Cayenne Wiley
Las Vegas,NV
Summary
Versatile leader with a proven track record in operations management, claims, and customer service. Experienced in effectively managing projects, bringing a keen eye for detail and a commitment to efficiency for timely project completion. Delivering results-driven project management solutions that contribute to organizational success.
Overview
12
12
years of professional experience
Work History
Communication Center Representative
Complex Care Solutions
Remote
03.2025 - Current
- Conduct outbound/inbound calls to health plan members to schedule in-home assessments by nurse practitioners or other clinical staff.
- Provide members with full details of the in-home assessment within guidelines of clients.
- Provide friendly customer service with a positive attitude, building rapport and trust with members.
- Present, promote, and sell benefits of in-home assessment through active listening skills, empathy, and the ability to overcome objections.
- Communication Center Representatives may also work to schedule appointments for client’s members in a physician’s office.
- Maintain compliance with Complex Care Solutions’s policies, procedures and mission statement.
- Adhere to all confidentiality and HIPAA requirements as outlined within Complex Care Solutions’s Operating Policies and Procedures in all ways and at all times with respect to any aspect of the data handled or services rendered in the undertaking of the position.
- Fulfill those responsibilities and/or duties that may be reasonably provided by Complex Care Solutions for the purpose of achieving operational and financial success of the Employer.
Delivery Courier
Uber
07.2023 - 02.2025
- Reduced customer complaints by providing timely updates and maintaining clear communication throughout the delivery process.
- Demonstrated a strong commitment to customer service excellence by maintaining a courteous demeanor in challenging situations and going above and beyond to ensure complete satisfaction.
HEDIS Supervisor & Claims Analyst
Clover Health
08.2019 - 07.2023
- Led HEDIS project resulting in an increase of company's star rating from 2 to 3.
- Providing evidence and reports of KPIs to senior management on a daily basis.
- Identifying business risks and opportunity through the analysis of information and results.
- Taking full responsibility for the day to day running of all operational areas.
- Setting and achieving operational goals and metrics.
- Pioneered multiple comprehensive training courses for new hires.
- Streamlined tracking and resolution of medical claims using specialized software tools.
- Mitigated risk by coordinating with Senior Analysts on complex patient claims.
- Oversaw invoice workflows, prioritizing audits to maintain payment timelines and data accuracy.
- Ensured adherence to regulatory compliance guidelines and maintained HIPAA standards.
- Monitored HEDIS metrics to assess patient care and clinical outcomes.
- Reviewed and purified data to comply with contractual and government standards.
Operations Supervisor
Aspire Healthcare
04.2016 - 11.2018
- Managed large teams of 30+ staff and coordinated team meetings.
- Prepared schedules and assignments to meet short- and long-term business demands.
- Evaluated credential files to identify red flags.
- Ensured accuracy of information while collaborating with medical facilities.
- Regularly update patient records, including demographics, insurance, and account information.
- Documented key information for medical teams and vendors efficiently.
- Updated health records with lab results and consultation details.
Call Center Operations Supervisor
Comprehensive Pain Specialists
02.2014 - 02.2016
- Managed a team of 20+ employees to ensure efficient operations and customer service.
- Organized training for new team members.
- Monitored employees work to assess performance and identify knowledge gaps.
- Conducted weekly team meetings to review progress and address any issues.
- Updated and maintained credential files to ensure accuracy.
- Scanned, faxed and filed documents to maintain proper office procedures.
Education
Medical Assistant Certification -
Nashville College of Medical Careers
Certified Nurse Assistant -
NATS
Skills
- Management
- Leadership
- Credentialing
- Training new hires
- Medicaid / Medicare
- ICD codes
- Insurance verification
- SOP creation
- Hosting meetings
- Auditing / Billing
- Remote Work Experience
- Records Collection
- SQL
- Claims Processing
- Microsoft Office Suite
- Customer Support (Phone/Email)
- EMR Systems
- Salesforce
Timeline
Communication Center Representative
Complex Care Solutions
03.2025 - Current
Delivery Courier
Uber
07.2023 - 02.2025
HEDIS Supervisor & Claims Analyst
Clover Health
08.2019 - 07.2023
Operations Supervisor
Aspire Healthcare
04.2016 - 11.2018
Call Center Operations Supervisor
Comprehensive Pain Specialists
02.2014 - 02.2016
Medical Assistant Certification -
Nashville College of Medical Careers
Certified Nurse Assistant -
NATS