Customer Service Representative
Resume:
Kelley A. Akimoto Knaggs
Mesa, AZ
******.******@*****.***
Summary:
Highly skilled and results-oriented professional with a proven track record in customer service and healthcare administration. Committed to providing exceptional support, ensuring customer satisfaction, and improving operational efficiency. Skilled in managing high-volume inbound calls and resolving complex issues, and multitasking in fast-paced environments. Strong attention to detail, adaptability to new technologies, and commitment to maintaining patient confidentiality and privacy. Committed to delivering comprehensive solutions and contributing to organizational success.
Professional Experience:
CSR Navigator
TriWest Healthcare Alliance
Phoenix, AZ(remote) 2024-present
- Provides subject matter expertise (SME) by correctly answering telephonic, electronic and chat inquiries regarding operational processes and complex customer service inquiries.
- Develops and maintains TRICARE benefit knowledge, processes and procedures. Attends and masters applicable training.
- Handles escalated inquiries from staff and other departments ensuring a quick and accurate resolution to maintain internal and external customer satisfaction.
- Connects with other department designated SMEs as needed to ensure first call resolution.
- During times of excessive inbound call volumes and/or task inventory, takes inbound or makes outbound calls depending on call volume needs.
- Takes direct inbound calls from specialized populations such as BEPP, BCAC, DCAO, MMSO, DHA to resolve caller concerns or questions.
- Tracks and analyzes escalation patterns to identify common issues, knowledge gaps, or process inefficiencies, sharing findings with management to drive improvements in training, policies and workflows.
- Partners with the Training, Knowledge Management, as well as other departments to resolve the identified knowledge gaps by supporting leaders with tools and information to resolve concerns.
- Maintains updated knowledge of software applications, on-line systems, Customer Service Representative procedures and processes.
- Assists Customer Service Representative leaders in tracking learning opportunities and Navigator Support Desk utilization.
- Supports the leadership teams through data and program knowledge. Coaches to correct responses but does not performance coach/lead.
- Documents all communications involving customer contacts.
- Coordinates complete resolution of service issues by interfacing with the TriWest Complaints & Grievance Specialists, Military and Veteran’s Services (MVS), and DHA, other departments when requested.
- Consistently contributes to the achievement of department productivity and performance metrics.
Provider Claims Representative
TriWest Healthcare Alliance
Phoenix, AZ (remote) 2023-2024
- Manage high-volume inbound calls from Providers regarding Veterans Insurance Claims as part of the Community Care Network (CCN).
- Deliver outstanding customer service within the fast-paced Community Care Network (CCN) contact center, ensuring exceptional care for Veterans.
- Expertly handle inbound calls related to authorizations for medical and behavioral health care, provider status and availability, and claims payment and status.
- Provide accurate assessment of caller requests, ensuring first-call resolution or appropriate escalation.
- Conduct account research and review to resolve administrative eligibility discrepancies.
- Address inquiries pertaining to authorization status, covered services, provider information, claims status, appeals, reauthorizations, and other critical topics related to Veteran care. Medical Census/Eligibility Verifications Specialist Behavioral Health Solutions
Tempe, Arizona 2022-2022
- Utilized advanced Medical Records Databases to determine psychiatric and therapy patient counts within skilled nursing facilities.
- Efficiently validated and entered patient information and insurance coverage into the system.
- Conducted thorough insurance eligibility verifications and maintained comprehensive documentation.
- Collaborated with physician offices and insurance companies to obtain necessary documentation for prior authorizations.
- Ensured seamless coordination and reimbursement of benefits by contacting relevant insurance carriers per patient.
- Worked closely with the billing team to address eligibility-related denials. Registration Specialist I
Carvana
Tempe, Arizona 2021-2022
- Conducted electronic document review, ensuring adherence to state-specific guidelines.
- Processed, signed, and submitted title applications, maintaining strict compliance with state regulations.
- Collaborated with statewide DMV offices, managing paperwork filing and documentation.
- Updated customer records promptly, ensuring accuracy and accessibility of information.
- Provided exceptional support to Customer Advocates and HUB employees, facilitating efficient customer follow-up.
Patient Service Rep-ER Registration
St. Alphonsus Medical Center
Nampa, Idaho 2014-2015
- Conducted thorough insurance verification, expediting patient care and billing processes.
- Expertly explained hospital regulations to new and returning patients, ensuring a positive experience.
- Accurately obtained and updated patient demographics and insurance information.
- Processed payment transactions and managed accounts receivable effectively.
- Handled multi-line phone systems, fax machines, copy machines, and credit card machines.
- Assisted patients in navigating state-funded insurance applications and alternative payment options.
- Adhered to strict HIPAA guidelines, ensuring the confidentiality of patient information. Clinical Administrative Assistant
Hospice of Santa Cruz County
Scotts Valley, California 2011-2013
- Provided comprehensive administrative support to patient care staff, optimizing operational efficiency.
- Expertly triaged and handled patient care-related phone calls, demonstrating strong communication skills.
- Organized and managed critical documentation flow related to patient care, admissions, discharges, transfers, and Medicare recertification.
- Collaborated with vendors, ensuring seamless coordination of services (DME, pharmacy, etc.).
- Maintained strict compliance with HIPAA guidelines, safeguarding patient privacy. Patient Service Rep-Emergency Room
Dignity Health Mercy Gilbert Medical Center
Gilbert, Arizona 2010-2011
- Demonstrated expertise in insurance verification, expediting patient admissions and billing processes.
- Effectively communicated hospital regulations to new and returning patients, fostering a supportive environment.
- Accurately obtained and updated patient demographics and insurance information.
- Managed payment transactions and maintained accounts receivable.
- Handled multi-line phone systems, fax machines, copy machines, and credit card machines.
- Assisted patients with state-funded insurance applications and alternative payment options.
- Ensured adherence to HIPAA guidelines, protecting patient confidentiality. Patient Access Rep-Urgent Care
Phoenix Children's Hospital
Glendale, Arizona 2009-2010
- Provided detailed explanations of hospital regulations to new and returning patients.
- Accurately obtained and updated patient demographics and insurance information.
- Efficiently managed multi-line phone systems, fax machines, copy machines, and credit card machines.
- Maintained strict compliance with HIPAA guidelines, ensuring the confidentiality of patient data. Patient Financial Services Rep-Emergency Room
Banner Baywood Medical Center
Mesa, Arizona 2007-2008
- Conducted thorough insurance verification, streamlining patient admissions and billing processes.
- Effectively explained hospital regulations to new and returning patients, ensuring a positive experience.
- Accurately obtained and updated patient demographics and insurance information.
- Processed payment transactions and managed accounts receivable efficiently.
- Handled multi-line phone systems, fax machines, copy machines, and credit card machines.
- Assisted patients in navigating state-funded insurance applications and alternative payment options.
- Complied with HIPAA guidelines, ensuring the confidentiality of patient information. Patient Services Rep-IP/OP Admitting
Dignity Health Dominican Hospital
Santa Cruz, California 2003-2006
- Compiled data for occupancy and census records, providing critical insights for hospital operations.
- Expertly explained hospital regulations to new and returning patients, fostering a welcoming environment.
- Maintained and set up new patient charts, ensuring accurate and up-to-date information.
- Performed Bed Control duties, optimizing patient flow within the facility.
- Obtained and updated patient demographics and insurance information with great attention to detail.
- Pre-registered and registered patients for surgical and outpatient procedures, facilitating a smooth admission process.
- Conducted payment transactions and managed accounts receivable.
- Handled multi-line phone systems, fax machines, and copy machines.
- Ensured compliance with HIPAA guidelines, safeguarding patient privacy. Education:
Cabrillo Community College
Comp Sci, G.E. 1995-1998, 2011-2012
Rio Salado Community College
Medical Terminology, Fundamentals in Health Care Delivery 2009-2010 American Public University System
Public Health 2013-2015
Skills:
Exceptional customer service and communication skills. Strong problem-solving and analytical abilities.
Detail-oriented with a focus on accuracy and data integrity. Proficient in PC, MS Office, Outlook, and various healthcare systems such as AMPFM, Misys, Allscripts, and Athena.
Ability to adapt quickly to new technologies and software. Knowledge of HIPAA guidelines and commitment to maintaining patient confidentiality.
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