Danielle Westerbeck
Pittsburgh,PA
Summary
Patient Service Representative with extensive experience at UPMC- Vision Institute, specializing in patient education and insurance verification. Demonstrated success in improving patient satisfaction through effective communication and conflict resolution. Proficient in HIPAA compliance and medical record management, facilitating seamless healthcare navigation and continuity of care.
Overview
14
14
years of professional experience
Work History
Patient Service Representative
UPMC- Vision Institute
Pittsburgh, PA
04.2023 - Current
- Help patients navigate the healthcare system by providing clear and understandable instructions.
- Provides follow-up to unresolved patient questions or needs to ensure the appropriate continuity of care.
- Assist with administrative duties in the office including but not limited to scanning of medical records and faxing.
- Schedule or connect patient to resources to schedule for ancillary services at checkout.
- Assist patients in education of financial responsibility and connect them to advocacy resources as needed.
- Obtain signature of patient or family member for consent to treatment and financial responsibility following the Health Insurance Portability and Accountability Act (HIPAA) rules and regulations.
- Confirm/verify insurance benefits with the appropriate carrier via online verification systems or telephone inquiries.
- Promote MyUPMC patient portal and assist patients in registration when applicable.
- Collect copayments and any other applicable patient payments at the point of service.
- Provide a warm greeting for all patients.
- Confirm and/or update patient registration information at checkout.
- Appropriately distribute / triage phone calls to other areas and / or clinical providers.
- Schedule follow-up appointments within the practice at checkout.
Sr. Client Manager
Highmark Inc.
Pittsburgh, PA
01.2017 - 09.2020
- Responsible for benefits management for 15 National Employer groups.
- Assisted in preparation of benefit design, performed financial analysis and market research.
- Functioned as the primary contact for client-facing issues.
- Partner with assigned Client Manager(s) to maintain and grow existing business and ensures positive account relationships are maintained.
- Assist in the preparation of benefit design analysis for specialized proposals and quotes.
- Develop detailed specifications for implementation of new products for clients.
- Conduct enrollment meetings during the account renewal process.
- Analyze operational business problems and provide problem resolution and effect change to all facets of the company.
- Leverage internal resources to bring the best service and problem resolution to assigned accounts.
- Work closely with Sales Support Analysts responsible for account processing and set-up to ensure accurate and seamless service delivery.
- Develop documents and processes to ensure effective communication via work plans for all account implementation activities.
- Function as the primary contact for the resolution of the day-to-day account service issues.
- Support customers during the implementation of sales contracts and throughout the relationship by resolving difficult issues in a timely and professional manner; taking responsibility for customer satisfaction and loyalty.
- Licensed in Life, Accident and Health Insurance.
Senior Customer Advocate
Highmark Inc.
Pittsburgh, PA
09.2011 - 01.2017
- Key contact for National Clients- United States Steel, Kennametal, and liaison between Highmark and Aetna.
- Participant in weekly meetings with the Sales area, external vendors, and group clients.
- Responsible for critical controls ensuring accurate member/claim reporting data is delivered to the client monthly.
- Respond to members, providers, group administrators, legislative and regulatory agency inquiries in an accurate and timely manner, ensuring acceptable service levels, metrics where performance guarantees are required.
- Assists with implementing new groups and existing groups benefit changes.
- Analyze claims data to identify and resolve complex issues.
- Review daily inventory and staffing levels and makes assignments accordingly.
- Monitor and manage daily call volumes, aged cases, trends to ensure adequate staffing and resources are available, ensuring performance goals are met and maintained.
- Assist with the claim support when necessary and managing the claims inventory.
- Mentor, train, and provide developmental support to staff.
- Delegate work to develop individual skills.
- Monitor premium payments due from members and promptly contact the client with past due payments.
- Responsible for the unapplied cash, refund, and cancellation reports for United States Steel.
- Draft responses to claims questions resulting from paid claims audit.
- Participate in audits as required by an account, which includes evaluating the accuracy of claims and adjustments against BCBSA guidelines, government regulations, corporate and departmental policies and procedures, contractual guidelines, benefit booklets, and other related requirements as applicable.
- Work independently to identify, address, and resolve issues.
- Assist claimants in scheduling diverse types of medical appointments.
- Maintain electronic records that contained claimant correspondence and medical records.
- Maintained approved participating provider directory.
Education
Associate of Arts - Psychology
University of Phoenix
Phoenix01.2014
Graduated with honors -
South Vo-Tech High School
Pittsburgh01.2001
Skills
- Patient registration and insurance verification
- HIPAA compliance
- Medical record management
- Patient education
- Customer service
- Communication skills
- Conflict resolution
- Team collaboration
- Data entry
- Appointment scheduling
- Financial needs determination
- Medical terminology
- Clinical data entry
- Medical insurance
- Electronic health records
- Scheduling appointments
- Post-discharge care coordination
- Health insurance knowledge
References
Furnished Upon Request
Timeline
Patient Service Representative
UPMC- Vision Institute
04.2023 - Current
Sr. Client Manager
Highmark Inc.
01.2017 - 09.2020
Senior Customer Advocate
Highmark Inc.
09.2011 - 01.2017
Associate of Arts - Psychology
University of Phoenix
Graduated with honors -
South Vo-Tech High School
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