HAWA SHERIFF
Summary
Highly experienced detailed Client Service Associate; with strong analytical, problem solving and research skills. Excellent listening skills, oral and written communication. Comfortable communicating with all levels of the organization and public. Gifted at working with all types of customers. Solid team player with upbeat, positive attitude and proven skill in establishing rapport with clients. Motivated to maintain customer satisfaction and contribute to company success. Articulate, enthusiastic and results-oriented with demonstrated passion for building relationships, cultivating partnerships and growing businesses.
Overview
10
10
years of professional experience
1
1
Certification
Work History
Provider Service Representative
Molina Healthcare
Remote
04.2022 - Current
- Answered inbound calls from hospitals, medical practices (medical/surgical and dental) and substance abuse/mental health facilities to answer medical policy insurance inquiries.
- Provides up to date benefit quotes stating copay, deductible, coinsurance, and out of pocket values for specific medical procedures
- Worked with Medicaid and Medicare claims as well as underpaid and overpaid claims.
- Researched CPT codes for various medical procedures giving the accurate benefit quote and supporting medical policies that may influence medical claim approval
- Reviewed medical policy bulletins if applicable for providers with claim denials
- Forwarded claims to appropriate departments for review and adjustment when claim denial errors are discovered
- Explained provider offsets/refunds to providers when payments are recouped for claims paid in error
- Processes claim referrals, new claim handoffs, nurse reviews, complaints (member/provider), grievance and appeals (member/provider) via target system
- Educates providers on our self-service options;Assists providers with credentialing issues
- Demonstrate ability to quickly build rapport and respond to customers/providers in an empathetic manner
- Aptitude to listen attentively, capture relevant information, and identify Member or Provider’s inquiries and concerns
- Capable of meeting/ exceeding individual performance goals established for the position in the areas of: Call Quality, Attendance, Adherence and other Contact Center objectives
- Able to proactively engage and collaborate with various Internal/ External departments.
- Developed relationships with new providers by providing guidance on how to use our systems, processes, and policies.
- Performed data entry tasks including entering patient information into electronic medical records systems.
- Investigated any potential fraud cases reported by providers or insurers according to established protocols.
- Analyzed reports generated from the system to ensure timely submission of claims and accurate reimbursement amounts.
Provider service representative
Aerotek - Louisville KY
Louisville, KY
08.2020 - 12.2021
- Managed COB, Medicare parts A & B, and Carve-out
- Quoted benefits according to Medicare/Medicaid guidelines and regulations
- Entered ICD9 codes CPT, Diagnosis codes for notification for medical services
- Worked with Medicaid and Medicare claims as well as underpaid and overpaid claims
- Researched errors by comparing enrollment error reports against system information along with Center for Medicare and Medicaid Services records.
Customer Service Representative/ Data Entry
Rxcrossroads CVS
Louisville, KY
06.2018 - 09.2019
- Received incoming calls from multiple customers such as physicians and patients, and processed requests by providing resolution or triage to the appropriate areas
- Documented customer correspondence in CRM to track requests, problems and solutions
- Upheld quality control policies and procedures to increase customer satisfaction
- Complete documentation of each member call in the electronic record, thoroughly completing required actions with a high level of detail to ensure compliance requirements are met with efficiency
- Audited customer account information to identify issues and develop solutions
- Processed documentation and troubleshot discrepancies to build client rapport.
- Developed strong relationships with customers by providing personalized assistance and support.
- Maintained detailed records of customer interactions, transactions and comments for future reference.
Administrative Assistant
KentuckyOne Health
Louisville, KY
01.2017 - 06.2018
- Managed the receptionist area, including greeting visitors and responding to telephone and in-person requests for information
- Answered and managed incoming and outgoing calls while recording accurate messages
- Maintained the front desk and reception area in a neat and organized fashion
- Made copies, sent faxes and handled all incoming and outgoing correspondence
- Organized files, developed spreadsheets, faxed reports and scanned documents
- Received and screened a high volume of internal and external communications, including email and mail
- Created and maintained spreadsheets using advanced excel functions and calculations to develop reports and lists
- Utilize MS Office fully in daily tasks and responsibilities.
Call Center Representative
Verizon
Rochester, NY
05.2014 - 07.2016
- Managed heavy phone communication and sales activities
- Identified and implemented enhancements to customer service, communications, and mediation process to improve efficiency and customer satisfaction
- Activated phones, hotspots, tablets, home internet, and kept up-to-date with cellular plans, features, and promotions
- Conferred with customers by telephone to provide information about products or services, took or entered orders, canceled accounts, or obtained details of complaints
- Performed troubleshooting in order to resolve customer issues with service and scheduled home visits to resolve more complex service issues.
Education
Bachelor of Arts in Political Science and Political Economy -
The University of Louisville
05.2020
Skills
- Microsoft Office
- Microsoft Word
- Microsoft Excel
- Analytical Skills
- Pega
- QNXT
- CRM
- Kronos
- Microsoft Teams
- CVS Caremark
- Availity
- Adobe Creative Suite
- Medical Terminology
- Customer Service
- Insurance Verification
- Genesys
- Claims Processing
- Provider Relations
- HIPAA Compliance
- De-Escalation Techniques
- Remote Office Availability
- PowerPoint
- Social Media Marketing
- Salesforce CRM
Certification
- Certified in CPR, AED, and First Aid
- Google Analytics
- Google Ads
Timeline
Provider Service Representative
Molina Healthcare
04.2022 - Current
Provider service representative
Aerotek - Louisville KY
08.2020 - 12.2021
Customer Service Representative/ Data Entry
Rxcrossroads CVS
06.2018 - 09.2019
Administrative Assistant
KentuckyOne Health
01.2017 - 06.2018
Call Center Representative
Verizon
05.2014 - 07.2016
Bachelor of Arts in Political Science and Political Economy -
The University of Louisville
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