Access Center Call
Resume:
Jalissa Appleberry
*******.**********@*****.***
*** * **** ***** *******, IL 60621
WORK EXPERIENCE
Rush University Medical Center
Access Specialist October 2023 - Current
• Answers all telephone calls for three clinics and radiology modalities, with the goals of accurately scheduling patients within guidelines, taking messages utilizing templates and routing clinical inquires to appropriate RN pool, clinical or administrative pools and complete clean registration.
• Assesses the caller’s need and responds with critical judgment and ensures the appropriate resolution for the inquiry or issue. Understands when to escalate calls to nurse, and/or RUMG Access Center leadership.
• Proactively monitor areas of concern or uncertainty relating to the practices and suggest possible resolutions around access Epic build issues.
• Exhibits strong understanding of specialized RUMG Access Center processes.
• Adheres to service specialized workflows for multiple specialty departments. Follows protocols built in Epic and documented practices scheduling requirements.
• Responsible for accurately documenting appointment information and notifying the patient of information critical to their visit.
• Drives and supports the RUMG revenue cycle by minimizing potential financial risk of patient accounts through patient insurance registration activities.
• Maintains a high level of understanding and acts as a patient resource for physician and ancillary service offerings, navigating the Rush campus, payment categories, and the billing procedures of Rush University Medical Group.
• Exhibits sensitivity to patient health information and protects confidentiality.
• Works cooperatively in a team environment and supports a flexible structure to ensure the success of the RUMG Access Center.
Blue Cross Blue Shield of Illinois
Customer Advocate Specialist May 2022 - Current
• Acted as a liaison between Blue Cross Blue Shield, providers, members, and vendors of
Illinois Medicaid Affordable Care Act
• Relayed information regarding eligibility, covered services, plan information, claims and
prior authorization to members and providers.
• Answered phone calls and written questions, concerns, and complaints regarding
memberships.
• Filed complaints and grievances regarding the membership plans and health services.
• Documented all inquiries and maintains accurate membership records.
• Managed member incentives (i.e transportation services, pregnant women, rewards)
• Assessed member eligibility and processing payments, applications, and requests.
• Investigated and resolved escalated membership and payment issues.
• Reach out to our third-party vendors, providers, or partners to advocate for our
members to ensure they are receiving the treatment and services they are entitled to.
Maximus Health Care Call Center
Lead Care Coordination Representative January 2020 – May 2022
• Resolved My HR Tickets and Workday tickets benefit inquires/ time off requests
• Assisted Entry Level Call Center Representatives with calls
• Handled escalated calls
• Audited call center staff calls and provided feedback
• Hosted training refreshers and informational sessions
• Acted as a liaison between Department of Human Services Medicaid Program, managed
care organizations, venders, and the Area Agency on Aging.
Contact this candidate