Destanie Gilford
Calera,OK
Summary
Committed to ensuring customer satisfaction by providing exceptional service and unmatched support. Proficient in utilizing customer service best practices and adept at exploring different solutions to address customer needs effectively.
Overview
10
10
years of professional experience
Work History
Customer Service Representative
Express Scripts
07.2024 - Current
- Resolved customer complaints with empathy, resulting in increased loyalty and repeat business.
- Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
- Handled escalated calls efficiently, finding satisfactory resolutions for both customers and the company alike.
- Enhanced customer satisfaction by promptly addressing concerns and providing accurate information.
- Developed rapport with customers through active listening skills, leading to higher retention rates and positive feedback from clients.
Insurance Verifier
Texoma Medical Center
02.2023 - 07.2024
- Verify insurance eligibility and coverage for patients
- Monitor and update insurance information in the system
- Communicate with insurance providers to obtain required information
- Developed a working knowledge of insurance plans, including Medicare and Medicaid regulations and requirements.
- Provided timely follow up with payers regarding payment status of claims.
- Identified discrepancies in patient's insurance coverage or benefits, ensuring accuracy of data entered into system.
- Researched third party payer guidelines related to prior authorizations, coding and billing processes.
- Responded promptly to customer inquiries regarding their benefits and eligibility status.
- Collaborated with internal staff members such as Billing Specialists, Medical Coders, to resolve any discrepancies in patient's insurance information.
Medical Office Specialist
TexomaCare
12.2021 - 02.2023
- Sending/receiving patient medical records; obtaining lab/x-ray reports, hospital notes, referral information, etc; completing forms/requisitions as needed; scheduling appointments
- Input all patient data regarding claims and prior authorizations into system accurately
- Verifying insurance coverage and patient demographics; managing charts to ensure information is completed and accurate
- Processed medical records requests from outside providers according to facility, state and federal law
- Prepared and distributed denial letters, detailing reasons for denial and possible appeal measures
- Communicated effectively with staff, patients and insurance companies by email and telephone
- Maintained knowledge of benefits claim processing, claims principles, medical terminology and procedures and HIPAA regulations
- Reached out to insurance carriers to obtain prior authorization for testing and procedures
- Received, recorded and filed medical payments by check, cash and credit card
Front Desk Receptionist
Premier Pulmonary & Sleep Medicine
12.2018 - 12.2021
- Schedule surgeries by making arrangements with the surgical center, verifying times with patients and preparing charts/orders
- Answering emergency calls and direct patients to the proper physician for care in a timely manner
- Collecting insurance copays, deductibles, and balances at the time of the patient's appointment
- Processing staff and patient incoming calls, faxes and inquiries, including incoming/outgoing referrals
- Taking patient's messages, providing directions/instructions to the patients according to physician orders and treatments
- Record and update patient information, managing scheduling follow ups and medication refills
- Collect past due balances, room patients, review past medical and surgical history, proficient in the utilization of electronic medical records, and managing clinical calls and emails throughout the day
Medical Records Clerk
Texoma Neurology Associates
09.2015 - 12.2018
- Performed clerical tasks such as filing, faxing, mailing, sorting through emails throughout the day
- Maintained accuracy, completeness and security for medical records and health information
- Retrieved and prepares charts for following day appointments
- Released information to persons or agencies according to regulations
- Retrieved and requested patient medical records for physicians, technicians and staff
- Insured patients charts was ready for appointments
- Prepared reports for state auditing of medical charts
- Input data into computer programs and filing systems
- Above-average file auditing skills
- Kept accurate log of all requests for medical information and records
Education
High School -
Denison High School
Denison, TX01.2013
No Degree - Business Administration And Management
Grayson College
Denison, TX12-2026
Skills
- Customer service
- Problem-solving
- Active listening
- Adaptability and flexibility
- Data entry
- Computer proficiency
- Problem resolution
- Critical thinking
- Call center experience
Timeline
Customer Service Representative
Express Scripts
07.2024 - Current
Insurance Verifier
Texoma Medical Center
02.2023 - 07.2024
Medical Office Specialist
TexomaCare
12.2021 - 02.2023
Front Desk Receptionist
Premier Pulmonary & Sleep Medicine
12.2018 - 12.2021
Medical Records Clerk
Texoma Neurology Associates
09.2015 - 12.2018
High School -
Denison High School
No Degree - Business Administration And Management
Grayson College
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