Remote Support Assistant with Strong Customer Service Skills

Houston, TX ***** 832-***-**** ****.********@*****.***

.

GAIL HOUSE

PROFESSIONAL SUMMARY

Experienced and reliable customer service representative with extensive experience helping in Managed Healthcare environment. Strong dedication to help providers and clients resolve issues and cultivate a positive image of the company. Excel in both team environments and alone. Proven ability to listen attentively, solve problems quickly and efficiently, and create high-quality professional relationships with providers and clients. Core competencies include Data Management, billing, research, problem resolution, Microsoft Office/Excel, contracts, team support / Ad-Hoc, planning & organizing, high-level administrative, payroll, sales/new business.

SKILLS

Customer service

Data entry

Decision-making

MS office

Discretion and confidentiality

Problem-Solving Collaboration Microsoft Excel HIPAA

Compliance Customer & Provider Relations Support

Communication Organizational Abilities

Team Player

Reimbursement & Denial Management

Team Leadership

WORK HISTORY

MEDICAL BILL COORDINATOR 09/2019 to Current

Sedgwick, LLC

Gather comprehensive documentation from varied internal and external sources relevant to issue raised in grievance/appeals.

Process correspondence to appealing party, timely and in accordance with federal/state regulations and established policies for all lines of business.

Provide superior customer service to internal staff, members, and providers in answering inquiries, gathering complaint information, or providing education.

Effectively use critical thinking to investigate and correctly categorize cases and determine a course of review action and parties to contact.

Effectively completed data entry for tracking and reporting of claim disputes.

Communicated resolution to appropriate parties.

Increased customer satisfaction by resolving grievance/appeals. Lowering grievance/appeal ratio to 40% within the first quarter.

Use company troubleshooting resolution tree to evaluate technical problems while leveraging personal expertise to find appropriate solutions.

Train new hires and transition team members across multiple business units as needed to promote cross collaboration and skill sets.

DATA MANAGEMENT 05/2012 to 09/2019

Rockport Healthcare Group

Verified and corrected discrepancies in provider data, improving data accuracy by 50% within the first quarter.

Entered PPO provider contracts into Access 97 system with an accuracy rate of 95.9%.

Effectively handled urgent data entry requests, ensuring a turnaround time of under 24 hours for high-priority tasks.

Executed data entry tasks 22% faster than team average.

Adapted to new technology tools as needed for efficient data management or presentation purposes.

Enhanced database efficiency by streamlining data management processes and implementing automation tools.

Streamlined data management processes for increased efficiency and reduced errors.

Ensured compliance with industry regulations and internal policies, rigorously auditing data management procedures.

Supported the development of a standardized data management policy, promoting consistency across all departments.

STAFFING SUPERVISOR 03/2014 to 09/2017

Arch Staffing, Houston, TX

Supervised staffing processes, ensuring alignment with company policies and operational needs.

Developed and implemented training programs for new staff, enhancing onboarding efficiency.

Monitored employee performance metrics, providing feedback to improve productivity and morale.

Coordinated recruitment efforts, sourcing candidates through various platforms and networking channels.

Streamlined scheduling processes, optimizing workforce allocation to meet client demands effectively.

Led initiatives to improve employee retention, fostering a positive workplace culture through engagement activities.

Increased client satisfaction by consistently meeting or exceeding staffing requirements within tight deadlines.

Coordinated closely with human resources to ensure a smooth transition for new hires, from the interview process through their first days on the job.

Ensured compliance with employment laws and regulations through diligent documentation and record-keeping practices.

FRONT OFFICE RECEPTIONIST 03/2006 to 05/2012

Rockport Healthcare Group

Greeted visitors, answered phones, and directed inquiries to the appropriate staff member.

Maintained a professional and friendly atmosphere in the reception area.

Effectively managed incoming and outgoing mail and packages.

Scheduled and coordinated meetings and appointments.

Assisted with administrative tasks such as filing, photocopying and scanning.

Crossed trained with other departments as needed.

Assisted with special projects as needed.

EDUCATION

University of Phoenix, Tempe, AZ

Bachelor of Science, Health Administration

COMMUNITY SERVICE & VOLUNTEER WORK

SHAPE Community Center, Volunteer Group Leader Assistant, 1995, 1996

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