Diamond Bailey
Sacramento,CA
Summary
Experienced healthcare customer service specialist with 4 years of dedicated patient care and support. Proficient in medical terminology, NextGen, and referral coordination, ensuring seamless and efficient healthcare services. Exceptional communication skills in both English and Spanish, enhancing patient satisfaction and understanding. Eager to contribute to a forward-thinking healthcare organization, fostering a culture of teamwork and collaboration for optimal patient outcomes.
Overview
5
5
years of professional experience
Work History
Individual and Family Plan Correspondent
Blue Shield of CA
08.2024 - 02.2025
- Resolved issues through active listening and open-ended questioning, escalating major problems to the manager.
- Improved customer satisfaction scores by applying superior conflict resolution and problem-solving skills.
- Used company software and databases to maintain records of services performed and patient conditions.
- Liaised with other healthcare professionals and healthcare insurance marketplace to develop comprehensive patient care plans and provide highest quality of care.
- Called insurance companies to get precertification and other benefits information on behalf of patients.
Customer Care Representative
Healthcare Options
12.2023 - 07.2024
- Demonstrated strong communication skills by educating members with accurate, unbiased
health information and assisted with their health plan selection and enrollment. - Collaborated with healthcare professionals to guarantee accurate and timely delivery of
member care services. - Contributed to organizational success by providing exceptional customer service and cultivating positive relationships with members, families, and healthcare partners.
- Provided empathetic and professional patient interactions, contributing to an increased
customer satisfaction rate. - Utilized advanced state database systems to maintain secure health information, ensuring
compliance with HIPPA regulations.
Patient Service Representative
Wellspace Health
04.2023 - 10.2023
- Curated and nurtured patient relationships to amplify empathy and increase capacity
building. - Facilitated timely referrals for patients to specialists, coordinating appointments and ensuring
necessary medical records were sent for continuity of care. - Partnered with healthcare providers to determine appropriate referrals based on patient’s
condition and insurance coverage. - Delivered exceptional patient support through effective inquiry resolution, issue resolution,
and appointment scheduling through NextGen. - Communicated with patients, providers, and insurance companies to obtain necessary
authorizations and approvals for referral services.
Beneficiary Services Representative
Medi-Cal Telephone Service Center
02.2020 - 02.2023
- Collaborated with teams and agencies to ensure timely and accurate medical billing, eligibility
and claims processing. - Provided personalized support to beneficiaries, enhancing understanding of health coverage,
and explanation of benefits, boosting customer satisfaction rate by 15% - Resolved beneficiary inquiries with empathy, ensuring a positive customer experience.
- Assisted call center team with medical billing, DME requests, and treatment authorizations
efficiently. - Handled over 200+ call inquiries weekly, maintaining the flow of a high call volume.
Education
Bachelors of Social Work
Sacramento State University
Sacramento, CA05-2026
Community Health Worker -
Elk Grove Adult & Community Education
06.2024
Skills
- NextGen
- Medical Terminology
- Spanish
- Communication skills
- Microsoft Suite
- Referral Coordination
- Active listening
Timeline
Individual and Family Plan Correspondent
Blue Shield of CA
08.2024 - 02.2025
Customer Care Representative
Healthcare Options
12.2023 - 07.2024
Patient Service Representative
Wellspace Health
04.2023 - 10.2023
Beneficiary Services Representative
Medi-Cal Telephone Service Center
02.2020 - 02.2023
Bachelors of Social Work
Sacramento State University
Community Health Worker -
Elk Grove Adult & Community Education
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