Katrina Hunter

Communicate with Care Team members (Care Coordinators, primary care physicians and other health care providers) to facilitate member care. Establishes close relationships with and serves as primary point of contact for members. Receipts inbound/outbound calls to and from members with complex medical issues. Connect members with doctors, coordinate their care needs. Provide information regarding available benefits. Help link members with local resources. Scheduling of medical appointments and outreach followups. Anticipate members needs and proactively identify solutions. Maintain documentation of all client encounters and complete reporting requirements according to company standards. Collaborated with clinical staff and external stakeholders to facilitate effective communication and resolution of administrative issues. Conducted daily audits to ensure quality of clinical documentation and data accuracy

Service as the first point of contact for pharmacist and members, assisting with order status, rejected claims, benefits and edibility. Help guide and educate members about the fundamentals of benefits and alternatives to medications per plan and formulary. Working with other departments prior authorization, member services and provider relation offices to ensure members are claims are processed accurately and timely. Encourage, reassure, support, demonstrating self-motivation and the ability to work independently. Complying with established policies and procedures, good time management in the completion of job functions. Exceeding quality guidelines and procedures.

Serve as point of contact Liaison(Alorica to Optum). Overseeing and ensuring real-time individual and overall line group call statistics are met. Administer the communication to and from Operations and other support departments. Work with various departments (e.g., training, operations) to coordinate multi-skill training. Supervise day-to-day activities of scheduling procedures, Analysis of real time workload , ensure the resolution of all client concerns and issues are handled by the support staff in a timely manner. Monitoring real time adherence via CMS, EIS and IEX systems (ALC, Hold Time, and RTA) across eight lines of business, three sites averaging headcount of 4.500 – 6,000 advocates. Collaborating with Operations and Training maximizing efficiency. Determining and communicating the driving focus of call volume to client. Troubleshooting system issues and daily logging of ticket information. Attending bridge calls as needed regarding Global Issues. Scheduling of shifts to also include training, overtime, time removal due to VTO, updating originally schedule with extra hours per client needs. working with Human Resources to ensure that Bereavement Leave, Jury Duty, FMLA and Personal Leave request are submitted and advocates schedules adjusted to ensure adherence guidelines are not affected. Conducted regular performance evaluations to assess staff productivity and make recommendations for training and professional development. Analyzed historical data and forecasted future staffing needs to effectively manage workforce resources and minimize operational costs.

Processing prescription refills for membere. Placing Outbound calls to the pharmacist regarding refills rejected at local pharmacy. Faxing and sending of e-mails to doctor's office for refills needs. Processing payments and insurance for refills, tracking of refills, deescalation of calls. Developed highly empathetic client relationships and earned reputation for exceeding goals. Guaranteed positive customer experiences and resolved all customer needs. Identified and resolved system and account issues. Answered and transfer incoming calls to other departments such as dispatch, customer care, direct sales and technical support. Placed medical equipment orders and provided price quotes Provided problem resolution based upon experience and standard operating procedures resulting in immediate resolution. Guide and educate callers on their prescription benefits, use of plan, formulary, premiums and status of orders and claims or inquiries; Identify issues and communicate solutions and steps to customers, pharmacies and physicians with prescription orders and reorders. Ask appropriate questions and listen actively while documenting required information in computer systems.