Dynamic Healthcare Customer Service Specialist
Resume:
Quella Jones
Willis, TX *****
***********@*****.***
Professional Summary
Dynamic customer service specialist with 8+ years of experience in fast-paced healthcare settings. Proven expertise in managing high-volume call centers, EMR systems, and billing processes while ensuring HIPAA compliance and accurate data handling. Committed to delivering empathetic communication and exceptional client support.
Work Experience
Business Representative
Kaiser Permanente-Walnut Creek, CA
June 2022 to April 2025
• Researched and resolved Guarantor and Patient Account edits, ensuring accuracy in eligibility and billing data.
• Identified and captured non-automated charges, supporting accurate claims processing and reimbursement.
• Managed inquiries and billing requests via telephone, correspondence, and work queues, maintaining professional relationships with clients and agencies.
• Researched and resolved refund and Request for Information Tracking System (RITS) requests, ensuring timely follow-up and documentation.
• Validated co-payment discrepancies and produced co-payment history reports, supporting financial eligibility processes.
• Created bills for Pro Fee services at non-KP facilities and documented all activities in KP HealthConnect.
• Collaborated with Hospital, Clinic, Emergency Department, and Member Services personnel to resolve account issues and support patient needs.
• Made independent decisions to accomplish responsibilities, maintaining in-depth understanding of operational changes with significant financial implications. Teleservice Representative Call Center
Kaiser Permanente-Sacramento, CA
June 2019 to June 2022
• Handled high volume of calls from members requesting or canceling appointments, demonstrating strong multi-tasking and time management skills.
• Screened patients for urgent needs and transferred calls to appropriate care, ensuring prompt and compassionate service.
• Updated demographics and pertinent information to maintain accurate eligibility and records for members and families.
• Consistently met or exceeded individual performance metrics, including call quality and member satisfaction ratings.
• Maintained a positive attitude during challenging interactions, effectively de-escalating situations and supporting clients.
• Managed difficult or emotional patient situations professionally while maintaining empathy and building rapport.
Unit Assistant
Kaiser Permanente Emergency Department-Antioch, CA June 2018 to June 2019
• Processed transfers and discharges using the Admit-Discharge-Transfer (ADT) system in the electronic medical record, ensuring accurate eligibility data.
• Answered and routed internal and external calls, providing timely information to patients, families, and agencies.
• Organized transfers to skilled nursing facilities and other hospitals, coordinating with discharge coordinators and external agencies.
• Prepared discharge packets and documents, supporting patient transitions and maintaining compliance.
• Assisted unit personnel with electronic medical record systems and acted as a resource for computer- related issues.
• Acted as greeter for the unit, supporting patient and family needs and facilitating communication.
• Coordinated discharge times and communicated with family members, ensuring timely and accurate information sharing.
TeleService Representative
Kaiser Permanente-Sacramento, CA
February 2016 to June 2018
• Handled high volumes of inbound calls, providing information, scheduling, and transferring calls to appropriate care providers.
• Dictated information from members and composed messages for providers, ensuring clear communication and documentation.
• Adhered to quality procedures and maintained strict confidentiality of patient records in compliance with HIPAA.
• Utilized PARRS, Health Connect, and Mainframe systems to manage patient information and appointments.
• Maintained average monthly quality scores of 98% or better, demonstrating attention to detail and service excellence.
Patient Financial Advisor
Kaiser Permanente-Walnut Creek, CA
June 2010 to February 2016
• Contacted patients to inform them of financial responsibility and arranged or collected payments for upcoming visits or surgeries.
• Registered and organized patient information and insurances, supporting eligibility and claims processes.
• Managed insurance authorizations and reimbursement, ensuring timely and accurate processing.
• Provided consultation regarding referrals to outside agencies and screened patients for Medical Financial Assistance Program eligibility.
• Processed high volumes of MFA applications, appeals, and urgent requests for patients being discharged, supporting access to care.
• Noted all information in KP Health Connect, maintaining accurate and confidential records. Claims Billing Editor
Kaiser Permanente-Oakland, CA
November 2005 to June 2010
• Audited claims in Health Connect, Epremis, and Arbis systems, ensuring accuracy and correcting errors for timely processing.
• Processed billing claims for payment from payors and ensured reimbursement for services rendered.
• Maintained knowledge of ICD-9 and CPT codes and utilized Mainframe, CIPS, Foundation, and EPIC Health Connect systems.
• Worked high-volume claims queues for multiple lines of business, supporting eligibility and claims accuracy.
• Collaborated between professional and hospital billing to ensure claims were correct and submitted for review.
TPL Urgents Clerk PBS
Kaiser Permanente-Oakland, CA
July 2005 to November 2005
• Requested urgent documents from Local Business Offices to satisfy Quality Assurance requirements for health claims.
• Finalized Health Claim Forms for accurate billing and eligibility verification.
• Ensured all documents matched billing charges for accurate and timely claims processing.
• Followed up daily with Local Business Offices to obtain vital information and support claim completion. Program Coordinator
Safety Center Drug & Alcohol PRG-Sacramento, CA
March 2005 to June 2005
• Assisted clients with orientation and enrollment in DUI program, addressing questions and eligibility requirements.
• Recorded daily attendance and maintained accurate records as required by law.
• Managed client payments, placing financial holds when necessary to ensure compliance with program requirements.
• Communicated with courts and DMV regarding client status and program completion. Insurance Service Rep
Tri Valley Insurance Agency-Auburn, CA
January 2003 to March 2005
• Answered high volumes of calls from insureds, lien-holders, and insurance companies regarding policy coverage and eligibility verification.
• Responded promptly to information requests to prevent insurance cancellations and supported escalated calls as needed.
• Set up auto claims by taking first reports from insureds and other parties, supporting claims processing. Insurance Service Supervisor
Abraham & Assoc-Carmichael, CA
December 2001 to January 2003
• Supervised and motivated Customer Service Representatives in a fast-paced environment, ensuring high-quality service delivery.
• Resolved sensitive and complex customer service issues escalated from staff and customers.
• Secured necessary information for insurance contracts, endorsements, and extensions, supporting eligibility and compliance.
• Performed administrative, customer service, and industry-specific computer functions to support office operations.
Education
High school diploma or GED
Inland Empire Job Corps-San Bernardino, CA
April 1987 to October 1987
Skills
• Customer Service
• Call Center
• Case management
• Medical Billing
• Data Entry
• Microsoft Word
• Microsoft Excel
• Microsoft Outlook
• HIPAA
• Medical terminology
• EMR systems
• Office experience
• Data collection
• Computer skills
• Typing
Languages
• English
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