Gina Adams
North Royalton,OH
Summary
Graduate of Tri-C Manufacturing Technology School with a certificate in Patient Access Specialist and CHAA certification. Experienced in assisting patients and members with pharmacy refills and insurance coverage inquiries. Thriving at CVS Caremark, where continuous training and education on Medicare coverage, computer system procedures, and individualized training through learning hub systems are provided. Collaborating with compassionate colleagues to effectively serve members, ensuring seamless medication delivery and pharmacy benefits navigation.
Overview
10
10
years of professional experience
Work History
Customer Service Representative
CVS Care Mark / Work from Home
09.2023 - Current
- Professional experience with Pharmacy Benefit Manager for FEP Medicare D plans
- Ensuring and Upholding all HIPAA regulations and procedures .
- Ensuring that all inquiries from Providers, Benefit Verification Specialists and any third parties are verified before they can receive any Required only information about member.
- Adaptability with constant changing processes, computer systems And work instruction procedures.
- Ability to maneuver through different systems and applications to ensure compliance of each call.
- Responsible for addressing customer inquiries and refills professionally and promptly.
- Resolving customer issues and concerns with compassion and empathy.
- Critical thinking
- Effectively communicating between oral and written communications among Supervisors, teams and colleagues.
- Providing accurate information about Refills and prescriptions
- Document customer interactions and all transactions, Submitting prior authorizations, coverage, determinations, and appeals.
- Collaborating with all functional teams to ensure customer satisfaction
- Handle a high volume of customer interaction with focus on quality
Customer Service Representative for Durable Medical Equipment Department
Discount Drug Mart, Inc.
03.2021 - 07.2022
- Upholding HIPAA privacy Practices, While Assisting Home Health Care Representatives, Patients, customers, Doctor offices, Insurance companies and referral sources over the phone
- Process reorders within an adequate timely manner
- Obtains necessary documentation (signed physician orders, clinical information, test results, etc.) to support medical necessity of equipment/supplies ordered
- Communicates back to the referral source and patient when it is determined that a coverage issue may exist
- Processed new accounts into the Brightree computer system
- Sends initial CMN to appropriate ordering doctor
- Follow-up on outstanding orders, send insurance verification as necessary
- Maintains and operates standard office equipment
- Documents all customer activity in the appropriate note systems
- Performs related office duties and helps with workflow.
Patient Service Representative
University Hospitals
04.2020 - 07.2020
- Part time Patient Access Representative for radiology department
- Greeting patients and following CDC recommendation for covid-19
- Providing customer services, checking patients in, verifying demographics and insurance information.
Vehicle Service Attendant
Cleveland Auto mall
06.2017 - 04.2020
- On call Title and Transport vehicles to Highway Patrol to be fully inspected before selling.
Customer Service
North Royalton City School Cafeterias
08.2014 - 01.2017
- Prepared and took inventory on baked products and produce
- Followed guidelines for cleaning and sanitation of all food and preparation areas
- Dated, rotated food and took inventory of daily used products.
Education
Comprehensive Patient Access Specialist, Medical Terminology, Electronic Health Records, Health Insurances, Regulatory Compliancy and Reimbursement -
Cuyahoga Community College Manufacturing Technology Center
Cleveland, OH10.2019
Skills
- Customer Service
- Problem-solving abilities
- Active Listening
- Critical Thinking
- Data Entry
- Customer Relations
- Problem Resolution
- Call center experience
- Computer Proficiency
- Payment Processing
- Client Relations
- Professional telephone demeanor
- Call Center Operations
- Microsoft Outlook
- Follow-up skills
- Call Management
- Product Knowledge
- Order Processing
- Documentation
- Administrative Support
- Data Collection
- Prioritization
- Building rapport
- Technical Support
- Clerical Support
- Research
- Reading Comprehension
- Proofreading
Timeline
Customer Service Representative
CVS Care Mark / Work from Home
09.2023 - Current
Customer Service Representative for Durable Medical Equipment Department
Discount Drug Mart, Inc.
03.2021 - 07.2022
Patient Service Representative
University Hospitals
04.2020 - 07.2020
Vehicle Service Attendant
Cleveland Auto mall
06.2017 - 04.2020
Customer Service
North Royalton City School Cafeterias
08.2014 - 01.2017
Comprehensive Patient Access Specialist, Medical Terminology, Electronic Health Records, Health Insurances, Regulatory Compliancy and Reimbursement -
Cuyahoga Community College Manufacturing Technology Center
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