Conzuella Jordan
Hampton
Summary
Member Service Advocate at Elevance Health specializing in claims processing and insurance verification. Demonstrated success in improving customer satisfaction through effective problem-solving and collaboration. Proficient in handling complex inquiries while ensuring compliance and accuracy, resulting in seamless patient experiences and strong relationship building.
Overview
14
14
years of professional experience
1
1
Certification
Work History
Member Service Advocate
Elevance Health
Norfolk
09.2023 - Current
- Educated members on claims processes and available resources to enhance understanding.
- Assisted members with inquiries regarding health insurance plans and benefits.
- Managed member accounts in customer relationship management system for streamlined operations.
- Documented member interactions accurately to ensure compliance and service quality.
- Collaborated with team members to resolve member-related issues efficiently.
- Provided support during open enrollment periods for health plans.
- Actively listened to member concerns and delivered timely, appropriate solutions.
- Provided exceptional customer service to members by responding promptly and courteously to inquiries, concerns, and requests.
Patient Access Team Lead
Sentara Williamsburg Regional Medical Center
Williamsburg
03.2017 - 03.2022
- Led patient access team operations at medical center
- Trained staff on registration procedures and systems
- Coordinated scheduling for patient admissions efficiently
- Implemented process improvements in patient intake
- Oversaw daily workflows in patient access department
- Mentored team members in customer service skills
- Managed patient records with confidentiality and accuracy
- Addressed and resolved patient concerns promptly
- Identified opportunities for process improvement within the department.
- Coordinated, monitored and evaluated the daily operations of the department.
- Recruited, trained and supervised new staff members in accordance with established guidelines.
- Facilitated communication between patients, physicians and other stakeholders regarding patient access needs.
- Developed and implemented policies and procedures related to patient access services.
- Managed patient registration activities including verifying insurance eligibility, collecting co-pays and deductibles and scheduling appointments.
- Monitored billing processes to ensure accuracy of information entered into system databases.
- Served as liaison between hospital administration, clinical staff and external vendors and partners.
- Responsible for ensuring that appropriate resources are available at all times.
- Assisted in developing strategies to increase patient satisfaction scores.
- Collaborated with other departments on projects as needed to ensure desired outcomes were met.
- Ensured compliance with all applicable laws, regulations, accreditation standards and organizational policies.
- Resolved customer complaints in a timely manner while maintaining high levels of customer service satisfaction.
- Applied HIPAA privacy and security regulations while handling patient information.
- Verified demographics and insurance information to register patients in computer system.
- Obtained necessary signatures for privacy laws and consent for treatment.
- Assembled registration paperwork and placed identification bands on patient.
- Communicated financial obligations to patients and collected fees at time of service.
- Explained various admission forms and policies, acquiring signatures for consent.
- Organized and maintained records by updating and obtaining both personal and financial information from patients.
- Updated reference materials with Medicare, Medicaid and third-party payer requirements, guidelines, policies and list of accepted insurance plans.
- Processed patient responsibility estimate determined by insurance at pre-registration.
Insurance Verification Specialist
Sentara Careplex Hospital
Hampton
03.2013 - 03.2017
- Verified patient insurance eligibility and benefits for timely approvals.
- Communicated with insurance companies to resolve verification issues.
- Reviewed medical records to ensure compliance with insurance requirements.
- Entered and maintained accurate patient information in electronic systems.
- Collaborated with healthcare providers to gather necessary documentation.
- Assisted patients in understanding their insurance coverage and options.
- Updated verification procedures based on policy changes and feedback.
- Verified that patients had proper insurance coverage prior to procedures or appointment scheduling.
- Updated patient and insurance data and input changes into company computer system.
- Called insurance companies to ascertain pertinent information regarding policies and payment benefits for patients.
- Communicated with insurance carrier, patient and third party or employer to verify patient insurance benefits.
- Entered data in EMR database to record payer, authorization requirements and coverage limitations.
- Navigated through multiple online systems to obtain documentation.
- Maintained accurate documentation on all pre-authorization requests, denials and appeals.
- Developed a working knowledge of insurance plans, including Medicare and Medicaid regulations and requirements.
- Contacted patients to confirm demographic information and communicate financial responsibilities.
- Checked documentation for appropriate coding, catching errors and making revisions.
- Retained strong medical terminology understanding in effort to better comprehend procedures.
- Contacted patients to arrange payment arrangements for deductible and out-of-pocket liability.
- Responded promptly to customer inquiries regarding their benefits and eligibility status.
- Participated in training sessions on new software programs used for verification purposes.
- Determined estimated self-pay portion by calculating charges, co-insurance and deductibles.
- Assisted in resolving claim issues related to billing and reimbursement inquiries.
- Liaised between physician, site of service and billing department to obtain appropriate documentation.
- Maintained confidentiality of patient information in accordance with HIPAA regulations.
- Responded to patient inquiries regarding insurance coverage and billing issues.
- Monitored and tracked the status of pending insurance verifications and authorizations.
- Liaised with insurance companies to obtain pre-authorizations for procedures and medications.
- Collaborated with healthcare providers to communicate insurance coverage and authorization details.
- Communicated with patients with compassion while keeping medical information private.
- Updated patient accounts with insurance verification information to ensure accurate billing.
Patient Access Team Lead
Sentara Williamsburg Regional Medical Center
Williamsburg
11.2011 - 03.2017
- Led patient access team operations at medical center
- Trained staff on registration procedures and systems
- Coordinated scheduling for patient admissions efficiently
- Implemented process improvements in patient intake
- Oversaw daily workflows in patient access department
- Mentored team members in customer service skills
- Managed patient records with confidentiality and accuracy
- Addressed and resolved patient concerns promptly
- Identified opportunities for process improvement within the department.
- Coordinated, monitored and evaluated the daily operations of the department.
- Analyzed data trends to identify areas of opportunity or concern related to patient access services.
- Facilitated communication between patients, physicians and other stakeholders regarding patient access needs.
- Developed and implemented policies and procedures related to patient access services.
- Managed patient registration activities including verifying insurance eligibility, collecting co-pays and deductibles and scheduling appointments.
- Monitored billing processes to ensure accuracy of information entered into system databases.
- Served as liaison between hospital administration, clinical staff and external vendors and partners.
- Responsible for ensuring that appropriate resources are available at all times.
- Assisted in developing strategies to increase patient satisfaction scores.
- Collaborated with other departments on projects as needed to ensure desired outcomes were met.
- Resolved customer complaints in a timely manner while maintaining high levels of customer service satisfaction.
- Applied HIPAA privacy and security regulations while handling patient information.
- Verified demographics and insurance information to register patients in computer system.
- Obtained necessary signatures for privacy laws and consent for treatment.
- Assembled registration paperwork and placed identification bands on patient.
- Communicated financial obligations to patients and collected fees at time of service.
- Explained various admission forms and policies, acquiring signatures for consent.
- Organized and maintained records by updating and obtaining both personal and financial information from patients.
- Updated reference materials with Medicare, Medicaid and third-party payer requirements, guidelines, policies and list of accepted insurance plans.
- Supported emergency department registration during peak times, ensuring rapid patient processing.
- Provided directions and information to patients and families, enhancing their hospital experience.
- Guided patients through the completion of consent and other required medical forms.
- Handled high volume of incoming calls, providing exceptional customer service to patients and families.
- Assisted in the implementation of new technologies and processes to improve patient access services.
- Addressed patient inquiries and concerns, resolving issues in a timely and empathetic manner.
- Processed patient co-pays, deductibles, and other payments, ensuring accurate financial records.
- Contributed to team meetings, sharing insights and strategies for improving patient access services.
- Processed insurance verifications and authorizations to ensure coverage of services.
- Coordinated with clinical staff to manage patient flow, reducing wait times and improving satisfaction.
- Managed patient check-in process, ensuring accurate data entry of personal and insurance information.
- Verified patients' insurance and payment methods during admissions or check-in processes.
- Collaborated with clinical and administrative staff to meet patient needs.
Education
Associate of Applied Science -
Winsalm Business College
Greensboro, NC06-1979
Skills
- Claims processing and insurance verification
- Customer relationship management
- Data entry and proficiency
- Patient registration and health insurance knowledge
- Problem solving and issue resolution
- Team collaboration and effective communication
- Process improvement strategies
- Customer service and support
- Complaint handling and dispute resolution
- Call center experience and inbound/outbound calling
- Typing speed of 60 wpm
- Calm under pressure and strong interpersonal skills
Certification
- Certified Health Access Associate
Affiliations
- Served in The US Army
References
References available upon request.
Timeline
Member Service Advocate
Elevance Health
09.2023 - Current
Patient Access Team Lead
Sentara Williamsburg Regional Medical Center
03.2017 - 03.2022
Insurance Verification Specialist
Sentara Careplex Hospital
03.2013 - 03.2017
Patient Access Team Lead
Sentara Williamsburg Regional Medical Center
11.2011 - 03.2017
Associate of Applied Science -
Winsalm Business College
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