Ariona Rome
Saint Louis,MO
Summary
Experienced quality analyst with a strong focus on ensuring product and process quality. Skilled in providing feedback to healthcare professionals, resolving discrepancies and safeguarding sensitive information. Detail-oriented, organized, and committed to delivering accurate and reliable results while adhering to company and industry guidelines.
Overview
7
7
years of professional experience
Work History
Quality Analyst
Veterans Evaluation Services
01.2024 - Current
- Participate in multidisciplinary teams focused on improving Veteran outcomes through process improvement
- Reviewing Medical Disability Examination reports and Disability Benefits Questionnaires generated by medical providers
- Work closely with medical providers to ensure Medical Disability Examination reports and Disability Benefit Questionnaires are consistent with the quality and timeliness requirements of the VA.
UM Administration Coordinator 2
PS Partner Solutions temp agency - Humana
07.2023 - 12.2023
- Attached faxes for chart reviews for the nursing team
- Documented calls/attach clinical information received
- Created authorizations/referrals as required for providers offices
- Collaborated with multiple departments/providers/roles
- Reviewed Diagnosis and ICD-10 codes to determine authorization requirements.
Consultant - Sales
Progressive Insurance
02.2023 - 07.2023
- Discussed auto insurance needs with members and potential members, assess and explain policy options
- Recommended and sell appropriate car insurance policies based on member needs
- Addressed questions about policies, premium payments, changes in coverage, and renewal options
- Stayed informed about industry trends, new products and provide members with up-to-date information.
Patient Billing Specialist
Washington University
10.2021 - 02.2023
- Communicated with insurance providers to resolve denied claims and resubmitted
- Scheduled appointments with available dermatologist
- Filed and updated patient information and medical records
- Consistently achieved production goals
- Communicated with medical providers and facilitated any necessary corrections to schedule.
Customer service advocate
United Healthcare
08.2020 - 10.2021
- Answered incoming calls from health care members to identify the type of assistance needed (Benefits and eligibility, billing and payments, authorizations for treatment, and explanation of benefits)
- Focused on resolving issues on the first call, navigating through complex computer systems to identify the status of the issue and provide appropriate response to the caller
- Delivered information and answer questions in a positive manner to facilitate strong relationships with members.
Sales
United Healthcare
04.2019 - 08.2020
- Assist Medicare-eligible individuals telephonically in the following ways
- Answer incoming phone calls from prospective members and identify the type of assistance and information the customer needs with the goal to convert the caller to a qualified lead and ultimately sale
- Ask appropriate questions and listen actively to identify specific questions or issues while documenting required information in computer systems
- Using knowledge of the product portfolio to accurately assess the distinct needs of different prospects, explain the differences between various products, and assist the prospect member in selecting a product that best meets their unique needs
- May make outbound call to prospective members to follow up on questions or to current members to review current or new products and services.
Patient Care Tech
BJC Christian Hospital
Saint Louis, MO
01.2018 - 04.2019
- Performed hourly rounds and responded promptly to call lights
- Utilized computer systems for charting patient data
- Assisted patients with eating, bathing, grooming, and supporting activities of daily living
- Reported changes in patient status to nursing staff in a timely manner
Skills
- Conflict resolution techniques
- Data analysis
- Quality Assurance
- Organizational and prioritization
Certifications and Licenses
- Certified nursing assistant
- Health insurance producer
Timeline
Quality Analyst
Veterans Evaluation Services
01.2024 - Current
UM Administration Coordinator 2
PS Partner Solutions temp agency - Humana
07.2023 - 12.2023
Consultant - Sales
Progressive Insurance
02.2023 - 07.2023
Patient Billing Specialist
Washington University
10.2021 - 02.2023
Customer service advocate
United Healthcare
08.2020 - 10.2021
Sales
United Healthcare
04.2019 - 08.2020
Patient Care Tech
BJC Christian Hospital
01.2018 - 04.2019