Open To Work
ADRIANA C THORNE
16830 Sol Preserve Drive - Port Charlotte,FL
Summary
Dynamic, bilingual customer service and leadership professional with extensive experience in healthcare insurance and revenue cycle management. Adept in insurance verification and CRM software. Proven track record of enhancing customer satisfaction and team performance, achieving a 20% increase in member retention. Strong analytical skills combined with effective communication foster organizational efficiency and compliance with Medicaid and Medicare standards.
Overview
38
38
years of professional experience
Work History
Customer Service Representative
Centene Corporation
Sunrise, Florida
05.2025 - Current
- Explained coverage options to members, ensuring an understanding of the insurance policy and coverage.
- Maintained updated knowledge through continuing education and advanced training.
- Managed customer accounts using company-specific CRM software effectively.
- Verified accuracy of customer data entered into the system.
- Ensured compliance with company guidelines and regulatory standards when dealing with members' accounts or policies.
- Utilized CRM software to document customer interactions, feedback, and resolutions.
- Conducted customer satisfaction surveys to identify areas for service improvement.
- Maintain productivity based on KPIs' guidelines.
- Follow Medicaid, CMS guidelines.
- Attention to detail
Patient Navigation Center Lead
TRINITY HEALTH
Fort Lauderdale, FL
01.2024 - 12.2024
- Provides first-class service to both internal and external customers to ensure satisfaction.
- Pre-registers outpatient appointments by obtaining necessary, accurate financial and demographic information to be entered into EPIC systems.
- Effectively delegate tasks and projects to colleagues, with appropriate follow-up, accountability, and reporting.
- Resolve escalated customer service issues.
- Identify opportunities to enhance internal processes for overall performance improvement and organizational efficiency.
- Coordinate the activities of the Customer Service team, and provide support and advice to team members.
- Monitor performance, lead the team to achieve key performance indicators (KPIs), and provide excellent service to customers.
- Evaluate customer feedback, and identify ways to maximize customer satisfaction.
- Ensure that standard operating procedures are documented and maintained.
- Produce electronic reports when required to do so.
- Answer customer inquiries by telephone and email, plus any other communication channels that are introduced by the company, such as live chat and social media.
- Work together with office practice managers to maintain medical providers' schedules and preferences in place.
Insurance Advocate-Remote
HEALTHFUND SOLUTIONS
Hollywood, FL
01.2023 - 12.2023
- Review daily hospital census for referrals received from eligibility, Case Management and Practice managers.
- Make follow-up calls to patients on their progress and/or insurance needs.
- Respond to daily emails and voicemails.
- Perform onsite interview visit to patients to assist with Market Place insurance coverage application and enrollment.
- Create electronic patient profiles including demographics, insurance, chief medical complaint, follow ups.
- Work on reports as assigned by leadership.
- Verify insurance eligibility utilizing maxRTE and Medicaid websites.
- Maintain communication with patients, internal and external work team members about patient cases resolutions.
- Mail letters to patients with case resolutions.
Patient Financial Services Specialist-Remote
NORTH AMERICAN PARTNERS IN ANESTHESIA
Sunrise, FL
01.2020 - 12.2021
- Ensures that all necessary demographic, billing, and clinical information is obtained and entered with timeliness and accuracy.
- Verifies insurance benefits and obtains pre-certification/authorization as necessary.
- Determines and accepts required payments, including but not limited to co-pays and deductibles.
- Review reports and combine accounts to re-prorate billing.
- Reduced patient billing concerns, assisted with charity applications.
- Updates claims information, reviewed disputes, removed or referred accounts to collections.
Patient Financial Services Representative
MEDNAX-PEDIATRIX MEDICAL GROUP
Sunrise, FL
01.2017 - 12.2020
- Developed and implemented superior customer service procedures, and increased performance levels.
- Responsible for hiring, training, motivating, coaching, evaluating, and retaining high-quality staff.
- Measure call center statistics to adequately adjust and enhance customer service staff performance.
- Knowledgeable in Medicaid, managed care, payment policies, as well as commercial payers.
- Experienced with insurance, patients’ self-pay, deductibles, and billing EOB analysis for collections/billing.
- Negotiated and approved the settlement of accounts and reasonable payment arrangements within corporate guidelines.
- Liaison to settle account balances with collection agencies.
- In charge of employee payroll biweekly preparation.
Call Center-Collections Supervisor-Hybrid
MEDNAX-PEDIATRIX MEDICAL GROUP
Sunrise, FL
01.2007 - 12.2017
- Developed and implemented superior customer service procedures and increased performance levels.
- Responsible for hiring, training, motivating, coaching, evaluating and retaining high quality staff.
- Measure call center statistics to adequately adjust and enhance customer service staff performance.
- Knowledgeable in Medicaid, Managed Care, payment policies as well as Commercial payers.
- Experienced with insurance, patients’ self-pay, deductibles and billing EOB analysis for collections /billing.
- Negotiated and approved settlement of accounts and reasonable payment arrangements within corporate guidelines.
- Liaison to settle account balances with collection agency.
- In charge of employee payroll biweekly preparation.
Medicare Recovery Case Worker -Remote
PERFORMANT CORP
Sunrise, FL
01.2021 - 12.2013
- Responsible for analysis of denied reimbursement claim.
- Ensures appropriate insurance coverage for compliance standards and revenue generation.
- Review health insurance information and documentation to ensure accuracy and locate errors or discrepancies.
- Takes action to recover mistaken Medicare payments.
- Responds to debtor inquiry appeal, refunds and dismissal cases.
- Identifies the correct and appropriate individual for pre-demand Conditional Payments.
Customer Service Manager
HIP ADMINISTRATORS OF FLORIDA/HIP HEALPLANS OF NY
Hollywood, FL
01.2003 - 12.2006
- Resolved Manager ‘s call escalations insuring to achieve the highest-level customer satisfaction.
- Conducted customer service department meetings to keep staff abreast of company procedural updates in service-related issues, new products and services.
- Participated in the review and revision of customer/member materials as deemed necessary.
- Held regular employee coaching sessions consisting of written summaries of each staff member, detailed feedback about quantity and quality work performance, attendance, work habits, areas needing improvement and very important praise and recognition.
- Managed call quota reports, customer/membership materials processing and claims inquiries.
- Directed positive motivational meetings to increase company morale.
- Conducted off-site Customer Medicare Retention meetings to explain all services provided by the company.
- Maintained up-to-date knowledge of new and existing Medicare healthcare regulations.
- Acted as liaison between internal and external member contacts to achieve resolution of customer complaints.
- In charge of correspondence of written inquiries regarding benefits, eligibility and HIP services and policies.
- Increased member retention by 20%, bringing increased revenues to the company and meeting required standard industry goals.
- Responded to customer account issues including benefits, eligibility services, policies and procedures as an Customer Service Senior Advocate.
- Proficiency with HMO, PPO, POS. Medicaid and Medicare policies and benefits.
Senior Medical Assistant
DR. EDWARD GOLDMAN, M.D.
Miami Lakes, FL
01.1992 - 12.1995
- Implemented medical patient information and record keeping system by organizing single files into streamlined five-tab structure, standardizing what information went in each tab for ease of information retrieval.
- Recognized with Employee of the Year award.
Clinical Assistant, Parkway Regional Medical Center
COMPREHENSIVE CANCER CENTERS
Miami, FL
01.1988 - 12.1992
- Assisted Oncology RNs with Chemotherapy and patient care.
- Performed patient healthcare screenings, insurance verification, billing inquiries and data entry functions.
- Assisted hospital counselor in family support groups and counseling services.
- Acquired knowledge of hospital codes and procedures.
- Received OSHA compliance and safety regulation Employee Recognition Award.
Education
Medical terminology, Coding and billing course -
Piper School
Sunrise, FLCoursework, AS - Nursing
Broward Community College
Hollywood, FLCoursework, Customer Service Management Skills -
Broward Community College
Hollywood, FLCertified Medical Assistant -
National School of Technology
North Miami Beach, FLSkills
- Epic Health Record system
- CRM software
- EMR systems
- Insurance verification
- Marketplace AHCA
- Medicaid and Medicare CMS systems
- Medsuite, GPMS, OBR, IPAX, BRIO, Medifax, Master Data Base, Q-Care, SAWS, and Crystal Reports billing systems
- MS Word, MS Outlook, MS Excel, MS PowerPoint
- Microsoft Teams
- Market prominence
- Paces and E-Paces systems
- Internet / intranet
- Nice, Avaya Centre Vu, Cisco, InContact IVR, call center supervisory programs
Languages
Spanish
Professional
Timeline
Customer Service Representative
Centene Corporation
05.2025 - Current
Patient Navigation Center Lead
TRINITY HEALTH
01.2024 - 12.2024
Insurance Advocate-Remote
HEALTHFUND SOLUTIONS
01.2023 - 12.2023
Medicare Recovery Case Worker -Remote
PERFORMANT CORP
01.2021 - 12.2013
Patient Financial Services Specialist-Remote
NORTH AMERICAN PARTNERS IN ANESTHESIA
01.2020 - 12.2021
Patient Financial Services Representative
MEDNAX-PEDIATRIX MEDICAL GROUP
01.2017 - 12.2020
Call Center-Collections Supervisor-Hybrid
MEDNAX-PEDIATRIX MEDICAL GROUP
01.2007 - 12.2017
Customer Service Manager
HIP ADMINISTRATORS OF FLORIDA/HIP HEALPLANS OF NY
01.2003 - 12.2006
Senior Medical Assistant
DR. EDWARD GOLDMAN, M.D.
01.1992 - 12.1995
Clinical Assistant, Parkway Regional Medical Center
COMPREHENSIVE CANCER CENTERS
01.1988 - 12.1992
Medical terminology, Coding and billing course -
Piper School
Coursework, AS - Nursing
Broward Community College
Coursework, Customer Service Management Skills -
Broward Community College
Certified Medical Assistant -
National School of Technology