Amelia Albano
Sacramento,CA
Summary
Detailed oriented, driven by patient satisfaction with over 15 years of experience in the medical industry. Looking to use my excellent analytical and communication skills to fill the role of Account Representative. Smart candidate keeps meticulous details on status of customers and collection efforts. Friendly and engaging with great attention to detail. Dynamic Job Title with extensive experience in customer service. Highly organized professional establishes relationships with customers. Stays calm under pressure. Hardworking and passionate job seeker with strong organizational skills eager to secure entry-level Job Title position. Ready to help team achieve company goals. To seek and maintain full-time position that offers professional challenges utilizing interpersonal skills, excellent time management and problem-solving skills. Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals. Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy.
Overview
25
25
years of professional experience
Work History
Account Representative
Customer Setvice Senior
United Healthcare/ Optum Business Services
11.2019 - 07.2024
- Provide consult and answer questions so patients may better understand the billing process, including insurance payments and other adjustments that may apply
- Advise and determine the best course of action and resolution to solve patient disputes, incorrect insurance billing, refund request, misapplied payments
- Set up payment plans for patient outstanding balances
- Inform indigent patients of the Financial Assistance Program, eligibility qualifications and how to apply
- Recognize TPL claims incorrectly billed to the health care payor requesting a claim rebill
- Accept patient credit card payments.
- Served as a trusted resource for colleagues seeking guidance on challenging situations or complex issues faced during daily interactions with customers.
- Collaborated with cross-functional teams to address customer concerns efficiently while maintaining positive relationships both internally and externally.
- Implemented innovative strategies aimed at reducing wait times for callers without compromising on quality of support provided.
- Conducted thorough follow-ups with clients to ensure all outstanding matters were resolved satisfactorily.
- Contributed to company''s growth with exceptional customer service, leading to increased client retention rates.
- Developed strong rapport with customers through active listening skills, empathy, and patience in handling their concerns.
- Handled escalated calls professionally while working towards amicable resolutions that satisfied both parties involved.
- Acted as a liaison between the company and its clientele by managing complaints effectively, ultimately improving the brand''s reputation for excellent service delivery.
- Improved team performance by providing constructive feedback, guidance, and encouragement to fellow Customer Service Representatives.
- Reduced overall call times by implementing effective problem-solving techniques in a timely manner.
- Mentored junior team members by sharing insights and experiences, boosting overall productivity and fostering a supportive work environment.
- Enhanced customer satisfaction by addressing and resolving complex inquiries promptly and professionally.
- Leveraged in-depth product knowledge to provide accurate information to customers, ensuring they made informed decisions based on their needs and preferences.
- Resolved escalated customer service inquiries and complaints to maintain satisfaction.
- Built positive rapport and relationships for high levels of customer satisfaction.
- Onboarded and trained customer representatives to meet performance and service goals.
- Implemented company policies and procedures for professional, cohesive customer care.
- Implemented customer service policies and procedures for consistent performance standards.
Randstad Staffing/ Support Staff, Sutter Health Employment Assistance Program/EAP
03.2019 - 05.2019
- Receive Member calls and transfer to the appropriate licensed clinician
- Locate members in 'Incedo' to confirm EAP benefits and a history of services provided
- Determine the urgency of member needs to ensure member safety and stability
- Initiate appropriate member referrals for Intake completion
- Provide Clinicians with email messages for member call backs
- Assist and complete other clerical aspects that support the EAP.
Patient Financial Advisor
Kaiser Permanente
03.2007 - 12.2013
- Acted as an advocate on patient's behalf by providing consultations and referrals to applicable private, federal, state and county aid programs to patients
- Worked closely with Discharge Planners and physicians to help develop a plan for continuous outpatient care
- Interviewed patients regarding workers' compensation, coordination of benefits, and Third-Party Liability
- Identified financial sponsorships for Kaiser members/non-members to determine financial obligations
- Performed weekly audits and verified information to identify data accuracy, billing errors, and compliance
- Provided extensive account follow up to resolve problematic and delinquent non-compliant patient accounts
- Researched and conducted independent healthcare investigations to identify and eliminate fraud and abuse
- Collected statistical data and prepared reports notating all activity concerning the KP Health Connect system
- Assisted with inpatient admitting for diagnosis and treatment to determine eligibility for ongoing treatment
- Reduce hospital costs associated with patient discharge by acquiring free medical equipment through personal research on private organizations.
State Disability Claim Processor
Kaiser Permanente
02.2003 - 03.2007
- Condensed patient medical history pertaining to disability diagnosis for claim processing
- Reviewed routine and moderately complex claims and edits to determine appropriate handling
- Researched and determined appropriate ICD diagnosis and procedure codes for the doctor's certificate
- Performed credit check to show Federal Poverty percentage and determine patient financial eligibility
- Identified system payment discrepancies for corrective action
- Improved outdated training modules concerning claim processing and the eligibility process
- Trained new claims employees on process and standard procedure
- Prepared correspondence for rejected claims records.
Occupational Medicine Clerk
Kaiser Permanente
01.2000 - 02.2003
- Received and assisted patients with completing necessary information including circumstances of injury
- Contacted patients' employers to obtain their workers' compensation information
- Documented injury reports and insurance information in the Kaiser Workers' Compensation Bedrock System
- Followed best practices consistent with Kaiser's strategic plan for patience experience
- Served as a patient advocate and intermediary between patient and health care team
- Utilized Claims Department policies and procedures, workflow and manuals to meet departmental production and quality metrics.
Education
Skills
- Excellent written and verbal communication
- Proficient in Workers Compensation Authorization/Billing/Collection workflow and activities
- In depth knowledge of HMOs, Medicare and Medical
- Certified in CPT and ICD coding
- Experienced in managing specialty outpatient medical practices
- Effectively manages multiple concurrent projects
- Customer Engagement
- Customer Relationship Management
- Account Management
- Document Control
- Goal-Oriented
- Account Reconciliation
- Prospecting skills
- Business Development
- Department collaboration
- Processing payments
- Opening and closing procedures
- Account Servicing
- Teamwork and Collaboration
- Problem-Solving
- Attention to Detail
- Problem-solving abilities
- Reliability
- Excellent Communication
- Team Collaboration
- Active Listening
- Effective Communication
- Adaptability and Flexibility
- Decision-Making
- Relationship Building
- Team building
- Self Motivation
Softwareservices
- MS4
- Incedo
- Outlook
- Genesys
- Microsoft Office Programs
- Excel/Spreadsheets
- Epic/Health Connect
- Foundation Systems
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Timeline
Customer Setvice Senior
United Healthcare/ Optum Business Services
11.2019 - 07.2024
Randstad Staffing/ Support Staff, Sutter Health Employment Assistance Program/EAP
03.2019 - 05.2019
Patient Financial Advisor
Kaiser Permanente
03.2007 - 12.2013
State Disability Claim Processor
Kaiser Permanente
02.2003 - 03.2007
Occupational Medicine Clerk
Kaiser Permanente
01.2000 - 02.2003