Bailey Clemons
Oshkosh,WI
Summary
Extremely driven and dedicated with years of experience in the medical industry in both patient and non-patient facing roles varying from customer service to claims. An innovative out-of-the-box thinker, with a vast knowledge of a wide array of computer programs who thrives in a fast-paced working environment, and brings an upbeat and energetic energy to the workplace.
Overview
4
4
years of professional experience
Work History
Sr. Customer Service Representative.
United Healthcare
07.2022 - Current
- Effectively and efficiently communicates, most up-to-date benet and policy information to members and providers.
- Developed highly empathetic client relationships and earned reputation for exceeding service standard goals.
- Responded proactively and positively to rapid change.
- Initiates prior authorization requests. When needed reports on status of prior authorization request and thoroughly explains approval or denial reasons to providers based on information that laid out by case managers.
- Demonstrates extensive claim knowledge by affectively explaining claim decision determination, appeal process and payment breakdown information to both providers and members.
- Effectively utilize multiple screens and programs per day to better assist members and providers including but not limited to Microsoft office, Microsoft excel, Omni Genesis, IEX, and various UNET screens.
Medical Office Assistant
Louisiana Orthopaedic Specialists
02.2022 - 07.2022
- Answered telephone calls to offer office information, answer questions, and direct calls to staff.
- Received, recorded and filed medical payments by check, cash, and credit card.
- Gathered forms and copied insurance cards to collect patient information for billing and insurance filing.
- Coordinated patient scheduling, check-in, check-out and payments for billing.
- Adhered to strict HIPAA guidelines to protect patient privacy.
- Provided prompt, polite and professional in-person and telephone customer service.
- Completed administrative patient intakes with case histories, insurance information and mandated forms.
- Scheduled patient appointments in respective doctors' calendars and followed up with reminder phone calls.
- Performed various administrative tasks by filing, copying and faxing documents.
- Coordinated referrals through insurance and other medical specialists and documented details in patient charts.
Customer Care Specialist
Lafayette Veterinary Care Center
04.2021 - 12.2021
- Helped large volume of customers every day with positive attitude and focus on customer satisfaction.
- Assessed and offered solutions to improve procedures and customer experiences.
- Verified accuracy of customer account information and updated when necessary.
- Responded to customer inquiries via phone, email and web-based platforms.
- Created customer profiles by answering questions and providing tailored experiences based on interests and agendas.
- Assisted in training new employees and participated in cross-training with other departments.
- Achieved high satisfaction rating through proactive one-call resolutions of customer issues.
Patient Accounts Representative
Lafayette General Health
12.2020 - 03.2021
- Monitored flags and resolved urgent items with accuracy and efficiency.
- Worked with outside entities to resolve issues with billing, claims and payments.
- Maintained office inventory and organized supplies for efficiency and expected needs.
- Secured patient information and confidential medical records in compliance with HIPAA privacy rule standards to protect patient's privacy.
- Stayed calm under pressure to and successfully dealt with difficult situations.
- Identified insurance payment sources and listed payers in proper sequence to establish chain of payment.
- Utilized knowledge of electronic medical record systems and medical terminology to perform diverse data entry tasks.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
- Managed large volume of medical claims on daily basis.
- Evaluated medical claims for accuracy and completeness and researched missing data.
- Carried out administrative tasks by communicating with clients, distributing mail, and scanning documents.
- Communicated effectively with staff members of operations, finance and clinical departments.
Medical Office Assistant
Ochsner Lafayette General
02.2020 - 12.2020
- Answered telephone calls to offer office information, answer questions, and direct calls to staff.
- Restocked each medical room with adequate supply of medications and supplies in preparation for patients.
- Gathered forms and copied insurance cards to collect patient information for billing and insurance filing.
- Adhered to strict HIPAA guidelines to protect patient privacy.
- Registered patients and completed associated paperwork for accurate records.
- Provided prompt, polite and professional in-person and telephone customer service.
- Updated patient information and insurance details for accurate electronic medical records.
- Answered phone calls and messages for 8 physician medical clinic, scheduling appointments, and handling patient inquiries.
- Prepared and processed patient referrals and transfer requests.
- Received and routed laboratory results to correct clinical staff members.
- Placed new supply orders, managed inventory and restocked clerical spaces.
- Completed administrative patient intakes with case histories, insurance information and mandated forms.
- Scheduled patient appointments in respective doctors' calendars and followed up with reminder phone calls.
- Performed various administrative tasks by filing, copying and faxing documents.
Assistant Store Manager
Buckle
10.2019 - 02.2020
- Rotated merchandise and displays to feature new products and promotions.
- Supervised and evaluated staff to help improve skills, achieve daily objectives, and attain advancement.
- Provided weekly work schedules to employees to accommodate business demands and vacation requests.
- Walked through store areas to identify and proactively resolve issues negatively impacting operations.
- Managed opening and closing procedures and recommended changes to enhance efficiency of daily activities.
- Coached sales associates in product specifications, sales incentives, and selling techniques, significantly increasing customer satisfaction ratings.
- Handled problematic customers and clients to assist lower-level employees and maintain excellent customer service.
- Tracked employee attendance and punctuality, addressing repeat problems quickly to prevent long-term habits.
- Interacted well with customers to build connections and nurture relationships.
- Supervised creation of exciting merchandise displays to catch attention of store customers.
- Responded to customer concerns, working with manager to significantly raise customer satisfaction ratings.
- Processed payments for credit and debit cards and returned proper change for cash transactions.
Education
High School Diploma -
Chalmette High School
Chalmette, LA05.2015
Skills
- Conflict Management
- Call Documentation
- Microsoft Office
- Office equipment proficiency
- Account updating
- Customer Relationship Management (CRM)
- Call Volume and Quality Metrics
- EMR Software
- HIPAA Compliance
- Spreadsheet Management
- Microsoft Excel
- Appointment Scheduling
References
Jennifer Doane
504-373-4197
jdoane01@yahoo.com
Janell Davis
313-282-2124
jksm89@gmail.com
Timeline
Sr. Customer Service Representative.
United Healthcare
07.2022 - Current
Medical Office Assistant
Louisiana Orthopaedic Specialists
02.2022 - 07.2022
Customer Care Specialist
Lafayette Veterinary Care Center
04.2021 - 12.2021
Patient Accounts Representative
Lafayette General Health
12.2020 - 03.2021
Medical Office Assistant
Ochsner Lafayette General
02.2020 - 12.2020
Assistant Store Manager
Buckle
10.2019 - 02.2020
High School Diploma -
Chalmette High School
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