Summary
Overview
Work History
Education
Skills
Timeline
Generic

Charlmaine Echols

Summary

Proactive and results-driven Surest Senior Provider Relations Advocate with a proven track record of addressing complex operational issues, enhancing provider satisfaction, and driving digital adoption for UHC. A trusted advisor with solid self-management skills, resilience, and persistence in problem-solving. Excels in collaboration across dynamic/matrixed organizations, delivering positive outcomes for providers and achieving business goals.

Overview

9
9
years of professional experience

Work History

Senior Inbound Clinical Administrative Coordinator

United Healthcare Group
11.2022 - Current
  • Provided comprehensive administrative support to department staff.
  • Triaged and determined root cause of escalated claims issues impacting provider’s Accounts Receivable.
  • Reviewed cases to determine need for escalation.
  • Managed patient scheduling and rescheduling, directing related billing issues to supervisor.
  • Assisted patients in adhering to prescribed care models via phone and email communications.
  • Provide inbound telephonic support for DSNP members.
  • Complete telephonic outreach to DSNP members utilizing manual dialing, as needed.
  • Assist with non-phone work, including que maintenance, reviewing tasks, and assignment of members.
  • Assists members' immediate needs when assigned Care Navigator is not available.
  • Educates member on gaps in care and assists with scheduling provider appointments. o Assists members with social determinants of health and links to community resources. o Ensures member has access to PCP.
  • Reviews voicemails and assigns out for callbacks.
  • Plan, prioritize, organize, and complete work to meet established timelines and goals.
  • Complete and coordinate projects as needed from management.
  • Provided input, support, and helped develop special projects such as Inbound OneNote and Star Gaps OneNote.
  • Assisted leadership with training Inbound team during STAR GAP Campaign.

Insurance Verification Specialist III

Alliance Walgreens Prime
10.2019 - 11.2022
  • Answered telephone calls to offer office information, answer questions, and direct calls to staff.
  • Complied with HIPAA guidelines and regulations for confidential patient data.
  • Updated patient records with accurate, current insurance policy information.
  • Managed high-volume insurance verifications within pressured timeframes for productive medical operations.
  • Led multiple facets of patient account services, including Major Medical/PBM benefit assessment, insurance verification, precertification, and preauthorization.
  • Communicated outstanding documentation requests and payer issues to facility contacts.
  • Specialized in patient access functions, demonstrating advanced understanding of insurance benefits and internal processes.
  • Ensured accurate coordination of benefits, maintaining positive relationships with Payers, Pharma, Physicians, and Patients.
  • Acted as a subject matter expert, resolving insurance-related concerns between sales staff and patients.
  • Achieved and maintained key performance indicators, managing daily eligibility workload, insurance claims, and various operational functions.
  • Managed and assisted sales/support team members, demonstrating leadership skills.
  • Acted as a point of escalation for critical customer questions or issues, maintaining confidentiality and professional communication.

Customer Service Advocate

Torchmark Corporation (United American/Globe Life)
07.2017 - 10.2019
  • Helped large volume of customers every day with positive attitude and focus on customer satisfaction.
  • Promoted superior experience by addressing customer concerns, demonstrating empathy, and resolving problems swiftly.
  • Learned and maintained in-depth understanding of product information, providing knowledgeable responses to diverse questions.
  • Completed opening and closing functions to meet operational needs.
  • First tier support for all customer claim inquiries and effectively communicate and resolve each related issue.
  • Assist with daily call volume and provide accurate resolutions to customer claim inquiries in a professional and courteous manner.
  • Ensure customer needs are met on every interaction (phone, email, written correspondence, faxes, etc.
  • Meet Quality Assurance requirements and other key performance metrics.
  • Work to research and resolve problems in a timely manner while maintaining productivity standards and performance.
  • Research and process Globe Life payments.
  • Help customer’s resolve all Part D prescription related issues.
  • Verify patient’s insurance and claim status for Medicare Supplements.

Insurance Verification Specialist

AppleOne (Texas Health Resources)
11.2016 - 04.2017
  • Complied with HIPAA guidelines and regulations for confidential patient data.
  • Assisted patients with understanding personalized insurance coverage and benefits.
  • Assured timely verification of insurance benefits prior to patient procedures or appointments.
  • Made contact with insurance carriers to discuss policies and individual patient benefits.
  • Responsible for ensuring external and internal telephone calls are answered in a professional and timely manner in accordance with department policies, procedures and performance goals.
  • Verified Commercial and Medicaid/Medicare insurance for eligibility and benefit utilizing one of the following methods as appropriate: RTS, payer’s website, and phone.
  • Called/or emailed Pre-registration of patient’s financial obligation at the time of service for any amount beyond the copay.
  • Worked closely with health center and call center staff to assist in identification of patient responsibility. Identifies accurate patient portions in order to collect money at the time of service (including past due account balances).
  • Worked with Epic EMR system and Invision
  • Processed and posted patient payments (credit card) in an accurate and timely manner in accordance with department policies, procedures and performance goals.
  • Maintained confidentiality of all information; adheres to all HIPAA guidelines/regulations.

Toxicology Processing Specialist/Customer Relation

SNI Staffing (Next Health/Southwest Laboratory
04.2016 - 09.2016
  • Provided members with optimum sales and service experience to enhance member affinity to company.
  • Worked to meet or exceed targets as defined in sales incentive plan and assigned by insurance manager.
  • Responded to customer inquiries and requests related to insurance products and membership.
  • Solicited and marketed to business and community events and performed outbound calling.

Ad A Staff

Dallas County Health And Human Services
03.2015 - 12.2015
  • Skilled at working independently and collaboratively in a team environment.
  • Self-motivated, with a strong sense of personal responsibility.
  • Proven ability to learn quickly and adapt to new situations.
  • Worked well in a team setting, providing support and guidance.
  • Answer applicants' questions about CEAP eligibility criteria.
  • Interview benefits recipients at specified intervals to certify their eligibility for assistance.
  • Interpret and explain information such as eligibility requirements, application details, payment methods, and applicants' legal rights.
  • Initiate procedures to grant, modify, deny, or terminate assistance, or refer applicants to other agencies for assistance.
  • Compile, record, and evaluate personal and financial data to verify completeness and accuracy, and to determine eligibility status.
  • Keep records of assigned cases and prepare required reports.
  • Schedule benefits claimants for adjudication interviews to address questions of eligibility.
  • Provide social workers with pertinent information gathered during applicant interviews.
  • Compute and authorize amounts of assistance for CEAP as well as monetary payments.
  • Monitor the payments of benefits throughout the duration of assistance.

Education

Associate of Arts - Business

Tarrant County College District
Fort Worth, TX
05.2015

Medical Office Administration - Medical Office Administration

Concorde Career Institute
Dallas, TX
02.2013

Skills

  • Claims Assessments
  • Documentation Skills
  • Medical Office Management
  • Clerical Assistance
  • Electronic Billing
  • Collection Techniques
  • Medicaid/Medicare
  • ICD-9/10 and CPT Coding
  • Keyboard (50wpm)
  • EOB Reconciliation
  • Microsoft Word and Excel
  • Front Office Procedures
  • Scheduling
  • HIPAA Training
  • Claims Submission
  • Posting
  • OSHA Standards
  • 10-Key (8000)
  • Patient Statements
  • A&P Terminology
  • Set Up Patient Accounts
  • Verify Insurance
  • Insurance Terminology
  • Ethics/Medical Standard
  • Customer Service

Timeline

Senior Inbound Clinical Administrative Coordinator

United Healthcare Group
11.2022 - Current

Insurance Verification Specialist III

Alliance Walgreens Prime
10.2019 - 11.2022

Customer Service Advocate

Torchmark Corporation (United American/Globe Life)
07.2017 - 10.2019

Insurance Verification Specialist

AppleOne (Texas Health Resources)
11.2016 - 04.2017

Toxicology Processing Specialist/Customer Relation

SNI Staffing (Next Health/Southwest Laboratory
04.2016 - 09.2016

Ad A Staff

Dallas County Health And Human Services
03.2015 - 12.2015

Associate of Arts - Business

Tarrant County College District

Medical Office Administration - Medical Office Administration

Concorde Career Institute

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Charlmaine Echols