Obtain a position as a collaborator in a people-oriented organization and can maximize customer service experiences in a challenging environment to achieve the corporate goals.
Overview
10
10
years of professional experience
Work History
HR Service Center Representative
Cleveland Clinic Foundation
03.2024 - Current
Utilized multiple software applications simultaneously for efficient data entry and record-keeping purposes during calls.
Reviews caregiver eligibility for FMLA, short-term disability and medical leave. Sends required eligibility and designation notices. Ensures compliance with internal and external policies and regulations.
Reviews medical documentation and works with nurse case manager to approve for appropriate benefit pay as well as job protection benefits.
Communicates and explains determinations and leave requirements to caregivers.
Creates leave cases in HRIS, timekeeping and payroll systems. Schedules payment for caregivers on unpaid and paid leaves of absence.
Serves as point of contact for leave inquiries and questions. Advises employees and managers on the organization's leave programs, including maternity or paternity leave, medical or disability leave, military leave, or unpaid leave.
Serves as escalation point of contact support to incoming calls/emails/requests from customers (e.g., caregivers, managers, candidates, dependents) to answer questions, resolve issues, and respond to inquiries related to specific area of focus (e.g., Benefits, Absence).
Medical Claims Representative
Progressive
06.2023 - 02.2024
Medical claims analysis to make sure we are paying for claims correctly
Reviewed medical notes and employer documents to make sure they aligned with the established protocol for reimbursement of wages and other-of-pocket expenses
Reviewed medical claims that were paid by health insurance carriers so that we can reimburse correctly
Investigation of coverage, fraud, and subrogation issues
Claims verification and resolution.
Provided excellent customer service to both patients and healthcare providers during the entire claims process.
Claims Processor II
Progressive
02.2022 - 05.2023
Separate and processes mail sent in by banks, attorneys, insurance companies and direct customers
Indexes non-medical mail and faxes into the appropriate claims so that adjuster can review it
Trains new hires on how process and index mail appropriately
Reviews new hire work before it goes into the system to make sure it is correct
Collaborates with another small group of associates to enhance team building efforts
Consistent top performer.
Kidney Transplant Financial Coordinator
Tampa General Hospital
07.2017 - 02.2020
Contacted insurance carriers to discuss policies and individual patient benefits
Answered questions over phone and in-person regarding billing, scheduling, and treatment
Assisted in pre-clearing patients for necessary appointments and procedures required by kidney transplant team
Reviewed bills to make sure accounts were paid by correct insurance carrier when it came to transplant services
Consistent team top performer
Exceeded goals by at least 10% every month.
Kidney Transplant Patient Financial Advocate
Cleveland Clinic Foundation
07.2017 - 02.2020
Verified coverage and benefit information for patients
Met with donors and recipients during full day evaluation to go over their benefits and to answer questions
Assisted in pre-clearing patients for necessary appointments and procedures required by kidney transplant team
Reviewed bills to make sure accounts were being paid by correct insurance carrier when it came to transplant services
Consistent team top performer
Exceeded monthly goals by at least 20%.
Patient Financial Advocate
Cleveland Clinic Foundation
12.2014 - 06.2017
Verified coverage and benefit information for patients
Obtained payment from self-pay patients
Assisted in pre-clearing patients for necessary appointments and procedures
Obtained out-of-pocket maximum and deductible amounts prior to scheduling patients
Reviewed billing to make sure any package pricing quoted was applied
Staff Physician, Department of Hospital Medicine at Cleveland Clinic FoundationStaff Physician, Department of Hospital Medicine at Cleveland Clinic Foundation