GLORIA D. MASON
Fairfield,OH
Summary
Self-directed customer service leader eager to offer considerable experience and education with regard to Call Center Metrics, Client Relations, New Business Development, Team Building, and Operations Support, Strong commitment to environment dynamics, with the ability to contribute and follow leadership directives. PROFILE OF QUALIFICATIONS Key Areas of Expertise Computer Literacy and Microsoft Office Applications (Word, Excel & Outlook), Windows 2000/XP, PIBA, NASCO and AS/400-based systems. Heavy telephone and Customer Service expertise within a call center environment. Exceptional attention to detail, strong communication skills and a motivated team player. Excellent interpersonal, analytical and decision making skills. Medical terminology
Driven Reimbursement Counselor offering [Number] years of expertise in providing exceptional customer care while assisting with billing needs. Gifted in quickly and accurately resolving issues related to payments, denials, appeals and reimbursements. Quick-thinking team player when working with colleagues and insurance representatives. Focused on completing requests while providing optimal customer service by discussing all payment options and organizations that provide assistance.
Overview
33
33
years of professional experience
Work History
PATIENT ASSISTANCE AND REIMBURSEMENT COUNSELOR
05.2015 - Current
- Engaged with patients and caregivers by enrolling them in supportive services for heart medications
- Provided financial assistance options to patient, caregivers, and health care professionals
- Verified patient’s insurance benefits coverage for prescription drugs and followed through with insurance companies when needed
- Performed the task of locating pharmacies with the patients prescribed drug in stock and contacting patients with results
- As a Call Center Representative consistently provided high quality assurance scores averaging 90-96% per quarter
- CIA Compliance and HIPPA Certified
- Ability to work in a team environment, effectively interacting with others
- Detail oriented and good follow through skills
PHARMACY SERVICE REPRESENTATIVE
CVS Caremark
10.2014 - 04.2015
- Ability to understand and apply basic computer skills and record data accurately
- Communicate clearly and professionally with internal and external departments, physician’s offices, and participants
- Familiar with key performance indicators
- Ability to receive and resolve issues over the phone and route appropriately
- Prepare orders and coordinate deliveries
- Collect and enter insurance and benefit data
- Conduct benefit investigations as needed
- Assist with administrative and operations duties as needed
CUSTOMER CARE REPRESENTATIVE
Horizon Blue Cross Blue Shield of New Jersey
04.2013 - 04.2014
CUSTOMER CARE REPRESENTATIVE
Magellan, Behavioral
04.2005 - 01.2011
- Answer provider and member inquiries regarding eligibility, benefits, claims, and authorization of services in areas of Mental Health and Substance Abuse
- EAP services, claim status, and authorization inquiries to callers while maintaining integrity, confidentiality and professionalism
- Investigate and resolve claim issues and concerns based on both medical necessity and CPT codes
- Provides outstanding service to both internal and external customers; resolves member and provider needs on the first call
- Actively listen and probe; identify and respond to Crisis calls, provide assistance to Clinician with regard to caller resolution
- Refer callers to Provider Services, links or make routine referrals, and triage decisions not requiring clinical judgment
- Thoroughly documents customers’ comments/information and forwards required information to the appropriate staff
- Performs necessary follow-up tasks to ensure member or provider’s needs are completely met
- Lead or participate in Care Management Center activities as requested that help improve Care Center performance, excellence and culture
- Assume full responsibility for self-development and career progression
- Proactively seek and participate in ongoing training with regard to all aspects of the Customer Service Associate role
- Assist in the mentoring and training of new Customer Service Representatives.
CUSTOMER SERVICE REPRESENTATIVE
Anthem Prescription Management and Services
12.1995 - 02.2005
- Answer customer inquiries regarding both pharmaceutical mail ordering services and products via telephone and written correspondence
- Analyze problems and provides informative, timely solutions
- Responds also to consumer questions regarding insurance benefits, provider contracts, eligibility and claims
- Operates a PC/image station to obtain and extract information; documents information, activities and changes in the database
- Thoroughly documents inquiry outcomes for accurate tracking and analysis
- Develops and maintains positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner
- Researches and analyzes data to address operational challenges and customer service issues
- Provides external and internal customers with requested information
- Communicate knowledge of company services, products, insurance benefits, provider contracts and claims
- Seeks, understands and responds to the needs and expectations of internal and external customers
- Authorized and evaluated criteria for medications to include authorization
- Processed mail order refills and provided general product information
- Responsible for tracking and researching prescriptions not filled or delivered in a timely manner to patients
- Revco mail Ordering Service
CUSTOMER SERVICE REPRESENTATIVE
Amerisure Insurance Company
11.1993 - 12.1995
CUSTOMER SERVICE REPRESENTATIVE
12.1990 - 11.1993
Third, Administration
- Customer Service representative for Consumer Directed Health Care Accounts
- Provide consumer with information and assistance with Flexible Spending Accounts
- Answer incoming inquiries from members including account balances, audit requests, claims submission and claim reimbursement information
- Investigate and resolve claim issues per IRS guidelines
- Inform members with regard to expectations of Flexible Spending Account Plan terms and usage
- Advise accordingly on eligible expenses per plan
- Responsible for tracking member inquiries utilizing UCSW
- Demonstrates excellent customer service skills as exhibited by courtesy, cooperative spirit and tact when interacting with members, providers and co-workers
- Advanced Microsoft suite proficiency
- Ability to organize and balance prioritizes to insure exceptional customer delivery expectations
- Responsible and dependable team member with ability to follow leadership directives.
Education
Associates of Science Degree - Medical Secretary
Coastal Carolina Community College
Skills
- Customer Communications
- Insurance Claims Processing
- Processing Insurance Claims
- Customer Service
- Pharmaceutical/Pharmacy Technician
Timeline
PATIENT ASSISTANCE AND REIMBURSEMENT COUNSELOR
05.2015 - Current
PHARMACY SERVICE REPRESENTATIVE
CVS Caremark
10.2014 - 04.2015
CUSTOMER CARE REPRESENTATIVE
Horizon Blue Cross Blue Shield of New Jersey
04.2013 - 04.2014
CUSTOMER CARE REPRESENTATIVE
Magellan, Behavioral
04.2005 - 01.2011
CUSTOMER SERVICE REPRESENTATIVE
Anthem Prescription Management and Services
12.1995 - 02.2005
CUSTOMER SERVICE REPRESENTATIVE
Amerisure Insurance Company
11.1993 - 12.1995
CUSTOMER SERVICE REPRESENTATIVE
12.1990 - 11.1993
Third, Administration
Associates of Science Degree - Medical Secretary
Coastal Carolina Community College
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