Service Representative Provider
Resume:
Evella Levine
N&E Carpentry Service ****-****
Columbus, OH 43232
*************@*****.***
Authorized to work in the US for any employer
Work Experience
Provider Service Representative II
Quantum Health-Dublin, OH
October 2024 to March 2025
• Resolve inquiries efficiently by handling inbound/outbound calls and addressing concerns in a timely manner.
• Show empathy and support to members during difficult healthcare situations.
• Provide clear guidance on healthcare plans, billing, and provider options.
• Advocate for members by coordinating with providers and insurers to remove barriers to care.
• Work collaboratively with internal teams to ensure accurate and seamless service.
• Meet performance goals while continuously learning and developing expertise in healthcare navigation.
• All other duties as assigned.
Provider Service Representative
HealthCare Support Staffing-Columbus, OH
January 2023 to February 2024
Day to Day Duties:
• Answered incoming healthcare contact center calls and route appropriately to clinical staff
• Gathered and verified demographic information and document calls using standard computer software and systems
• Use tools and apply problem-solving skills to identify immediate caller needs, including potential crisis calls; escalate crisis calls according to standard operating procedures
• Used verbal communication strategies to effectively elicit information, gain confidence from caller and provide reassurance
• Answered inbound calls and made outbound calls according to department policies and procedures
• Used active listening skills and interviewing techniques to accurately identify caller’s presenting concerns
• Identified and employ alternative approaches to communicate with callers when encountering barriers Provider Service Representative
Reveleer-New Albany, OH
February 2022 to November 2022
• Met or exceeded individual production targets as defined by management (e.g. number of charts reviewed per day, etc.)
• Met or exceeded quality standards as defined by management (e.g. % charts kicked back, etc.)
• Performed job requirements according to defined standards
• Worked collaboratively with others on the Intake team as well as other teams within HDVI
• Actin a professional manner when faced with difficult situations
• Prioritized processing of the records in a timely manner based on the various business needs and worked well under pressure
• Demonstrated flexibility regarding changes in daily routine, and work shift
• Worked independently and follow through on assignments with minimal direction
• Reviewed scanned documents to ensure the documents were legible in the system
• Compared scanned documents against the provided information within MRCS system to ensure documents to be correct medical records
• Discussed mis-scanned and mis-indexed documents with the scanning and indexing staff to ensure the documents are appropriately re-scanned/re-indexed
• Identified opportunities to improve processes and standards
• Expert organizational skills, have strong attention to detail, and work well under pressure.
• Communicated effectively with provider offices, clients and internal resources
• Accurately downloaded attach records within MRC
• Maintained proficiency with all imaging procedures and records processes
• Performed quality assurance tasks on any media based records processes
• Recorded quality assurance results
• Performed effectively under conditions of a fluctuating workload and prioritize record processing in a timely manner based on the various business needs
• Entered and updated daily time management and goals information Competencies
• Possessed excellent organizational and follow up skills, with a strong attention to detail
• Possessed and demonstrated skills necessary to analyze information, problems, procedures and situations
• Used of decisive, good judgment to make thoughtful decisions in a timely and confident manner
• Maintained a professional presence that creates a positive impression and demonstrates self- confidence.
• Self-motivated with ability to handle, organize and prioritize multiple tasks and able to perform under pressure to meet deadlines.
• Familiarity with HIPAA regulations
• Understanding of medical terminology
• Documented management experience
• Scheduling experience
• Customer Service Experience
• High school graduate
• Computer knowledge - including MS Office suite (Excel, Power Point, Word, etc.)
• Communicate clearly and effectively
Customer Service Representative's
Contact Us Inc Communications-Hilliard, OH
April 2016 to September 2017
Received incoming escalated calls from new hires regarding health insurance coverage and concerns, assisted with training new employees, prepared training documents for new staff, recorded and documented all calls, completed Q/A's for department staff, assisted with over flow calls, received process insurance payments, reported suspicious fraud cases when warranted, and other duties as assigned. Delivery Driver
Boston Market-Columbus, OH
October 2013 to April 2016
Responsibilities included Delivery and meal set up for the catering division. Assisted with placing and serving orders, kitchen and lobby clean, other duties as assigned. Customer Service.
Project Manager
One Stop Facility Maintenance-Gahanna, OH
July 2011 to November 2012
Responsibilities included but not limited to, answered incoming calls in a prompt and courteous manner. Gave quotations, pricing, and other required information that may be needed. Negotiated rates with Commercial vendors and contractors according to policy and procedures for subcontracts and commercial bids. Scheduled service calls with managers on duty. Followed up with technicians and customers for job status and completion. Contacted and requested missing information and or required documentation from potential subcontractors. Scanned, emailed, and faxed, all completed contracts to corporate office. Resolved and responded to all customers inquires and complaints. Processed vendor payments. Trained and managed new staff. Documented and maintained records of all Sales and Profits from marketing team, and completed other duties as assigned.
Admissions Assistant
Bradford School-Columbus, OH
September 2010 to May 2011
Made outbound calls to high school seniors for college tour with admissions representatives. Maintained written documentation regarding the admissions process. Assisted and accepted payments for new students enrollees. Answered incoming calls pertaining to school policy and new enrollee procedures Other duties as assigned..
Senior Customer Service Representative
Nationwide Insurance/ Palmetto Government Benefits Administration-Columbus, OH April 1998 to July 2005
Provided effective and efficient customer service receiving inbound calls from Providers and Beneficiaries concerning the Medicare Part A, B, and D programs according to CMS/HCFA rules and regulations. Provided eligibility determinations, claims and review processing procedures in a courteous manner. Alert to and identify fraud, overpayments and abuses even when the beneficiary or provider did not realize it or articulate it as such. Made outbound calls to educate provider's regarding denied claims. Developed and maintained a thorough knowledge of Medicare
Part A, B, D, secondary and other supplemental insurance practices. Trained and managed new staff, performed other duties as assigned.
Telemarketing Sales Representative
J-Barr Co-Columbus, OH
April 1994 to April 1998
Responsibilities included but not limited to, made outbound calls to homeowners to schedule appointments for sales team to provide information regarding company products and services. Provided information on their loan processes. Documented and Maintained a thorough Knowledge of government and other financial institutions loan process. Worked close with various banks and finance companies for loan approvals as well as prepared documentation for final loan closings. Collaborated with wholesalers and sales agents regarding material cost and job completion date.. Made outgoing calls to potential customers for sales team. Performed other duties as assigned. CSR - Customer Service Representative
Safelite Auto Glass Repair-Dublin, OH
January 1997 to December 1997
Dublin, OH - January 1997 to December 1997
Received Inbound calls from customers, insurance claim reps and technicians for all vehicle glass issues and concerns, while providing consistency, accuracy and completeness in development. Used light sale techniques for new business.
• Used professional communication etiquette and listening skills to answer a variety of inbound sales calls, effectively and compassionately guiding customers and scheduling appointments.
• Communicated appropriately in both a scripted and non-scripted environment, with the ability to have an impromptu and authentic conversation that builds rapport by focusing on each customer's specific needs.
• Provided solutions to resolve customer complaints and concerns over the course of the call (applying persuasion techniques to influence as appropriate) -- always presenting the most accurate product and service information.
• Maintained a professional composure when actively asking customers for the sale or negotiating the price.
• Entered data into the system in real time, editing for accuracy during the call. Other duties as assigned. Provider Service Rep
Education
Diploma
South High School-Columbus, OH
January 1991 to December 1991
Skills
• Customer support experience within manufacturing industry
• Time management
• Microsoft Office
• Internal employee customer service
• Customer support experience within telecommunications industry
• Communication skills (10+ years)
• Salesforce
• Partner customer support
• Phone customer support
• Knowledge of Federal Medicare Part B / A and other Private Healthcare Benefits Administration Practice and Procedures (10+ years)
• Pivot tables
• Microsoft Teams
• Customer support experience within healthcare industry
• Handling customer exchanges
• Management
• Customer support experience within government industry
• Sales
• Account management
• Microsoft Word
• Large enterprise client interaction
• Medical Terminology (10+ years)
• Retail sales
• Zendesk Sell
• Knowledge of Ohio State Medicaid Practice and Procedures (10+ years)
• Customer support experience within finance industry
• International customer service experience
• Order processing
• Customer service
• Data entry
• Sr. Facilities Maintenance CSR (10+ years)
• Contract Negotiation (10+ years)
• Live Chat (8 years)
• Claim's Billing and Process Procedures (10+ years)
• Microsoft Outlook (10+ years)
• Tax Preparation (10+ years)
• File's and Document Control Management (10+ years)
• Auto Glass Techniques and Installation (1 year)
• Slack
• Small business owner customer support experience
• ServiceNow
• Google Workspace
• Providing product information
• Call center agent experience
• Government agency customer support
• Phone call management
• Leadership (5 years)
• Managing teams in a customer support role - Largest customer support team managed (6-10 team members)
• Customer training
• Customer service video conferencing
• Customer support - Customer support experience (More than 20 years)
• Telemarketing (7 years)
• Phone etiquette
• Improving customer support response time - Customer support response time improved (1-5%)
• Live chat
• English
• In-person customer service
• Customer support experience within education industry
• Customer returns handling
• Non-technical user support
• Customer support specialist experience
• Billing issue inquiries
• Project Facilities Maintenance Management (3 years)
• Search engines
• Order inquiry handling
• Teaching
• Office Management (10+ years)
• Customer service manager experience
• Email customer support
• Individual consumer customer service
• Microsoft Dynamics 365
• Customer support experience within retail industry
• Customer issue escalation
• Customer support experience within hospitality industry
• SMS customer support
• Managing customer accounts
• Marketing
• Home Improvement/Carpentry Sales and Operations Practice and Procedures (10+ years)
• Typing
• Customer Service Representative (10+ years)
• HIPAA Privacy Rules and Regulations (10+ years)
• Customer support experience within non-profit industry
• Quality Assurance Practice and Procedures (10+ years)
• Health Care Medical Terminology (10+ years)
• Windows
• Knowledge and Navigation of multiple CRM Software and Applications (10+ years) Certifications and Licenses
Driver's License
Certified Scrum Master
BLS Certification
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