Customer Service Data Entry

Monique Griffin

************@*****.*** 813-***-**** Tampa, FL

SUMMARY

Experienced customer service professional with 14 years of expertise in high-volume call center environments, seeking a Call Center Agent role. Proven track record in managing inbound and outbound communications, resolving escalations, and ensuring customer satisfaction. Skilled in data entry, CRM systems, and maintaining compliance with industry regulations.

WORK EXPERIENCE

UnitedHealth Group

Customer Service Rep/ scheduler Dec 2024 - Jan 2025

• Assisted colleagues and supervisors with resolving and documenting patient issues through effective management of daily paperwork.

• Identified financial, medical, and legal risks during customer interactions and adhered to appropriate procedures.

• Utilized internal systems to address customer inquiries related to appointments, authorizations, claims, invoices, eligibility, benefits, appeals, and TARs.

• Converted verbal information into clear and accurate written documentation following established guidelines.

• Guided new or potential members in selecting a primary care provider and provided general information about the medical group.

• Coordinated with clinicians and supported Telehealth Nurses, including arranging durable medical equipment, transportation, and home health services.

• Entered primary care provider changes into the system to ensure accurate and up-to-date records. Pyx Health

Remote Outreach Coordinator Contractor Oct 2024 - Dec 2024

• Conducted daily outreach calls to eligible members, informing them about program benefits and securing enrollments.

• Responded to inbound calls from various stakeholders, providing courteous and prompt service.

• Interacted with a diverse patient base, including Medicaid and Medicare members.

• Recorded member demographics and healthcare data accurately in their respective records.

• Utilized approved communication scripts to clarify terms, address concerns, and engage members effectively.

• Reported member feedback and escalations to leadership in compliance with company policies and procedures. Remx

Remote Customer Service Representative May 2024 - Sep 2024

• Delivered high-quality customer service by processing prescription refills and coordinating shipment schedules to meet the needs of patients, doctors, and healthcare providers.

• Resolved inquiries and issues in compliance with company policies and protocols.

• Handled insurance claim processing with attention to detail and accuracy.

• Entered and updated doctor prescription information into the healthcare database.

• Conducted 30-50 daily outbound calls to maintain customer relations and fulfill service requirements using Salesforce and Five9 systems.

• Maintained accurate records through diligent data entry and log management.

• Case Management

• Escalation Handling

Elevance Health Tampa, FL

HEDIS Service Associate II Dec 2023 - May 2024

• Conducted comprehensive medical chart reviews for accurate data extraction and entry into specific database systems.

• Coordinated patient list distribution and managed onsite appointment scheduling with healthcare providers, ensuring timely follow-up communications.

• Addressed and resolved vendor pends through detailed claims investigations, effectively maintaining member data in Excel within project timelines.

• Executed both inbound and outbound calls to healthcare providers to update and maintain accurate provider information.

• Served as a subject matter expert in data analysis, compiling reports, formulating recommendations, and guiding team members and stakeholders.

• Provided essential administrative and telephonic support to a departmental data collection initiative, adapting to a high-pressure environment to meet critical deadlines.

• Assisted data abstractors with in-depth research utilizing the company's claims and medical records systems to identify member care locations.

• Ensured compliance with data management protocols and contributed to the overall efficiency and accuracy of the data collection process.

• Data Collection

• Compliance Monitoring

• CRM (Customer Relationship Management)

Wellcare/Centene Florida Tampa, FL

Escalation Response Specialist Nov 2019 - Jan 2024

• Ensured adherence to HIPAA and regulatory standards in managing Medicare complaints and enrollment processes.

• Enhanced medical claims efficiency through proactive handling of customer inquiries via inbound and outbound communications.

• Documented interactions and managed written customer communications, meeting company quality and performance benchmarks.

• Facilitated improved customer satisfaction by assisting with transportation services and website navigation.

• Provided resolution to complaints and escalations, delivering feedback to improve member/provider issue management.

• Achieved timely and professional tracking and resolution of all assigned complaints and inquiries.

• Collaborated with contact center team to assess and investigate escalated inquiries, ensuring valid complaint resolution.

• Sustained comprehensive knowledge of products and services to deliver effective customer support.

• Processed orders for durable medical equipment, adhering to customer needs and specifications.

• Leveraged knowledge of Medicare Parts A, B, C, and D to optimize service delivery and customer experience.

• CRM (Customer Relationship Management)

• Escalation Handling

• Compliance Monitoring

• Process Improvement

Beacon Health Options Tampa, FL

Member Service Representative Feb 2019 - Nov 2019

• Addressed high-volume inbound calls, delivering accurate claims and eligibility information to healthcare providers.

• Managed Medicare-related inquiries effectively, facilitating efficient access to essential information via the provider portal.

• Handled enrollment inquiries, ensuring timely and accurate processing for members.

• Maintained provider information, updating records to reflect current data for service optimization.

• Consistently managed 50-100 daily inbound calls, ensuring quality support and service continuity. The Axiom Group

Customer Service Representative Jan 2018 - Feb 2019

• Addressed and resolved customer inquiries through effective inbound and outbound communication, providing precise Homeowners Association (HOA) billing information.

• Assisted the accounting manager in maintaining ledger records and successfully collected on overdue HOA accounts, enhancing financial accuracy and tracking.

• collect overdue collection balances

• process billing payments

Foresight Medical Tampa, FL

Intake Coordinator Apr 2017 - Sep 2017

• Processed insurance claims accurately, including data entry for UB-04 and HCFA 1500 forms.

• Collaborated with collections departments to reconcile implant claims and communicated with hospitals for surgery information.

• Conducted outbound calls to hospitals and medical facilities to collect patient claim information. Health Integrated, Inc Tampa, FL

Intake Specialist Jun 2016 - Mar 2017

• Facilitated medical authorizations and coordinated inpatient admissions in compliance with Medicaid billing standards.

• Managed account communications, addressing physician inquiries and followed up on overdue accounts for payment updates.

Isais Healthcare Tampa, FL

Intake Specialist Oct 2015 - May 2016

• Coordinated medical authorizations and supported nursing staff to enhance patient service efficiency.

• Managed medical billing, coding, and claims for Durable Medical Equipment and Home Healthcare, ensuring compliance with HIPAA regulations.

Mymatrixx Pharmacy Solutions Tampa, FL

Pharmacy Services Rep Sep 2011 - Oct 2015

• Managed insurance and workers' compensation claims with a focus on accuracy and adherence to compliance standards.

• Resolved customer and healthcare provider inquiries, maintaining clear communication and high satisfaction levels.

• Improved operational workflows by executing data entry and medication processing, elevating pharmacy billing service quality.

EDUCATION

Stepping Stones High School

High school Diploma

Tampa, FL

CERTIFICATIONS

Pharmacy Technician

SKILLS

Billing (3 Years) • Medicaid (1 Year) • Pharmacy (7 Years) • Customer Service • Call Center • Customer Care • Guest Services • Customer Relationship Management • Relationship Management • Icd-10 • Insurance Verification

• Pharmacy Technician Experience • EMR Systems • Workers' Compensation • Hipaa • Microsoft Excel • Windows

• Microsoft Office • Computer Skills • Typing • Communication Skills • Medical Sales • Accounts Receivable • Live Chat • Organizational Skills • Data entry • Zendesk • IT help desk • Help desk support • Scheduling • Hedis support

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