Summary
Overview
Work History
Education
Skills
Timeline
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Donna Morehead

Summary

Results-driven team player with a positive and analytical approach to completing assigned tasks. Solid understanding of data entry and customer service. Comfortable in high-stress, high-call volume environments. Knowledge in insurance policies and regulatory requirements, adept at using software to manage and process claims. Contributes to overall operational efficiency. Quick learner of new software, ensures accurate and timely processing, always striving to exceed expectations.

Overview

13
13
years of professional experience

Work History

Claims Processor

Isolved
01.2023 - Current
  • Managed and Reviewed high volume of claims, via phones and virtual correspondence. Prioritizing tasks to meet deadlines while consistently ensuring high quality output.
  • Reviewed all supporting documents to verify claims eligibility and accuracy. Ensured all claims met company policy and compliance regulations.
  • Collaborated with cross-functional teams to resolve complex claims issues efficiently and effectively.
  • Utilized specialized software to process incoming claims, enter data and generate reports.
  • Followed up with customers on unresolved issues.
  • Handled escalated customer concerns regarding claim denials or delays with empathy and professionalism.
  • Maintained strict confidentiality when dealing with sensitive information about patients medical histories or personal details.
  • Reduced claim processing time for faster customer service and improved satisfaction rates.
  • Provided coaching and mentoring to new hires, contributing to their successful integration into the team.
  • Responded to customer inquiries, providing detailed explanations of insurance policies and claims processes.
  • Maintained detailed records of all processed claims for easy retrieval during audits or disputes.
  • Researched and resolved complex medical claims issues to support timely processing.
  • Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
  • Verified patient insurance coverage and benefits for medical claims.
  • 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.
  • Demonstrated excellent multitasking abilities by simultaneously handling multiple tasks such as navigating systems, taking notes on calls, and answering inquiries from clients on multiple modes of communication.
  • Exceeded performance metrics consistently, earning recognition as a top performer within the team.

Customer Service Representative

HAP
01.2020 - 01.2023
  • Professionally handled incoming calls while demonstrating strong interpersonal, listening, verbal communication, and business writing skills.
  • Demonstrated and utilized an understanding of HMO/PPO/POS delivery system and claims billing.
  • Handled assigned projects from start to successful completion, including appropriate follow-up and documentation.
  • Developed strong product knowledge to provide informed recommendations based on individual customer needs.
  • Resolved escalated customer issues, restoring confidence in the company's commitment to service excellence.
  • Ensured compliance with HIPAA regulations when handling sensitive patient information, protecting client privacy at all times.
  • Enhanced patient satisfaction by efficiently addressing and resolving healthcare-related inquiries.
  • Expanded knowledge of medical terminology and insurance policies through continuous learning initiatives, enhancing accuracy in communication with clients.
  • Maintained accurate records of customer interactions, ensuring proper documentation within the company's database while ensuring proper follow-up and resolution of issues.
  • Expedited service times with effective triage of incoming calls, directing all incoming inquiries to the correct department or resource.
  • Delivered exceptional support during high call volume periods by maintaining composure and professionalism under pressure.
  • Promoted a positive work environment through active participation in team meetings and contributing ideas for organizational success.
  • Responded proactively and positively to rapid change.
  • Investigated and resolved customer inquiries and complaints quickly.

Team Leader

Henry Ford Hospice
01.2012 - 01.2020
  • Set performance expectations for the team, monitoring progress towards goals and providing constructive feedback as needed.
  • Proactively identified scheduling issues and developed quick solutions to promote efficiency.
  • Empowered team members by delegating responsibilities according to individual strengths and areas of expertise.
  • Reduced patient anxiety and stress by offering a calm, reassuring presence during difficult emotional moments or periods of physical discomfort.
  • Managed conflict resolution among team members, fostering a positive and collaborative work environment.
  • Optimized workflow by prioritizing tasks based on urgency and aligning staff assignments accordingly.
  • Developed team member's skills through targeted coaching sessions, resulting in improved individual performance.
  • Protected privacy and delivered comfort to preserve the dignity of terminal patients and family members.
  • Collaborated with other department leaders to establish shared goals and ensure alignment across teams.
  • Fostered a positive work environment by addressing employee schedule concerns promptly and with empathy.
  • Supported company growth by effectively managing an increasing volume of scheduling requests without compromising service quality.
  • Evaluated team member performance against established objectives during regular reviews, offering praise for achievements or identifying areas requiring further development.
  • Improved resource allocation by regularly reviewing staff skills, availability, and workload distribution.
  • Trained and mentored new staff, contributing to a supportive work environment and improved retention rates.
  • Managed patient caseloads effectively, ensuring timely interventions and thorough follow-ups to mitigate potential complications.
  • Participated in professional development opportunities regularly to stay current on best practices in the field of hospice care.

Education

Nursing - Phlebotomy

Henry Ford
Dearborn, MI

Skills

  • Customer Service
  • Team Building
  • Account and Records Management
  • Written/Verbal Communication
  • Analytical Skills
  • Claims Review
  • Data Entry Proficiency
  • Conflict Resolution
  • Training and Mentoring
  • Problem-Solving Skills
  • High Volume Inbound Calls/Emails
  • Grievance Resolution
  • Quality Assurance
  • Policy Interpretation
  • Claims Processing Software
  • Program Efficiency: Microsoft Office, Teams, Facets, Pega, RRD, Cognos, Careradius, EviCore, Epic, WEX

Timeline

Claims Processor

Isolved
01.2023 - Current

Customer Service Representative

HAP
01.2020 - 01.2023

Team Leader

Henry Ford Hospice
01.2012 - 01.2020

Nursing - Phlebotomy

Henry Ford

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Donna Morehead