchandise repairs and general questions.
Managed store chats to facilitate transaction processing, special orders, and customer service resolutions.
Build cases for every call and store chat. When necessary escalate to proper departments or assign to other phone reps to complete or follow up.
Handle call escalations, supervisor call backs, evaluate cases and ensure that all the necessary information is included in the case before escalating it to the proper department.
Weekly launch pad audits, peer coaching sessions, assist with new hire training classes, chat team room monitoring, monitor reps schedule adherence, and ensure all phone lines have available representatives to receive different types of customer calls.
Citrix, Salesforce, Remedy WEB, Genesis, Workday, Hybris, Cisco any connect, Cloud, Genesys and Microsoft), Teams, All Microsoft Applications including Teams and Outlook,Commerce Hub, DOM, IMS, Repair 2.0, HP Credit, Solar, Business Track, SVS (OSI) (GC), Sales Audit, and Epsilon.
BroadPath Healthcare Solutions - Medicare Advantage Member Specialist
02/2018 - 08/2018
Take inbound calls from HealthNet/Allwell Medicare Advantage members with questions regarding benefits, prescriptions, premiums, claims and EOBs. I update members demographic information, locate and assign primary care physicians, process monthly premium payments as well as educating the member as much as possible so that they can utilize their plan properly and get the most out of the services as possible.
I am also a part of multiple outbound projects such as new member welcome calls, customer service recovery calls and appeals and grievance follow up calls.
I meet and exceed all expectations with an average quality assurance scores of 95% and above along with productions scores of 90% or above.
Humana - Medicare Advantage New Member Assessment Specialist
Irving, TX • 11/2017 - 02/2018
Took inbound calls from new Humana Medicare Advantage members with questions about their coverage such as coverage dates, in/out of network benefits and providers, riders, and other programs that were offered.
Placed outbound calls to new members welcoming them to Humana and to complete a brief health survey to determine which programs would benefit the member at no additional cost.
Completed all required work assignments and calls while meeting quality and production goals with scores of 90% or above.
HealthSmart Care Management Solutions - Intake Coordinator
Irving, TX • 02/2017 - 10/2017
Took inbound calls from healthcare providers, facilities and payers requesting pre-certification for inpatient and outpatient services as well as status checks on pre-determinations, appeals and quality reviews.
Completed or initiate the pre-certification process after obtaining the required information and reviewing individual group pre-certification requirements.
Assign specific pre-certification request to the proper RN for review and decision as well as setting follow up activities for other departments as needed for utilization management.
Footprint Retail Services - Merchandiser
Lisle, IL • 11/2012 - 02/2017
Complete all assigned merchandising functions accurately and within the time parameters set forth by the Project or District Manager; organize and implement merchandising plans.
Markose Eye Associates - Optical Assistant
Lewisville, TX • 12/2015 - 04/2016
Facilitate patient flow by greeting and checking in patients.
Verify insurance information and assist patients with preliminary vision tests.
Collect payments and keep accurate records.
Aegis / United Health Care - Member Service Agent
Irving, TX • 06/2013 - 10/2014
Received calls from United Health Care Medicare Advantage Plan members who had questions regarding coverage, benefits and claims.
Researched unpaid benefit claims and assisted the members with the information and actions needed to correct denied or unpaid claims.
AWARDS
Academic Honors Recognition / Honor Roll.
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