Arthea Barnes
Midland,GA
Summary
Knowledgeable and dedicated customer service professional with extensive experience in Call Center industry. Solid team player with outgoing, positive demeanor and proven skills in establishing rapport with clients. Motivated to maintain customer satisfaction and contribute to company success. Specialize in quality, speed and process optimization. Self-motivated and true team player. Results-driven and focused on delivering exceptional support for customer needs. Successfully manages concerns and resolves conflicts to maximize customer satisfaction. Offers strong background in customer relations and communication.
Overview
12
12
years of professional experience
1
1
Certification
Work History
Member Service Representative
Humana
Midland, GA
11.2020 - 04.2023
- Assist with inbound and outbound calls regarding benefit information about network providers, authorization status, referrals, telephonic plan changes, claim, and Medicare Advantage inquiries.
- Verify members Medicaid coverage.
- Assisted members with account management, including updating personal information and automatic payments.
- Provided exceptional service through active listening, understanding member needs, and offering appropriate solutions.
- Educate on additional benefits and assistance available to members according to plan and region.
- Educate members on copays, coinsurance, deductibles, and occasionally premiums.
- Resolved customer issues through thorough dispute investigation.
- Promoted superior experience by addressing customer concerns, demonstrating empathy, and resolving problems swiftly.
- Met customer call metrics for service levels, handle time and productivity.
Customer Service Representative
Prime Therapeutics LLC
Columbus, GA
10.2019 - 02.2020
- Monitor and track patient authorizations, verify active insurance and coverage, ensure payment for services by verifying benefits with insurance providers.
- Take inbound calls to engage members and/or providers to verify clinical information
- Handle customer inquiries both telephonically and by fax.
- Document all call information according to standard operating procedures and attach clinical information when necessary
- Identify and de-escalate issues.
- Enhanced customer satisfaction by promptly addressing concerns and providing accurate information.
- Resolved customer complaints with empathy.
- Enhanced customer satisfaction by efficiently processing authorization requests and verifying eligibility.
- Streamlined workflows for faster response times and improved productivity, managing high volume of daily tasks.
- Reduced errors in authorization approvals by meticulously reviewing documentation and cross-referencing information.
- Maintained up-to-date knowledge on industry regulations and company policies to ensure accurate processing of authorizations.
HEALTHCARE MEMBER SERVICES
BroadPath Healthcare
Stone Mountain, GA
10.2018 - 12.2018
- Answer inbound calls from current health insurance members responding to inquiries regarding benefit and eligibility information, claims and billing questions, and primary care physician assignments
- Assist with calls from providers with questions regarding member eligibility, coverages, benefit types, copays, and claims.
- Managed 60+ high call volumes while maintaining exceptional service quality, consistently surpassing performance benchmarks set by management.
- Ship plan material including member ID card and detail plan booklet.
- Streamlined claim processing for faster reimbursement, utilizing knowledge of insurance policies and procedures.
- Managed high call volume while maintaining accuracy and professionalism in documentation of interactions with customers.
- Expedited resolution of customer concerns, providing exceptional service through clear communication and active listening skills.
- Streamlined membership renewal process for increased efficiency and retention rates.
SPECIALTY SCHEDULING
Kaiser Permanente
Duluth, GA
11.2016 - 07.2018
- Optimized scheduling efficiency by managing and coordinating appointments for multiple departments.
- Maintained accurate patient records, ensuring smooth transitions between appointments and healthcare providers.
- Ensured HIPAA compliance within all aspects of central scheduler role, maintaining confidentiality of sensitive information at all times.
- Managed high call volumes effectively through prioritization; triaging calls based on urgency and patient needs.
- Communicated information to patients regarding requirements for appointments and test preparation.
- Verified insurance coverage and eligibility for medical services prior to scheduling appointments to prevent billing issues.
CARE COORDINATOR
ONE CALL DIAGNOSTICS
Alpharetta, GA
06.2015 - 05.2016
- Schedule Diagnostic Test for Workers Comp and Auto claim patients.
- Managed high call volume while remaining focused on delivering excellent customer experiences.
- Followed up with patients to reschedule missed appointments.
- Update all parties on claim including Adjusters, Nurse case managers, Providers, and attorneys, via fax, email, and telephone call.
- Schedule appointments on patient behalf with verbal authorization
- Allocate providers to accommodate procedures ordered for patient.
- Confirm ordered procedures are authorized by insurance company.
- Schedule additional services such as translation and transportation.
- Gather and document all missing pertinent information regarding claim.
Education
Bachelor of Science - Business Administration
Strayer University
Columbus, GA10.2025
GED -
GEORGIA PIEDMONT
Clarkston, GA05.2015
Skills
- Member Relations
- Information Updates
- Appointment Scheduling and Confirmation
- Customer Service/Support
- Data Entry
- Medical Terminology Knowledge
- Claims
- Appeal
- Typing Proficiency
- Call Volume and Quality Metrics
- Time Management
- Document and Records Management
- Documentation
Certification
- CMS POLICIES
- AUTHORIZATIONS
- INSURANCE
- CLAIMS (PHARMACY AND BENEFITS)
- OUTREACH
- MEDICARE/MEDICAID
- MEDICAL TERMINOLOGY
- GRIEVANCE/APPEALS
- COVERAGE DETERMINATIONS
- DATA ENTRY
Timeline
Member Service Representative
Humana
11.2020 - 04.2023
Customer Service Representative
Prime Therapeutics LLC
10.2019 - 02.2020
HEALTHCARE MEMBER SERVICES
BroadPath Healthcare
10.2018 - 12.2018
SPECIALTY SCHEDULING
Kaiser Permanente
11.2016 - 07.2018
CARE COORDINATOR
ONE CALL DIAGNOSTICS
06.2015 - 05.2016
Bachelor of Science - Business Administration
Strayer University
GED -
GEORGIA PIEDMONT