Duke Thomas
Summary
Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals. Tenacious Representative possessing dynamic interpersonal expertise for developing fruitful customer relationships. Adept mediator of client requirements and organizational interests promoting mutually beneficial deals. Focused communicator fostering favorable service applications for maximizing customer interest and satisfaction. Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy.
Overview
12
12
years of professional experience
1
1
Certification
Work History
Advocate4me Rep Sr/Service Navigator
United Health Care
09.2022 - Current
- · Provides telephonic outreach to Medicaid members to complete social determinants of health assessments. Educates member on gaps in care and assists with scheduling provider appointments.
- Assists members with social determinants of health and links to community resources. Ensures member has access to PCP. Identifies gaps in care and assists in closure of gaps. Outreaches members on caseload consistent with program guidelines.
- Consistently meets metrics, both quality & performance. Provides excellent customer service to both members and providers. Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from members. Maintains confidential health information according to state and federal regulations including HIPAA.
Customer Service Representative
Wipro Health Plan Services
02.2021 - 08.2022
- Analyzed and processed rejected claims by investigating and gathering information to determine the error on the claims Assessed & resolved claims within evaluation Negotiates settlement of claims up to designated authority level and makes claim paid Calculated and assigned timely & appropriate reserves to claims and continues and continues to monitor reserve adequacy throughout the life of the claim
- Handled all Medicare billing and collections transactions and communicated with personnel at various local offices Provided exceptional customer service by answering questions, explaining services, and ensuring total satisfaction with the handling of each transaction.
CS Representative
Maximus Health Services
09.2018 - 01.2021
- Taking Medicare calls about premium or unpaid bills or changing plans helping fix problems calming down finding solutions ,Responsible for improving customer retention through programs and exemplary service provided to the customer,Make recommendations according to customer's needs on features, accessories, upgrades and options,Respond to customer inquiries in a confident, timely and accurate manner,Evaluate data to determine and implement the appropriate course of action to resolve or coordinate service recovery as needed,Efficiently and successfully navigate multiple system.
- Responded quickly to emergency situations to assess and deflect issues.
- Answered constant flow of customer calls with minimal wait times.
Inventory Specialist Supervisor
Management Health Solutions, Inc
01.2013 - 01.2018
- Counting hospital inventory making sure all counts are correct from all workers making sure were there on time working to perfection ,Implementation / Execution: Ability to manage multiple competing priorities to meet the specific business needs of the area..Expert working knowledge of HIPPA, PHI and all laws relative to access and release of medical records/PHI (protected health information system), Coordinates department acquisition and logging of medical records for all discharged patients,Audits various patient logs and reports to ensure accuracy of medical record distribution functions
- Follows up on inconsistencies, as required,Facilitates the review of medical records for deficiencies and proper assembly based on established policies and procedures,Collaborates with appropriate clinical departments to resolve various record deficiencies, and close files according to regulatory guidelines,Reviews and updates medical records with coding deficiencies
- Codes discharges utilizing the ICD-10-CM coding classification system
- Reviewed and monitored inbound inventory, outbound shipments and book adjustment transactions.
Receptionist
Stream Global Services
06.2011 - 06.2013
- Proficient in all Microsoft office programs a dept communicator with superior writing skills and self management capabilities
- Ensures all processes are entered into department computer system for tracking and recordkeeping purposes ,Conducts regular quality audits of medical records
- Presents results to management, related committees and meetings,Participates in staff educational activities to optimize department performance,Coordinates various department projects (records distribution to off-site storage facilities, microfilming, compliance audits, etc.), as required
Education
High School Diploma -
Smart Horizon
Skills
- Assembly
- Fast learner
- Data Entry
- Excel
- Problem solving
- Quality Control
- Powerpoint
- Home Health
- Customer Service (8 years)
- Computer Skills (4 years)
- Computer Literacy (5 years)
- Microsoft Office (4 years)
- Customer Care
- CSR
- Customer Support
- Call Center
- Writing Skills
- Microsoft Word
- Materials Handling
- Typing
- Quality Inspection
- Management
- Logistics
- Windows (2 years)
- IVR
- Leadership
- Sales
- Retail sales
- Medical terminology
- HIPAA
- Quality Audits
- Quality Assurance
- Negotiation
- Medical Coding
- Data collection
- Communication skills
- Certifications and Licenses
- Interpreting instructions or signs and solving problems
- Full results: Proficient
- Indeed Assessments provides skills tests that are not indicative of a license or certification, or continued
- Development in any professional field
Certification
- M&R CERTIFED L1-3
Timeline
Advocate4me Rep Sr/Service Navigator
United Health Care
09.2022 - Current
Customer Service Representative
Wipro Health Plan Services
02.2021 - 08.2022
CS Representative
Maximus Health Services
09.2018 - 01.2021
Inventory Specialist Supervisor
Management Health Solutions, Inc
01.2013 - 01.2018
Receptionist
Stream Global Services
06.2011 - 06.2013
High School Diploma -
Smart Horizon
Similar Profiles
Tiara L SmithTiara L Smith
Advisor 2 at United Health CareAdvisor 2 at United Health Care
Alicia AncisoAlicia Anciso
Customer Service Representative at United Health CareCustomer Service Representative at United Health Care
Modupe Adeola AgunbiadeModupe Adeola Agunbiade
Senior Clinical Administrative Coordinator at UNITED HEALTH CARESenior Clinical Administrative Coordinator at UNITED HEALTH CARE
Rebecca AllisonRebecca Allison
Post Service Appeals RN at United Health CarePost Service Appeals RN at United Health Care
Kanahi BeatheaKanahi Beathea
Advocate4me Rep Sr/Service Navigator at United Health CareAdvocate4me Rep Sr/Service Navigator at United Health Care