Summary
Overview
Work History
Education
Skills
Timeline
Hi, I’m

Constance Davis

Phenix City,USA
Constance Davis

Summary

Skillful and dedicated Professional with extensive experience in the coordination, development, and support of daily operational and administrative functions. A leader in managing a company as well as individual team efforts through effective, motivating and mentoring strategies Establish good working relationships with internal and external customers Encourage creativity, independence, initiative and higher order thinking to increase performance Highly focused and results- oriented in supporting operations: able to identify goals and priorities Motivated professional with excellent research, written and interpersonal communication skills Proficient in Microsoft Office System, ACMP, MACESS, FACETS, NEXTGEN, CIW,WGS, Microsoft Windows operating system, Web Browsers, and Electronic Mail Major strengths include strong leadership, excellent communication skills, dependable, independent, competent, strong team player, attention to detail, dutiful respect for compliance in all regulated environments. Thorough knowledge of current customer service practices, a clear vision to accomplish the company goals, computer and internet literate.

Polished professional manages multiple tasks, utilizes electronic medical record systems, and provides excellent customer service to patients and staff. Adheres to medical records policies and procedures to comply with HIPAA regulations. Track record of effectively troubleshooting issues and maintaining patient confidentiality.

Overview

17
years of professional experience

Work History

Elevance Health (Carelon)

Medical Management Specialist-I
04.2022 - 09.2024

Job overview

  • Gathered clinical information regarding case and determines appropriate area to refer or assign case (utilization management, case management, Med Review)
  • Provides information regarding network providers or general program information when requested
  • Assist with complex cases
  • Acts as liaison between Medical Management and/or Operations and internal departments
  • Maintains and updates tracking databases, spreadsheets, internal reviews
  • Prepares reports and documents all actions
  • Responsibilities exclude conducting any utilization management review activities which require interpretation of clinical information
  • Developed comprehensive training materials for new Medical Management Specialists, ensuring a consistent standard of knowledge across the team.
  • Identified opportunities for cost savings in healthcare delivery, ultimately contributing to overall organizational profitability.
  • Conducted thorough audits of medical records to ensure compliance with legal requirements and industry best practices.
  • Provided expert guidance during critical decision-making moments, resulting in timely interventions that saved lives or reduced long-term complications for patients.
  • Championed a culture of continuous improvement by encouraging staff to identify areas for potential enhancement and working collaboratively to implement changes.
  • Established strong relationships with external stakeholders, including insurance companies and regulatory agencies, ensuring smooth operations and compliance with relevant guidelines.
  • Facilitated cross-functional meetings between departments to improve communication and collaboration within the organization.
  • Enhanced patient care by implementing efficient medical management processes and protocols.
  • Mentored junior staff members, helping them develop their skills as Medical Management Specialists while also fostering a positive work environment.
  • Collaborated with healthcare providers for better coordination of patient care plans, resulting in more seamless treatment experiences.
  • Implemented innovative case management strategies that resulted in reduced lengths of stay for patients receiving complex treatments.
  • Spearheaded the implementation of new technologies, leading to more efficient processes and improved patient outcomes.
  • Contributed to strategic planning initiatives within the organization, utilizing extensive industry knowledge to inform future growth and development.
  • Maintained accuracy, completeness, and security for medical records and health information.
  • Utilized electronic medical record systems to store, retrieve and process patient data.
  • Verified accuracy of patient information in medical records.
  • Scanned and uploaded medical records into electronic medical records system.
  • Input data into computer programs and filing systems.
  • Communicated effectively with staff, patients, and insurance companies by email and telephone.
  • Reviewed medical records for completeness and filed records in alphabetic and numeric order.
  • Tracked and monitored requests for medical records release.
  • Transcribed and entered patient medical information into electronic medical records systems.

Vacasa Vacation Rentals

Customer Service Representative
04.2022 - 06.2023

Job overview

  • Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
  • Resolved customer complaints with empathy, resulting in increased loyalty and repeat business.
  • Handled escalated calls efficiently, finding satisfactory resolutions for both customers and the company alike.
  • Responded to customer requests for products, services, and company information.
  • Developed strong product knowledge to provide informed recommendations based on individual customer needs.
  • Developed rapport with customers through active listening skills, leading to higher retention rates and positive feedback from clients.

Anthem

Customer Service Representative I-III
02.2013 - 04.2022

Job overview

  • Respond to customer inquiries via phone, correspondence, and email in a high-volume managed care operational center
  • Time sensitive response using exceptional written and verbal communication skills
  • Maintain exceptional performance metric in highly stressful deadline driven environment
  • Research and analyze data to address operational challenges and optimize company process efficiency
  • Ability to adapt to ever changing environment and multiple mergers
  • Manage assigned queues keeping up to date and current on all claims and meeting productivity criteria
  • Ability to multitask while maintaining attention to detail
  • Ability to work efficiently and calmly in an environment with changing priorities
  • Detail oriented with efficient time management and strong communication skills
  • Communicate with providers and Member for claim issue resolution
  • Review and validation of requests for claim review and other claims documents
  • Demonstrate solid judgment and discretion working with confidential information
  • Work with teams inside and outside the department, and external customers as needed
  • Handle escalated calls; take appropriate action to calm upset customers and resolve customer complaints
  • Provide feedback to Call Center Management regarding employees’ performance
  • Act as the primary point of contact for CSRs in the absence of a supervisor

Road America

Supervisor
04.2007 - 11.2011

Job overview

  • Managed a team of 25 or more individuals
  • Supervised and trained team members according to company’s metrics for quality and call-handling
  • Oversaw daily operations of the department, ensuring smooth workflow and timely completion of tasks.
  • Ability to work efficiently and calmly in an environment with changing priorities
  • Applied strong leadership talents and problem-solving skills to maintain team efficiency and organize workflows.
  • Detail oriented with efficient time management and strong communication skills
  • Improved customer satisfaction with timely response to inquiries, addressing concerns, and finding effective solutions.
  • Communicate with providers and Member for claim issue resolution
  • Increased team productivity by implementing efficient workflows and setting clear expectations for staff members.
  • Work with teams inside and outside the department, and external customers as needed
  • Handle escalated calls; take appropriate action to calm upset customers and resolve customer complaints
  • Provide feedback to Call Center Management regarding employees’ performance

Education

CVCC
Phenix City, AL

Associate of Arts from Business Communication
12-2005

University Overview

Skills

  • HIPAA compliance
  • Healthcare analytics
  • Microsoft office
  • Insurance verification
  • Patient care coordination
  • Quality improvement
  • Utilization review
  • Healthcare management

Timeline

Customer Service Representative
Vacasa Vacation Rentals
04.2022 - 06.2023
Medical Management Specialist-I
Elevance Health (Carelon)
04.2022 - 09.2024
Customer Service Representative I-III
Anthem
02.2013 - 04.2022
Supervisor
Road America
04.2007 - 11.2011
CVCC
Associate of Arts from Business Communication
Constance Davis