Amber Harrold
Rancho Cucamonga,CA
Summary
Authorized to work in the US for any employer
Overview
7
7
years of professional experience
Work History
Kaiser Permanente Case Coordinator
Artech
07.2023 - Current
- Maintaining current knowledge of applicable procedures and compliance requirements to optimize effectiveness.
- Leveling Grievance Cases to the correct department to be processed within timeframe.
- Identifying CCU/ERU Components to ensure urgent cases does not go out of compliance.
- Creating Family Cases
- Combining/Merging Cases within the 15 day time when identifying a 180 day Case
- Sorted and placed mail into mailboxes and post office boxes with high levels of accuracy.
- Maintain confidentiality of patient finances, records, and health statuses.
- The ability to navigate between systems ex. Health Connect, Metrs, Epic etc
- Responding to emails in a timely manner.
- The ability to take on new task when presented the opportunity.
- Being able to identify Appeal cases/ researching for a denial letter to confirm if in fact a true appeal or not
- Weighed letters and packages and calculated costs based on classification, weight, and destination.
- Maintained mailroom supply inventories.
- Assisted with implementing new mailroom systems and training staff to improve operations.
L.A Care Health Customer Service Rep 2
AgreeYa Solutions
02.2022 - 05.2023
- Adheres to and participates in Company’s mandatory HIPAA privacy program / practices and Business
- Ethics and Compliance programs / practices
- Research caller’s issues/problems and find solutions
- Billing of claims to the appropriate party
- Follow up with Insurance at a timely manner
- Timely follow up with patients
- Actively listened to customers, handled concerns quickly and escalated major issues to supervisor.
- Handled customer inquiries and suggestions courteously and professionally.
- Answered constant flow of customer calls with minimal wait times.
- Updated account information to maintain customer records.
- Offered advice and assistance to customers, paying attention to special needs or wants.
- Clarified customer issues and determined root cause of problems to resolve product or service complaints.
- Take patient complaints, post discounts, set up budget plans, follow up with medical records department and also provide estimates
- Developed appeals functions, policies and procedures and documentation.
- Collected premiums and issued accurate receipts.
- Reviewed complaints and claims from workplaces, determined validity and helped build satisfactory resolutions.
Magellan Customer Service Rep
TalentBurst
08.2022 - 01.2023
- Actively listens and probes callers in a professionally and timely manner to determine purpose of the calls.
- Researches and articulately communicates information regarding member eligibility, benefits, EAP services, claim status, and authorization inquiries to callers while maintaining confidentiality.
- Resolves customer administrative concerns as the first line of contact - this may include claim resolutions and other expressions of dissatisfaction.
- Assists in the mentoring and training of new staff.
- Comprehensively assembles and enters patient information into the appropriate delivery system to initiate the EAP, * Care and Utilization management programs.
- Demonstrates flexibility in areas such as job duties and schedule in order to aid in better serving members.
- Educates providers on how to submit claims and when/where to submit a treatment plan.
- Identifies and responds to Crisis calls and continues assistance with the Clinician until the call has been resolved.
- Informs providers and members on client's appeal process.
- Performs necessary follow-up tasks to ensure member or provider needs are completely met.
- Provides information regarding client's in-network and out-of-network reimbursement rates and states multiple networks to providers.
Customer Service Representative
Inovalon
02.2021 - 04.2022
- Outbound and inbound calls at a very fast pace
- Scheduling appointments to set up a time for a personal health visit with insurance company
- Inputting information into Apollo data
- Attending company meetings through video chat
- Working remotely
- Quality assurance
- Utilized customer service software to manage interactions and track customer satisfaction.
- Delivered exceptional customer service to every customer by leveraging extensive knowledge of products and services and creating welcoming, positive experiences.
- Calling doctors offices confirming site information
- Answering escalated calls and finding solutions that best fit scenario
Customer Service
Bobo's Beauty
07.2019 - 01.2021
- Resolving customer complaints
- Responded to customer requests for products, services, and company information.
- Taking innovatory
- Finding new ways too better the company growth
- Making relationships with customers
- Working with Mangers side by side
- Handling register and payments
- Answering escalated calls/ face to face escalations
Customer Service Representative
Cardinal Health
02.2017 - 08.2020
- Handled customer inquiries and suggestions courteously and professionally.
- Actively listened to customers, handled concerns quickly and escalated major issues to supervisor.
- Answered constant flow of customer calls with minimal wait times.
- Helped large volume of customers every day with positive attitude and focus on customer satisfaction.
- Documented and detailed calls and complaints using call center's CRM database.
- Adhered to company policies and scripts to consistently achieve call-time and quality standards.
- Responded to customer calls and emails to answer questions about products and services.
- Detailed payment options and explained price, receipt and billing details to customers.
- Attended telephone skills and program information training sessions to boost aptitude.
- Escalated complicated customer account issues to supervisors and help desk workers.
- Resolved concerns with products or services to help with retention and drive sales.
Education
Trade - Dental Assisting
American Career College
Ontario, CA12.2013
High school diploma -
Siatech
San Bernardino, CA06.2011
Skills
- Medical Imaging
- Insurance Verification (4 years)
- Medical Scheduling
- Front Desk (4 years)
- Dental Assisting
- Payroll
- Quality assurance (2 years)
- Process improvement
- Google Suite
- Security system
- Salesforce
- Analysis skills
- Mental Health Counseling
- HIPAA
- Chairside Assisting
- Live Chat
- Certifications and Licenses
- Certified Dental Assistant
- Quality Assurance
- Data Collection
Timeline
Kaiser Permanente Case Coordinator
Artech
07.2023 - Current
Magellan Customer Service Rep
TalentBurst
08.2022 - 01.2023
L.A Care Health Customer Service Rep 2
AgreeYa Solutions
02.2022 - 05.2023
Customer Service Representative
Inovalon
02.2021 - 04.2022
Customer Service
Bobo's Beauty
07.2019 - 01.2021
Customer Service Representative
Cardinal Health
02.2017 - 08.2020
Trade - Dental Assisting
American Career College
High school diploma -
Siatech