Authorizations Lead with Customer Service Expertise

Kristin Williams

Glendale, AZ

Interview Availability: 24 Hours prior notice

Professional Summary:

• I am seeking a challenging and interesting position with a growing company.

• A self-motivated, dependable and dedicated employee, who takes great pride in any work performed; eager to learn new and exciting responsibilities, utilizing management and leadership experience Skills:

• Customer service oriented

• MS Windows proficient /Outlook Express

• Excellent communication skills

• Bilingual (English & Spanish(Speak))

• Medical Authorizations/Appeals/Peer to Peer Reviews

• Conflict resolution

• Strong organizational skills

• Developed listening skills

• Fast learner with a wide range of practical skills to Include billing/coding and posting.

• Creative problem solver

• Energetic work attitude

• Training

• NICE Universe proficient

• 10 Key proficient

Experience:

Simonmed Imaging, INC - Phoenix, AZ Jul 2019 to Dec 2024 Authorizations Lead

• Taking inbound calls and obtaining authorizations on High Tech Imaging studies such as Nuclear Medication Exams, CT, MRI exams.

• Working as a team and independently to meet goals set-forth by the company and help train new hires and work with them on policies and procedures of the company.

• Meet and exceed goals set by company and helping others with tips on how to meet goals when they are not meeting the requirements of the company.

Aetna Healthcare INC - Phoenix, AZ Jun 2017 to Jul 2019 Lead Customer Service Representative

• Inbound call center for the State of Arizona Medicaid Program.

• Assist members with benefits, claims, grievances, and appeals.

• Assisting with arranging transportation to and from doctor’s appointments.

• Assisting other customer service representatives with questions and concerns on questions and inquiries from members that are unknown to the agent assisting the member.

• Meeting all metrics set forth by the company and consistently meeting and exceeding all expectations set forth also by the company.

• Billing, coding of medical claims.

Alaska Airlines - Tempe, AZ Mar 2017 to Jun 2017

Customer Service Agent

• Inbound call center taking multiple calls from passengers and customers to meet and exceed all expectations from them.

• Assisting with booking flights, changing flights, assisting in flight delays, booking mileage and reward flights and ensuring total customer satisfaction while meeting and exceeding all expectations of the company. Cook Children’s Hospital - Fort Worth, TX May 2015 to Dec 2016 Information Services Representative

• Providing information to individuals seeking assistance, typing 59 wpm, faxing, copies, taking messages, paging systems as needed, delivering messages to doctors, nurses, and individuals when emergencies occur, alerts, codes and shift reliefs.

• Providing training and processes to co-workers that need assistance, providing internal and external assistance and information as requested when necessary. Following up when needed to ensure proper protocol followed.

• I am a detail-oriented individual who takes great pride in all my work and I am a positive team player. Victory Mid-Cities Hospital - Hurst, TX Mar 2014 to Apr 2015 Registrar/Billing

• Register patients for surgical procedures, front desk reception, billing for the procedures, answering telephones, transferring callers to correct areas, guiding representatives to correct areas, assisting with all administrative duties assigned by supervisor, providing overall excellent customer service while representing the company and following protocols and procedures.

OptumRx/United Healthcare Inc. - Irvine, CA Nov 2012 to Feb 2014 Customer Service

• Inbound representative taking calls daily from medical offices, customers, drug manufacturers/representatives for patients with chronic diseases.

• Following protocol on drug reviews, refilling prescriptions, outbound calls to obtain missing information when necessary, following up and ensuring total customer satisfaction.

• Meeting/exceeding all set guidelines and metrics set forth by the company.

• Following scripting provided when appropriate and documenting all calls taken to provide the most appropriate action taken and the next steps needed.

Life Technologies, INC. - New York, NY Jul 2011 to Feb 2012 Senior Customer Service/Relations

• Handling in-bound calls, assisting customers (internal and external) in a professional manner, handling complex issues on returns, credits, debits, invoices, billing, and re-billing when necessary.

• Following proper chain of command for approvals on credits and debits when exceeds limitations.

• Following proper guidelines set forth by company and government on shipments and returns.

• Charging proper restocking fees and issuing labels for proper return and explaining proper return guidelines (I.E. on dry ice, wet ice, refrigerated).

• Maintaining follow up logs and meeting deadlines and timeframes as required by company.

• Explaining proper timeframes for returning products and reaching out to the appropriate account manager when needing approval for waiving fees.

Aetna, Inc. - Arlington, TX Apr 2004 to Apr 2011

Senior Customer Service Representative

• Handling in-bound calls, assisting providers in a professional and courteous manner, single point of contact resolution while providing benefits and claim status.

• Assisting, mentoring co-workers on challenging tasks to provide the final resolution for the provider.

• Dedicated Exxon Mobil representative, Customer Care Skill, Elite Team, Diversity Team, Mentoring of New Hires, Texas Public Schools Dedicated Representative and Proscat Skill, Escalated Que and Help Desk.

• Working under the Team Leader, Support Specialist and assisting them on other tasks and responsibilities to meet deadlines and timeframes.

• Working with providers on billing and coding codes and diagnosis codes to bill with to ensure approval of claim paid and authorizations.

Percepta, A Ford Motor Company - San Diego, CA Mar 2001 to Dec 2003 Quality Assurance Specialist

• Evaluate and coach calls according to the guidelines set forth by Ford Motor Company to ensure excellent customer service is being always provided.

• Training new employees on company policies and procedures and facilitates improvement training to current employees.

• Travelled to Toronto, Canada in April 2003 as one of four individuals chosen to assist in the migration of our San Diego location.

• Spent three weeks training new representatives and sharing knowledge on the Concern Resolution process for the Lincoln/Mercury Line.

Percepta, A Ford Motor Company – San Diego, CA Mar 2001 to Dec 2003 Customer Service Representative

• Responsible for promoting and enhancing positive customer relationships with customers and dealerships.

• Receives customer contacts including inbound calls and provides resolution in a timely manner.

• Understanding of technology, scripts, and product knowledge.

• Actively listens to customers, providing answers while controlling the call to lead the customer in an efficient, professional manner.

• Accountable for resolution of customers concerns, showing empathy, credibility, and confidence.

• Handling sensitive situations in a calm constructive manner while showing effectiveness in high-pressure situations

Education:

• Associates Degree in Business and Finance - Palomar College San Marcos, CA

Contact this candidate