Aretina B Bates
Chattanooga,TN
Summary
Dynamic Senior Customer Care Associate with proven expertise at BlueCross BlueShield of Tennessee, excelling in project management and customer service. Adept at resolving complex inquiries and ensuring compliance, I leverage analytical skills to enhance operational efficiency and drive strategic outcomes. Committed to delivering exceptional results in high-pressure environments.
Overview
8
8
years of professional experience
Work History
Senior Customer Care Associate
BLUECROSS BLUESHIELD OF TENNESSEE
Chattanooga, TN
01.2023 - Current
- Receiving, investigating, and resolving all customer inquiries timely and accurately
- Handling customer service inquiries and problems via the telephone
- Ensuring all customer communication is documented
- Interact through various channels such as Chat, Phone, E-mail and TEAMS
- Educating callers to ensure resolution is achieved on first contact
- Plans, prioritizes, organizes, and completes work to meet the established objectives
- (Remote)
Contracts Administrative Associate
BLUECROSS BLUESHIELD OF TENNESSEE/ALLSOURCE PPS
Chattanooga, TN
08.2022 - 08.2023
- Installation and administration of assigned contracts and amendments in the Emptoris contract management system
- Managed system to ensure compliance with BCBST contract standards
- Interfaced with credentialing and provider enrollment staff to ensure data and systems are in sync
- Maintained physical and/or electronic file system
- Performed quality assurance auditing to verify accuracy in downstream systems
- Planned, prioritized, organized, and completed work to meet the established objectives
- (Remote)
Associate Benefits Specialist
UNUM
Chattanooga, TN
03.2022 - 08.2022
- Utilized Analytical and problem-solving skills
- Multitasked and balanced goals and priorities effectively in a high-volume environment
- Demonstrated the ability to operate with a sense of urgency and make balanced decisions
- Utilized claim investigative techniques to identify and evaluate claim information
- Analyzed and researched a variety of complex contractual information
- (Hybrid)
Contracts Administrative Associate
BLUECROSS BLUESHIELD OF TENNESSEE /AEROTEK
Chattanooga, TN
02.2020 - 03.2022
- Installation and administration of assigned contracts and amendments in the Emptoris contract management system
- Managed system to ensure compliance with BCBST contract standards
- Interfaced with credentialing and provider enrollment staff to ensure data and systems are in sync
- Maintained physical and/or electronic file system
- Performed quality assurance auditing to verify accuracy in downstream systems
- Planned, prioritized, organized, and completed work to meet the established objectives
- (Remote)
Insurance Follow-up Representative
MOUNTAIN MANAGEMENT / MEMORIAL HOSPITAL
Chattanooga, TN
04.2018 - 01.2020
- Validated outstanding claims that are billed, received, processed, and paid according to carrier contracts
- Utilized functionality in the application to identify and process denial and unpaid claim queues before filing limits met
- Submitted written documentation, remittance advice, and re-filed claim denials to various carriers
- Coordinated project working specific managed care commercial insurance accounts ensuring claims were paid
- Navigated payer websites to facilitate eligibility, claim status, claim corrections, and appeals
Refunds Analyst
NORTH AMERICAN CREDIT SERVICES
Chattanooga, TN
05.2017 - 03.2018
- Performed financial analysis of credit balance accounts to determine appropriate action
- Processed patient and insurance refunds in NextGen and submitted balance batches to the accounting dept for disbursement of refund checks, researched and resolved any unapplied cash for refunds
- Collaborated cross-functionally to ensure daily activities aligned with the organization's overall goals and objectives
- Led project assisting out-of-state hospital in recovery of overpayments made by insurance companies and members
- Documented accounts clearly and concisely of all activity and resolved all accounts to final resolution
Patient Access Representative II
MEMORIAL HOSPITAL / CONIFER HEALTH
Chattanooga, TN
10.2017 - 03.2017
- Secured medical necessity checks/verification in accordance with the Centers for Medicare and Medicaid services
- Verified insurance, benefits, coverage and eligibility
- Specialized in obtaining insurance authorizations for scheduled and unscheduled hospital services
- Interpreted physician orders, medical terminology and insurance cards while maintaining conifers standard of care
- Maintained and built collaborative relationships with both internal and external clients
- Coordinated communication as a liaison between members, doctors, and insurance carriers regarding account issues
- Posted contractual allowances, various adjustments, collection reports, and returned checks to appropriate accounts
Education
Master of Business Administration - Business Analytics
East Tennessee State University
Johnson City, TN12-2025
Bachelor of Science - Technical Management, Project Management
DeVry University
Associate of Arts - Business, General Management
American InterContinental University
Skills
- Project Management
- Risk Management
- Oral and written Communication skills
- Analytical Skills
- Critical Thinking
- Strategic Planning
- Decision Making
- Multitasking
- Time Management
- Interpersonal and Organizational Skills
- Customer Service
- Medicare/CMS
- Microsoft Office Outlook
- Microsoft Office Access
- Microsoft Office Visio
- Microsoft Office Tableau
- Microsoft Office SAS
- Peoplesoft
- Kronos
- NextGen
- BPM
- Epic
- Facets
- Emptoris
- SharePoint
- DocuSign
- Skype
- Zoom
- Agent workspace
Timeline
Senior Customer Care Associate
BLUECROSS BLUESHIELD OF TENNESSEE
01.2023 - Current
Contracts Administrative Associate
BLUECROSS BLUESHIELD OF TENNESSEE/ALLSOURCE PPS
08.2022 - 08.2023
Associate Benefits Specialist
UNUM
03.2022 - 08.2022
Contracts Administrative Associate
BLUECROSS BLUESHIELD OF TENNESSEE /AEROTEK
02.2020 - 03.2022
Insurance Follow-up Representative
MOUNTAIN MANAGEMENT / MEMORIAL HOSPITAL
04.2018 - 01.2020
Patient Access Representative II
MEMORIAL HOSPITAL / CONIFER HEALTH
10.2017 - 03.2017
Refunds Analyst
NORTH AMERICAN CREDIT SERVICES
05.2017 - 03.2018
Master of Business Administration - Business Analytics
East Tennessee State University
Bachelor of Science - Technical Management, Project Management
DeVry University
Associate of Arts - Business, General Management
American InterContinental University