Summary
Overview
Work History
Education
Skills
Certification
Additional Information
Languages
Timeline
Generic

DARRIELLE HAYES

Tampa,FL

Summary

Effective Medical Claims Processor with strong background building rapport with providers to discuss claim status or claim denials. Driven performer equipped to handle multiple administrative tasks effectively. Exemplary worker with highly investigative skills when processing claims.

Overview

11
11
years of professional experience
1
1
Certification

Work History

Medical Claims Adjuster

Lincare Healthcare
04.2022 - Current
  • Review and make sure all documentation created and received meets insurance guidelines
  • Researched and resolved complex medical claims issues to support timely processing.
  • Contact Doctors' offices, hospitals, and insurance companies to ensure all necessary billing documents are received
  • Answer/make phone calls using proper telephone etiquette
  • Promotes products and facilitates customer needs to utilize company's products or services by adequately assessing customer qualification, thoroughly explaining product/services benefits, and assisting with facilitating physician communication as necessary
  • Records customer information and maintains database by obtaining, entering, and verifying required data
  • Ensures quality service by following departmental and company policies, procedures, and standards
  • Facilitates sales process by communicating/sharing information with appropriate internal and external contacts
  • Completes and ensures accurate validation of insurance benefits
  • Provides customer follow-up as required
  • Contributes to departmental objectives by accomplishing required contact and sales results, tracking and reporting progress of sales results
  • Processes Accept to Host in LITE
  • Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
  • Managed large volume of medical claims on daily basis.
  • Paid or denied medical claims based upon established claims processing criteria.
  • Verified patient insurance coverage and benefits for medical claims.

Collections Representative

Bank of America
12.2021 - 02.2023
  • Answer inbound customer requests via telephone, email or chat or any additional method of inbound communication; regarding credit card services demonstrate proficiency with all internal tools
  • Contact and interface for customers regarding support, troubleshooting and problem resolution
  • Resolve technical support issues for supported products within identified timeframes with a focus on first call resolution
  • Identify beneficial product opportunities for existing customers and communicate to sales team via workflow process
  • Document all activities with customers in CRM per defined process and procedures
  • Resolve open cases within specified guidelines
  • Elevate issues following escalation procedure timely and as appropriate

Member Service Representative/ Tech suppport

USAA
11.2019 - 12.2021
  • Answer inbound customer requests via telephone, email or chat or any additional method of inbound communication; demonstrate proficiency with all internal tools
  • Contact and interface for customers regarding support, troubleshooting and problem resolution
  • Resolve technical support issues for supported products within identified timeframes with a focus on first call resolution
  • Identify beneficial product opportunities for existing customers and communicate to sales team via workflow process
  • Document all activities with customers in CRM per defined process and procedures
  • Resolve open cases within specified guidelines
  • Elevate issues following escalation procedure timely and as appropriate
  • Other duties as requested and/or determined
  • Answered a high volume of calls from customers or their representative, regarding bill balances, or new services
  • General customer concerns
  • Trouble-shooting computer and networking issues
  • Maintaining, Administrating and Monitoring client networks, servers, systems, software and applications
  • Logging all activities in trouble ticketing system
  • Experience with call center telephony and ticket system software (Remedy, ServiceNow, Salesforce)
  • Experience supporting applications running on Windows operating system
  • Providing technical assistance and support related to computer systems, hardware, and software
  • They are responsible for answering queries and addressing system and user issues in a timely and professional manner
  • Good organizational skills
  • Ability to multi-task, including the ability to type while talking on the phone
  • Ability to work independently and as part of a team.Receives and/or places telephone calls to handle any/
  • All aspects of customer accounts, including solicitation, inquiries, and problem resolution
  • Banking
  • Insurance billing
  • Wire operations

Material Handler

Aramark
09.2018 - 02.2021
  • Verifies and keeps records on incoming and outgoing shipments and prepares items for shipment
  • Receives, lifts, moves, stores, issues, counts, sorts, weighs, and verifies items on requisitions or invoices
  • Receives and processes a wider variety of incoming freight, including stationery supplies, chemicals, electronic equipment, and other materials daily across perimeter buildings and according to priority
  • Compares incoming and outgoing shipments to bills of lading, invoices, orders, or other records to verify information
  • Determines method of shipment, utilizing knowledge of shipping procedures, routes, and rates
  • Unpacks and examines incoming shipments, rejects damaged items, records shortages, and corresponds with shipper to rectify damages and shortages
  • Fills orders, issues supplies from stock and rotates stock to ensure freshness
  • Resolves delivery problems using a computerized account payable/purchasing system
  • Maintains confidentiality of all items received and shipped
  • Assembles and delivers equipment such as glassware carts
  • Utilizes in-house inventory tracking system
  • Prepares assets for distribution, including transportation and storage
  • Returns damaged items or other items to vendors that do not meet aramark specifications
  • Maintains cleanliness and orderliness of storage areas by sweeping and mopping
  • Provides security for all stock in the storeroom and/or refrigerator/freezer
  • Follows all safety requirements of aramark, the facility, local, state, and federal jurisdictions
  • May move or transport materials or supplies to other departments using hand or industrial trucks
  • Complies with all aramark HACCP/OSHA, and/ or local policies and procedures related to all assigned work
  • Reports all accidents and injuries in a timely manner
  • Complies with all company safety and risk management policies and procedures
  • Participates in regular safety meetings, safety training and hazard assessments.

CSR - Customer Service Representative

Crius Energy
02.2013 - 08.2018
  • Manages and oversees a team of call center agents
  • Motivates and supports agents through feedback and communication
  • Measures KPI’s like inbound calls, call waiting, and call abandonment
  • Assists with taking agents’ calls if they can’t handle the workload
  • Improves quality of results by recommending changes
  • Provides product/service information by answering questions and offering assistance
  • Keep track of employee attendance, and make sure work procedures are complied with
  • Assist in hiring and onboarding new employees
  • Prepares monthly and annual performance reports
  • Creates targets and goals for improvement
  • Answer inbound customer requests via telephone, email or chat or any additional method of inbound communication
  • Demonstrate proficiency with all internal tools
  • Contact and interface for customers regarding support, troubleshooting and problem resolution
  • Computer skills - Microsoft Office, Word, Excel, PowerPoint
  • Customer service for art mobility
  • Be able to handle an average 110 customer interactions
  • Provide prompt, accurate and courteous responses to customers
  • Solve routine and complex problems
  • Display active listening and superior customer service skills for both external & internal customers
  • Document activity to the DDF system
  • Consistently check appropriate DDF screen for report results to call back to customer
  • Display the ability to enter orders manually via our fax process

Warehouse Associate

Tampa Tribune
01.2014 - 01.2015
  • Took orders and packed items for customer deliveries
  • Operated dolly and pallet jack
  • Loaded and unloaded merchandise
  • Organized materials
  • Manually inspected items
  • Processed delivery reports and inventory
  • Worked in a production warehouse

Cashier/Customer Service

Wal-Mart
01.2013 - 01.2014
  • Handle cash, credit, or check transactions with customers
  • Scan goods and collect payments
  • Ensure pricing is correct
  • Issue change, receipts, refunds, or tickets
  • Redeem stamps and coupons
  • Count money in cash drawers at the beginning and end of shifts to ensure that amounts are correct and that there is adequate change
  • Make sales referrals, cross-sell products, and introduce new ones
  • Resolve customer complaints, guide them, and provide relevant information
  • Bag items carefully
  • Greet customers when entering or leaving establishment
  • Maintain clean and tidy checkout areas
  • Keep reports of transactions

Education

Diploma - BioMed

Hillsborough Community College
Tampa, FL
2017

Associate - Computer Technology

Middleton High School
Tampa, FL
2014

Skills

  • Customer Care
  • CSR
  • Customer Service
  • Customer Support
  • Bilingual
  • Cold Calling
  • Telesales
  • B2B
  • Selling
  • Telemarketing
  • Quota
  • Prospecting
  • Multi tasking (6 years)
  • Communications (6 years)
  • Microsoft Outlook (2 years)
  • Microsoft Powerpoint (4 years)
  • Call Center
  • Microsoft Excel (5 years)
  • Authorizations (4 years)
  • Phone Etiquette (4 years)
  • Administrative and business operations (5 years)
  • Medical Terminology (4 years)
  • English (4 years)
  • ERP Systems (3 years)
  • Microsoft Word (8 years)
  • Salesforce (5 years)
  • Time Management (5 years)
  • CPT Coding (5 years)
  • ICD Coding (5 years)
  • ICD-10 (4 years)
  • Microsoft Office (8 years)
  • Shipping & Receiving (4 years)
  • Sales Experience
  • Spanish
  • Inside Sales
  • EMR Systems
  • Order Entry
  • ICD-9
  • Medical Billing
  • Insurance Verification
  • HIPAA
  • Medical Records
  • Account Management
  • Medical Scheduling
  • Negotiation
  • Anatomy Knowledge
  • Hospital Experience
  • Medical Coding
  • Medical Office Experience
  • Physiology Knowledge
  • Epic
  • Data Entry
  • Vital Signs
  • Experience Administering Injections
  • Triage
  • Accounting
  • Laboratory Experience
  • Patient Care
  • Transcription
  • QuickBooks
  • Cerner
  • Typing (7 years)
  • Windows
  • 4G/LTE
  • Financial services
  • Banking
  • Technical support
  • Database administration
  • Managed care
  • Leadership
  • Copywriting
  • Restaurant experience
  • Software troubleshooting
  • Help desk
  • Medical collection
  • Payroll
  • Performance marketing
  • Mac OS
  • Analysis skills
  • Sales
  • Active Directory
  • Operating Systems
  • Upselling
  • Data collection
  • Live chat
  • HubSpot
  • Medical sales
  • Search Engine Optimization (SEO)
  • Microsoft Windows Server
  • Recruiting
  • Pivot tables
  • Problem management
  • GAAP
  • Linux
  • Medicare
  • E-commerce
  • Network Support
  • System Administration
  • Zendesk
  • Multi-line phone systems
  • IOS
  • Google Suite
  • Analytics
  • Home care
  • Records management
  • CRM software
  • Military
  • Desktop Support
  • VMWare
  • Travel planning (5 years)
  • Mobile devices
  • Mentoring
  • Project management
  • Microsoft SQL Server
  • Network Administration
  • Oracle
  • Microsoft SharePoint
  • VPN
  • Mortgage servicing
  • Search engines
  • Team management
  • PCI
  • Computer literacy
  • Databases
  • Loan processing
  • Benefits administration
  • Human resources
  • SharePoint
  • IOS development
  • Enterprise software
  • SCCM
  • Root cause analysis
  • Business development
  • Bank Secrecy Act
  • Research
  • Debits & credits
  • Training & development
  • Conflict management
  • Customer relationship management
  • Remote Access Software
  • Citrix
  • User Interface (UI)
  • SQL
  • DNS
  • LAN
  • Business Requirements
  • Visio
  • Mechanical knowledge
  • Fraud
  • Communication skills
  • Litigation
  • Multilingual
  • AS400 (5 years)
  • VIRTUOX (3 years)
  • IDS (5 years)
  • SAP CRM (5 years)
  • Data Security Procedures
  • Inpatient Records Coding
  • Insurance Claims
  • Provider Relations

Certification

Microsoft Certified Professional (MCP) Present Microsoft office certificate Series 7 Series 66 Securities Industry Essentials Series 63 Food Handler Certification Pallet Jack Certification CompTIA Network+ Bartender License CompTIA A

Additional Information

  • Willing to relocate: Anywhere, Authorized to work in the US for any employer

Languages

English
Native or Bilingual
Spanish
Limited Working

Timeline

Medical Claims Adjuster

Lincare Healthcare
04.2022 - Current

Collections Representative

Bank of America
12.2021 - 02.2023

Member Service Representative/ Tech suppport

USAA
11.2019 - 12.2021

Material Handler

Aramark
09.2018 - 02.2021

Warehouse Associate

Tampa Tribune
01.2014 - 01.2015

CSR - Customer Service Representative

Crius Energy
02.2013 - 08.2018

Cashier/Customer Service

Wal-Mart
01.2013 - 01.2014

Diploma - BioMed

Hillsborough Community College

Associate - Computer Technology

Middleton High School

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DARRIELLE HAYES