Summary
Overview
Work History
Education
Skills
Timeline
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Felisha Washington

Summary

Experienced engagement professional prepared to excel in this role. Strong track record in fostering effective collaboration, driving client satisfaction, and meeting strategic goals. Expertise in communication, relationship-building, and adapting to changing needs. Reliable team player focused on achieving impactful results and enhancing overall engagement.

Overview

13
13
years of professional experience

Work History

Engagement Specialist

CVS HEALTH
04.2022 - Current
  • Initiates telephonic engagement with assigned members to introduce the program with the goal of enrolling the member in Aetna Care Management
  • Enhanced patient engagement by developing and implementing personalized care plans.
  • Utilized electronic health record systems effectively managed and organized patient data securelyss.
  • Accurately and consistently document each call in the members electronic record, thoroughly completing required actions with a high level of detail to ensure we meet our during enrollment calls, appropriately managing difficult or emotional member situations, responding promptly to member needs, and demonstrating empathy compliance requirements.
  • Streamlined communication between healthcare providers and patients for improved treatment adherence.

Customer Service Associate

IPFS
12.2017 - 01.2022
  • Assisted customers in understanding their financial statements, providing clarity regarding charges or fees.
  • Coordinated efforts between multiple departments such as collections, credit solutions, and risk management when necessary for customer issue resolution.
  • Conducted thorough research to resolve complex billing issues, preventing escalations and ensuring accurate resolutions.
  • Provided support during high call volume periods, maintaining professionalism under pressure.
  • Reduced delinquencies with proactive communication and payment plan negotiations.

Claims Representative

AIG Insurance
12.2015 - 12.2017
  • Payed and processed claims within designated authority level
  • Examined claims forms and other records to determine insurance coverage
  • Interviewed or corresponded with agents and claimants to correct errors or omissions and to investigate questionable claims
  • Enhanced claim processing efficiency by streamlining workflows and implementing best practices.
  • Determined appropriateness of payers to protect organization and minimize risk.
  • Processed and recorded new policies and claims.

Prior Authorization Specialist

CIGNA HEALTH
04.2014 - 03.2015
  • Input all patient data regarding claims and prior authorizations into system accurately.
  • Reached out to insurance carriers to obtain prior authorization for testing and procedures.
  • Verified eligibility and compliance with authorization requirements for service providers.
  • Fielded telephone inquiries on authorization details from plan members and medical staff.
  • Researched denied claims and contacted insurance companies to resolve these issues.
  • Obtained and logged accurate patient insurance and demographic information for use by insurance providers and medical personnel.

Claims Representative

OPTUM HEALTH
05.2012 - 04.2014
  • Maintained confidentiality of patient finances, records, and health statuses.
  • Assured timely verification of insurance benefits prior to patient procedures or appointments.
  • Enhanced claim processing efficiency by streamlining workflows and implementing best practices.
  • Followed up with customers on unresolved issues.
  • Determined appropriateness of payers to protect organization and minimize risk.

Education

Wisner High School
05-1997

Skills

  • Problem-solving
  • Customer service
  • Communication management
  • Decision-making

Timeline

Engagement Specialist

CVS HEALTH
04.2022 - Current

Customer Service Associate

IPFS
12.2017 - 01.2022

Claims Representative

AIG Insurance
12.2015 - 12.2017

Prior Authorization Specialist

CIGNA HEALTH
04.2014 - 03.2015

Claims Representative

OPTUM HEALTH
05.2012 - 04.2014

Wisner High School

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Felisha Washington