Open To Work
Brittney Hayes
Excellus Blue Cross Blue Shield
Rochester,NY
11
years of professional experience
Service-oriented in customer care with an extensive background in a call center type environment. Core competencies include familiarity in a fast-paced environment, great rapport with members along with colleagues, and maintaining professionalism as well as excellent communication and time management skills. Handles tasks with accuracy and efficiency. Highly-motivated employee with desire to take on new challenges. Strong worth ethic, adaptability and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.
Work History
Safety Net Project Coordinator
3 Years 5 Months- Processing member specific tasks for three case managers.
- Contacting provider offices and external care management agencies for care coordination and collaboration.
- Researching claims and correspondence in Care Advance and Facets to gather information pertaining to member's health plan utilization.
- Precepting and assisted in training new hires.
- Outreaching members to conduct health risk assessments.
- Follow up with providers to receive compliant DOH-4359 forms.
Front Desk Associate
5 Months- Answered phones to respond to customer inquiries and transferred calls to appropriate staff members.
- Managed patient check-in and check-out procedures, and payments.
- Delivered friendly and knowledgeable support to current and prospective customers.
- Handled payment processing and provided customers with receipts and proper bills and change.
- Collaborated closely with other departments when necessary.
- Provided administrative support to coworkers, taking on additional tasks during high-volume periods.
Patient Engagement Specialist
2 Years 10 Months- Engages and interacts with member and providers daily.
- Navigate several databases frequently (I.E Facets, Macess, Care Radius).
- Reviews medical claims using Facets database.
- Runs Power BI Report weekly.
- Reviews and sends emails to nurses and colleagues when needed.
- Receives inbound calls from members, and the case management queue line.
- Compiled information from patients and caregivers or family members to identify care concerns.
Pharmacy Specialist
1 Year 5 Months- Review and determine coverage of both prescription and medical requests
- Sends authorizations to pharmacists for final determinations
- Fax provider the appropriate correspondences
- Responsible for contacting both provider and member with final decisions
- Managed incoming calls from patients regarding prescription status or other questions related to their medications.
Provider Services
1 Year 1 Month- Use of computers for various applications
- Answer telephones and give information to providers, or transfer calls to appropriate departments
- Create service forms, maintain, and enter information into databases
- Check to ensure that appropriate changes were made to resolve provider issues
- Resolve customers' service or billing complaints by sending claims for adjustments
- Build cases for review.
Medicare Customer Care Representative
1 Year 7 Months- Create, maintain, and enter information into databases.
- Inform and educate members on their billing/ invoice set up and billing payment procedures.
- Remain up to date on frequent policy changes/ updates to Medicare policies.
- Place outgoing phone calls to members to complete follow up on their requests and inquiries.
- Escalated unresolved issues requiring further investigation or specialized expertise.
- Kept member and system account information accurate and current to support timely resolutions for concerns.
Education
GPA: 3.0
Skills
Proficiency in claims terminology
Medical database navigation (I.E. Macess
Facets
Care Radius
Clinical Care Advance)
Task Delegation
Customer de-escalation
Microsoft Office (I.E. Excel
Word
and Outlook)
Accurate data entry and processing
Multi-Line Phone Systems
Flexible and Adaptable
Phone and Email Etiquette
Decision Making
Data Gathering
Customer Service
Timeline
Safety Net Project Coordinator
Excellus Blue Cross Blue Shield
03.2023 - CurrentRead More
Front Desk Associate
Elizabeth Wende Breast Care
09.2022 - 02.2023Read More
Patient Engagement Specialist
MVP Health Care
11.2019 - 09.2022Read More
Pharmacy Specialist
MVP Health Care
06.2018 - 11.2019Read More
Provider Services
MVP Health Care
05.2017 - 06.2018Read More
Medicare Customer Care Representative
Excellus Blue Cross Blue Shield
08.2015 - 03.2017Read More
Joseph C. Wilson Magnet High School
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