Alvolyn Shaw
Patient Suport Advocate
Houston,TX
Summary
Over 10 plus years of diverse, challenging assignments case managing by obtaining client information by answering telephone calls and providing information, coupled with a focused approach to the task at hand while anticipating potential obstacles. Highly organized professional with vast experience in office administration demonstrated thorough and detail-oriented commitment to key projects. Possess solid team-work skills; able to thrive in a fast-paced environment. Strong dedication to job accomplishment.
Energetic medical professional ready to provide compassionate and respectful care to patients. Possesses excellent team collaboration and communication skills. Committed to offering quality patient experiences.
Overview
8
8
years of professional experience
Work History
Patient Support Specialist
Optum
10.2024 - Current
- Assist patient with scheduling appointments
- Helping patients request Medication refills
- Sending a documenting encounters helping patients check the status of prior authorization
- Check the status of referrals
- Assist patient with changing their PCP
- Help parents schedule appointments for their children in the pediatric department
Member Advocate II
Concentrix-Cigna Health
10.2023 - 10.2024
- Maintain a high-volume workload within a fast-paced environment. Assisted an average of 550 clients in any given week and consistently met performance benchmarks in all areas (speed, accuracy and volume).
- Helped company attain the highest client service ratings (as determined by external auditors) - earned 100% marks in all categories including communication skills, listening skills, problem resolution and politeness.
- Submitted requests to the proper department to prevent reoccurring issues and recommend improvements in the process and procedure.
- Assist customer with enrolling in there medical plans
- Explain Medicare
- Explain open enrollment and late enrollment penalty
- Assist customer with updating demographics
- Using sales force
- Working through knowledge X change.
Claim Specilist
Robert Half
09.2022 - 10.2024
- Assist patients with scheduling doctor appointments.
- Sending refill request to the clinical team
- Reading lab results
- Followed up with customers on unresolved issues.
- Collaborated with claims department and industry anti-fraud organizations to resolve claims.
- Evaluated accuracy and quality of data entered into agency management system.
- Reviewed applications and supporting documents to verify claims eligibility and accuracy.
- Utilized specialized software to process incoming claims, enter data and generate reports.
- Identified and reported potential fraud or abuse related to claims to protect system's integrity.
Claim Specialist
Iqor
01.2018 - 01.2022
- Developed and maintained system workflow and configuration and routinely monitored data transfer from and to computerized maintenance management systems.
- Logged and tracked problems and work tickets with external vendor support.
- Managed user access and accounts and performed user setup configuration including permissions levels and user security roles.
- Assisted in onboarding of new claims processors to familiarize with company procedures, policies and processes.
- Tracked and reported on claims processing metrics to aid senior management in making informed decisions.
- Established positive and trusting relationships with injured clients, administering efficient customer service and processing claims quickly.
- Complied with regulations and guidelines related to claims processing to maintain quality and adherence to standards.
Education
Diploma -
Spring High School
Skills
- Customer service
- Communication skills
- Medical Scheduling
- Medical Records
- Typing
- Medical Office Experience
- Microsoft Outlook Expert Solver
- Organizational skills
- Clerical Experience
- Microsoft Excel Expert
- Case management
- Office experience
- Microsoft Word Expert
- Database Management
- EMR Systems
- Patient Care
- Maintenance
- Time Management
- HIPAA
- Policy adherence
- Patient confidentiality
- Dispute handling
- Appointment scheduling
- Insurance verification
- Escalation management
- Patient satisfaction
- Medical terminology
- Data entry proficiency
- Personal care assistance
- Vitals assessments
- Empathetic communication
- Written communication
- Time management
Languages
English
Full Professional
Timeline
Patient Support Specialist
Optum
10.2024 - Current
Member Advocate II
Concentrix-Cigna Health
10.2023 - 10.2024
Claim Specilist
Robert Half
09.2022 - 10.2024
Claim Specialist
Iqor
01.2018 - 01.2022
Diploma -
Spring High School