Dawn Divis

• Prepare, validate and complete all step necessary to clear new cases for pre-scheduled services. This includes, but is not limited to validating and gathering insurance and demographic information.
• Interact with insurance companies via website, phone, or fax to verify benefits, obtain authorizations, identify insurance guidelines, and facilitate communication.
• Gather information to verify benefits and benefits eligibility by utilizing Epic system.
• Complete and/or obtains all necessary authorizations for service(s) to be performed. Work with clinical providers, on-site case management team, as well as team members LPN/RN or Nurse Auditor in Prior Authorization or CDI department.
• Perform Pre-Service collection estimation functions and communicates patient liability with patient.
• Provide point of service information and logistics to ensure an exceptional patient experience.
• Assume responsibility for revenue cycle management and is key in developing processes with hospital department heads to maximize and enhance revenue/reimbursement for services provided. Provide leadership in billing to improve transactional accuracy.
• Develops and maintains reports and statistical information on a timely monthly basis.
• Improved team productivity with regular communication and progress updates, fostering a collaborative work environment
• Training new employees
• Assist patients in obtaining insurance, ie: Medicaid, Marketplace coverage.
• Other related duties as required

• Customer Service/Call Center during normal business hours.
• Enhanced customer satisfaction by addressing insurance-related inquiries and resolving issues promptly.
• Maintained high standards of customer service by building relationships with clients.
• Resolved discrepancies in insurance payments by collaborating with carriers.
• Answers billing questions with accuracy and processing payments over the phone.
• Correspondence mail processing - accurate processing of patient and insurance correspondence in accordance with company policies and in compliance with the managed care contracts, federal programs and other third party payers.
• Research and investigation of unsettled claims.
• Apply accurate edits for secondary and tertiary claim balance errors that prevented the claim from completing the billing process.
• Worked with team members and leadership to identify and develop process improvements.
• Submitted claims to insurance companies and researched and resolved denials and explanations of benefit rejections.

• Customer Service/Call Center during normal business hours.
• Assisted colleagues during peak workload periods, demonstrating strong teamwork and commitment to overall departmental success.
• Assisted patients in understanding their coverage benefits, providing clear explanations and addressing any concerns or questions.
• Answers billing questions with accuracy and processing payments over the phone.
• Correspondence mail processing - accurate processing of patient and insurance correspondence in accordance with company policies and in compliance with the managed care contracts, federal programs and other third party payers.
• Research and investigation of unsettled claims.
• Apply accurate edits for secondary and tertiary claim balance errors that prevented the claim from completing the billing process.
• Worked with team members and leadership to identify and develop process improvements.
• Submitted claims to insurance companies and researched and resolved denials and explanations of benefit rejections.

• Promoted high customer satisfaction by resolving problems with knowledgeable and friendly service. Kept records of customer interactions or transactions, thoroughly recording details of inquiries.
• Exceeded established service goals while leveraging customer service, sales and employee management best practices.
• Mentored junior team members and managed employee relationships.
• Hand selected by leadership to mentor new employees as well as work on time sensitive projects while maintaining stellar quality.
• Used combined experience, research skills and communications expertise Summary Skills Experience to maintain control of difficult calls.
• Worked effectively under pressure and with demanding performance targets to handle 10+ calls per hour.
• Improved customer satisfaction by actively listening to concerns and providing prompt resolutions.
• Provided in-depth product knowledge to customers, assisting with informed purchasing decisions.
• Collaborated with cross-functional teams to address customer feedback and implement service improvements.

Provide best in class customer service to company's insured and agents answering billing related questions. Partners with insureds, agents, risk control managers, and underwriters via phone and email to resolve various insurance policy concerns in a timely manner. Use problem solving skills to resolve daily inquiries from agents and insureds – report and research inconsistencies as they arise.

Handles payments information to process payment transactions, set up. Electronic Funds Transfers and construct payment plans on audit balances.

Trained new employees on all aspects of the billing position.

• Helped large volume of customers every day with positive attitude and focus on customer satisfaction.
• Handled customer complaints professionally, resulting in satisfactory outcomes and positive feedback.
• Answered customer telephone calls promptly to avoid on-hold wait times.

• Provide information on a variety of customer service issues requiring knowledge of retirement and investment products and transactions focusing on customer satisfaction, quality, and efficiency
• De-escalated problematic customer concerns, maintaining calm, friendly demeanor.
• Upheld quality control policies and procedures to increase customer satisfaction.
• Handled customer inquiries and suggestions courteously and professionally.
• Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.

• Perform Sales Order Form Audits for agents selling Verizon services.
• Collaborated with cross-functional teams to identify areas of improvement, leading to increased operational effectiveness.
• Mentored junior analysts, fostering professional development while enhancing overall team performance.
• Travel to vendor sites ensuring contract adherence both in office procedures as well as vendor agents in the field. Meet with external vendors to communicate audit findings and confirm corrective actions as necessary.
• Partnered with Channel Management and Corporate Training to ensure consistent communication to vendor agents of procedure changes and ongoing training. Project Manage various projects as required. Researched and responded to the highest level of escalations; Public Utility Complaints, Executive office complaints, internal review of performance and sales misconduct (National Escalation Center).
• Supervised a staff of up to 40 temporary employees performing data entry functions.
• 25 years of experience in multiple positions over my tenure with Verizon. Each role was a promotion from the previous position.