Customer Support Specialist, Overnight Shift Ready

Lisa Raymond

Wesley Chapel, FL *****

315-***-**** ************@*****.***

PROFESSIONAL SUMMARY

Well-qualified professional with a positive and friendly demeanor. Strong attention to detail, effective communication skills, and a solid history of tackling diverse and challenging requirements. Well-versed in customer service and working in a 24/7 uptime environment.

SKILLS

Call management

Data compiling

Technical assistance

Multitasking Abilities

RX Claim/ Netcard

HHA

Staff education and training

Data Entry

Customer Service Expert

Salesforce CRM

MONDAY CRM

Dependable and Responsible

WORK HISTORY

IMPLEMENTATION COORDINATOR 11/2024 to Present

Welldyne – Lakeland, FL

Coordinate project implementation activities across various teams.

Monitor project timelines, budgets, and resources.

Facilitate communication between stakeholders and team members.

Identify and resolve issues that may arise during project execution.

Prepare and present project status reports to management.

Oversee existing client changes and works collaboratively with Client Services to implement and monitor said changes

Provide Sales and Client Service support which includes direct contact with customers and/or customer representatives

Oversees implementations including accuracy of information to both the plan sponsor and to members

Facilitate interdepartmental relations and communication as it specifically relates to managed accounts including Finance, IT, Clinical, and other departments as needed

Contribute to the development of implementation SOPs, internal quality assurance and efficiency to create incredible service experience

Produce objective reporting regarding critical path items, opportunities, and overall customer standing

Apply communication principles and appropriate positioning of information to deliver to various client types

Conducts post-implementation analysis to identify areas for improvement, new process development to mitigate risks for future implementations

SCHEDULING COORDINATOR-ONCALL 3/2024 to10/2025

Gentiva Healthcare - Syracuse, NY

Provided support for 13 branches in 3 different states answering a high volume of calls after business hours.

Back filled shifts for any call offs

Maintained after hours call log

ACCOUNT MANAGER 04/2024 to 11/2024

SAV-RX- Fremont, NE

Asked appropriate open-ended questions to discover customers' needs and requirements and client intent.

Worked closely with clients to provide overall satisfaction.

Daily service of assigned accounts, which includes web-tool training, eligibility help, troubleshooting plan or member issues, report requests, and coordination with internal departments to fulfill day-to-day client needs and requests,

Assisted in plan implementation and interaction for plan updates and changes, run testing for 30 days after group live dates to track rejections and any other issues.

Assisted implementation process– including attending client implementation meetings, reviewing plan set-up, and processing member materials.

Coordinate meetings with clients

Traveled for Board of Trustee/client meetings

Rebate Report Requests

Completion of marketing materials for assigned book of business to include Welcome Letters, brochures, Clinical notices

ACCOUNT COORDINATOR 03/2023 to 4/2024

WellDyneRx - Lakeland, FL

Asked appropriate open-ended questions to discover customers' needs and requirements.

Working closely with clients to provide overall satisfaction.

Assist the Account Team in the service of assigned accounts, which includes web-tool training, eligibility help, troubleshooting plan or member issues, report requests, and coordination with internal departments to fulfill day-to-day client needs or requests,

Assist in plan implementation and interaction for plan updates and changes,

Assist the Account Team in the account implementation process– including attending client implementation meetings, reviewing plan set-up, and processing member materials.

Coordinated meetings, calls, and demos with the account management team.

PHARMACY PRIOR AUTHORIZATION COORDINATOR 1 08/2022 to 03/2023

WellDyneRx - Lakeland

Initiated Prior Authorizations, Pre-Certifications, Pre-Determinations, and Advanced Benefit Determination requests for new and existing patients.

Performed pharmacy test claims and follow-up regarding results.

Worked on the patient's behalf to identify and assess reimbursement coverage options for those with insurance and to coordinate and/or investigate financial options for those without insurance.

Worked with physician offices to facilitate obtaining prior authorization from third-party payers to maximize patients' access to treatment.

Verified eligibility and compliance with authorization requirements for service providers.

Help support the appeal process to overturn insurance denials and/or benefit exclusions when needed.

Works with Intake, Billing, and Collection teams to resolve claims issues.

Maintains confidentiality of all PHI in compliance with state and federal law.

MEMBER SERVICES III- PHARMACY HELP/OVERRIDE DESK 04/2022 to 08/2022

WellDyneRx - Lakeland, FL

Responsible for taking administrative calls from pharmacies, physicians' offices, and members, with the goal being a first-call resolution. These calls included but were not limited to refill requests too soon and vacation override requests.

Accountable for placing call notes in the appropriate areas every time a request is handled.

Worked closely with pharmacies, providers, and members to resolve any questions or issues involving PAs.

Ability to clearly identify problems, analyze situations, and rectify pharmacy, provider, or member concerns using established procedures.

Ability to handle difficult people and problems by resolving matters effectively and on time.

Provided support to pharmacies having difficulty processing claims.

Applied appropriate policies, procedures, and eligibility and benefit policies.

Maintained confidentiality of all PHI in compliance with state and federal law.

Consistently meet established productivity, schedule adherence, and quality standards while maintaining a good attendance record.

MEMBER SERVICES REPRESENTATIVE 11/2021 to 04/2022

WellDyneRx - Lakeland, FL

Responded in a prompt, professional, and courteous manner to member questions regarding the placement of an order and/or the status of an order.

Provided a basic level of customer support, referring complex issues or questions to appropriate support staff.

Used computer to access member records and process orders.

Handled difficult people and problems professionally.

Helped a large volume of customers every day with a positive attitude and focus on customer satisfaction.

Coordinated with operations staff to resolve service problems and boost client satisfaction.

INCIDENT SUPPORT SPECIALIST 09/2023 to Current

Modivcare - Liverpool, NY

•Assess incidents, conduct necessary investigations, and ensure appropriate follow-up with all local, state, and federal entities.

•Present investigative dialogue and reports to the CQI team and program leadership for discussion

•Train staff on incident reporting process, Safety principles, procedures, and protocols, including on-site and in the community, Risk prevention measures, and federal and state regulations

•Assess incidents, conduct necessary investigations, and ensure appropriate follow-up with all local, state, and federal entities.

•Present investigative dialogue and reports to the CQI team and program leadership for discussion

•Meet all deadlines required by ODP, state licensing, and federal partners related to incident reporting and notifications.

SCHEDULING COORDINATOR 11/2018 to 09/2023

All Metro Home Care - Liverpool, NY

Gathered employee data to develop monthly work schedules, enabling proper staffing for each client for each shift.

Sole scheduling of 150 caregivers for 100 clients.

Counseling caregivers on policies and procedures,

Approving vacation requests

Filling in shifts for any call-offs

Created new master weeks and filled positions for new clients.

Advise caregivers to submit timesheets when they do not correctly clock in and out and connect all EVV clock-ins and outs via the HHA dashboard.

HEALTHCARE COORDINATOR-HEAD SCHEDULER 10/2016 to 11/2018

Stafkings Healthcare Systems, Inc - Liverpool, NY

Responsible for 250 caregivers and 450 client schedules.

Completion of incident reports and SRI reports.

Verified the caregiver's flowsheets for payroll.

Entering client authorizations for aide service.

Intake of new clients.

EDUCATION

Bryant & Stratton College - Syracuse NY Associate of Applied Science

Business Management, 06/1992

CERTIFICATIONS

Registered Pharmacy Technician -Rpht114213

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