Felicity Rhodes
Summary
Experienced in conducting performance evaluations, quality assessments, and implementing process improvements. Utilizes data-driven insights to optimize operational efficiency and uphold high standards. Demonstrates expertise in industry best practices and methodologies to ensure consistent quality and performance. Recognized for strong analytical skills and dedication to achieving results, fostering collaborative leadership within teams and adapting effectively to evolving needs.
Overview
11
11
years of professional experience
Work History
Customer Service Rep
Iqor
10.2024 - Current
- Analyzed billing discrepancies, resolved disputes, and processed payments to enhance customer satisfaction and account accuracy.
- Navigate multiple systems and applications to efficiently address and resolve customer inquiries and issues.
- Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
- Resolved customer complaints with empathy, resulting in increased loyalty and repeat business.
- Enhanced customer satisfaction by promptly addressing concerns and providing accurate information.
- Developed strong product knowledge to provide informed recommendations based on individual customer needs.
Front Desk Manager
Hyatt
06.2023 - 08.2024
- Trained staff on front procedures and policies, ensuring adherence to company standards and efficient guest service.
- Kept accounts in balance and ran daily reports to verify totals.
- Mentored and trained new hires, fostering a supportive work environment that facilitated professional growth.
- Manage administrative duties, maintain critical files, and generate reports to track occupancy and revenue, enhancing operational efficiency.
- Promote loyalty programs and collaborate with the team to streamline guest check-in and check-out processes, focusing on customer satisfaction and repeat business.
- Trained new staff on correct procedures, compliance requirements, and performance strategies.
- Greeted visitors and customers upon arrival, offered assistance, and answered questions to build rapport and retention.
Performance Quality Analyst II
Elevance
08.2021 - 06.2023
- Analyzed issues and implemented corrective actions to enhance performance outcomes.
- Conducted quality control inspections, ensuring compliance with safety standards.
- Developed and integrated quality control procedures into technical manuals for staff reference.
- Conducted regular performance reviews, providing constructive feedback for employee growth and development.
- Ensured compliance with industry regulations by conducting thorough audits of processes and documentation standards.
- Managed multiple projects simultaneously while adhering to strict deadlines, delivering high-quality results consistently.
Medical Management Specialist II
Elevance
03.2020 - 08.2021
- Updated and maintained tracking databases to ensure accurate health plan information, including the management of prior authorization processes.
- Facilitated communication between software users and technical staff, providing assistance with complex case resolutions.
- Contributed to quality improvement programs, ensuring members received timely and appropriate healthcare, while adhering to regulatory compliance and accreditation standards while working remotely.
- Analyzed data on patient outcomes to identify areas for improvement in service delivery and resource allocation.
- Conducted thorough audits of medical records to ensure compliance with legal requirements and industry best practices.
Health Program Representative III
Elevance
06.2018 - 03.2020
- Managed resolution of intricate issues, directing staff to suitable resources and effectively handling escalated calls to maintain service quality.
- Developed training materials and provided mentorship to enhance team competencies, ensuring staff adherence to departmental standards and goals.
- Collected and analyzed information from various healthcare stakeholders to support informed decision-making and departmental operations, with minimal supervision.
- Increased awareness of available health services through the creation of engaging promotional materials and public presentations.
- Monitored program compliance with state regulations, ensuring continued accreditation and funding eligibility.
- Conducted needs assessments to identify gaps in service provision, informing the development of new programs tailored to community needs.
- Improved patient outcomes by implementing health education programs and providing resources for community members.
Utilization Management Representative
Elevance
05.2017 - 06.2018
- Managed accurate data entry of referral requests while working remotely and conducted clinical screening to ensure compliance with plan specifications.
- Assessed contract and benefit eligibility, authorizing necessary inpatient and outpatient services following company protocols.
- Served as a liaison between patients, healthcare providers, and insurance companies to facilitate timely approvals of necessary treatments.
- Ensured proper documentation and coding of medical treatments, enhancing billing accuracy and reimbursement rates.
- Provided comprehensive support to clinical staff, assisting in the development of guidelines for appropriate service utilization.
HEDIS Service Associate
Elevance
01.2014 - 05.2017
- Analyzed and abstracted provider medical records for quality data collection, ensuring adherence to auditor requirements and supporting the over-read process.
- Served as an analyst and consultant on HEDIS data utilization and quality improvement initiatives, reporting on quality-of-care issues in compliance with state and accrediting body standards.
- Led and trained temporary staff, developing training materials, and oversaw the accuracy and timeliness of contract/regulatory report submissions.
- Managed customer issues and enhanced satisfaction by matching optimal solutions to individual customer needs.
- Balanced multiple priorities effectively while maintaining a keen focus on delivering exceptional customer experiences consistently.
Education
Associate of Applied Science - Human Services
Tidewater Community College
Norfolk, VA05.2014
Skills
- Reception Management
- Operational efficiency management
- Documentation and Reporting
- Information Gathering
- Critical analysis
- Data analysis
- Decision-making
- Time management
- Effective team leadership
Timeline
Customer Service Rep
Iqor
10.2024 - Current
Front Desk Manager
Hyatt
06.2023 - 08.2024
Performance Quality Analyst II
Elevance
08.2021 - 06.2023
Medical Management Specialist II
Elevance
03.2020 - 08.2021
Health Program Representative III
Elevance
06.2018 - 03.2020
Utilization Management Representative
Elevance
05.2017 - 06.2018
HEDIS Service Associate
Elevance
01.2014 - 05.2017
Associate of Applied Science - Human Services
Tidewater Community College
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