Dalphnye Hayes
Upper Marlboro,Maryland
Summary
Results-driven professional with extensive experience in member services, provider relations, and administrative support within a healthcare setting. Adept at leveraging organizational skills and a strong work ethic to enhance operational efficiency and customer satisfaction. Seeking to contribute to a dynamic team where my skills in communication, problem-solving, and relationship-building can drive company growth and excellence.
Overview
37
37
years of professional experience
Work History
Member Services Coordinator
Kaiser Permanente
Falls Church, VA
01.2008 - Current
- Serve as the primary resource expert on all products, benefits, and policies, ensuring effective operationalization and administration
- Assist members with resolving issues related to benefits, appointment access, medical referrals, claim payments, and service quality, ensuring compliance with state and federal regulations
- Conduct orientations for members, staff, and providers to ensure thorough understanding of Kaiser Services, systems, and procedures
- Participate in interdepartmental meetings and contribute to the smooth operation of the medical center
- Proficient in METRS which allowing for processing grievance, inquiries and assist with processing appeals cases; Also, use the Healthconnect system to view members chart, look up claims and waive copays if necessary
- Manage payments for on-Exchange Member accounts and provide information about Medicare Advantage benefits and products
- Collaborate with Northern Virginia Medicare Specialist for member enrollment in Kaiser Permanente Advantage
- Assist other service areas in the absence of the Member Services Coordinator
Communications Coordinator
Kaiser Permanente
Rockville, MD
01.2006 - 01.2008
- Managed provider relationships by addressing inquiries related to claims, accounts receivable, and internal processes
- Handled all calls and internal inquiries related to provider issues and documented contacts for trend analysis and reporting
- Represented the appeals committee and worked collaboratively across departments to resolve provider issues and create educational tools
- Utilized tact and diplomacy to communicate resolutions and maintained understanding of the healthcare market
- Contributed to the Appeals and Grievances Committee for issue resolution
- Also, assist members with their request to file an appeal when denied services/care
Administrative Assistant
Kaiser Permanente
Largo, MD
01.1999 - 01.2006
- Facilitated day-to-day operations for the medical center and administrative team, supporting the Administrator and Physician Director
- Served as the primary contact for internal and external business activities, using computer skills to manage Microsoft applications and internal resources
- Managed inquiries, follow-ups, and correspondence, ensuring accurate and efficient communication
Administration Assistant
Veterans Administration
, DC
07.1987 - 06.1988
- Organized and maintained files, including electronic records.
- Managed daily calendars for multiple staff members.
- Assisted with the preparation of reports, presentations, and spreadsheets.
- Created and distributed documents, such as agendas and meeting minutes.
- Provided administrative support to management team.
- Coordinated meetings and travel arrangements for employees.
- Prepared invoices, expense reports, memos, letters, and other documents using Microsoft Office Suite applications.
- Greeted visitors in a courteous manner and provided assistance when necessary.
- Performed data entry tasks accurately within specified timeframes.
- Answered incoming calls in a professional manner.
Education
Bachelor of Business Administration - Healthcare Management
Colorado Technical University
Master of Business Administration (MBA) -
Colorado Technical University
High School Diploma -
Largo High School
Skills
- Communication Skills: Proficient in conveying complex information clearly and effectively
- Building Relationships: Skilled in fostering strong professional connections with members and colleagues
- Decision Making: Capable of making informed decisions that positively impact operations and customer service
- Strong Work Ethic: Dedicated and reliable with a commitment to high-quality performance
- Positive Attitude: Maintains a constructive and enthusiastic approach to work challenges
- Problem Solving: Effective in identifying issues and implementing practical solutions
References
Available upon request
Timeline
Member Services Coordinator
Kaiser Permanente
01.2008 - Current
Communications Coordinator
Kaiser Permanente
01.2006 - 01.2008
Administrative Assistant
Kaiser Permanente
01.1999 - 01.2006
Administration Assistant
Veterans Administration
07.1987 - 06.1988
Bachelor of Business Administration - Healthcare Management
Colorado Technical University
Master of Business Administration (MBA) -
Colorado Technical University
High School Diploma -
Largo High School
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