Hope R. Overby
HealthCare Professional
Millersville,MD
Summary
Collaborative individual with expertise in providing exemplary service regarding benefits support. Multitasking Benefits Specialist knowledgeable in state and federal regulations and maintaining employee confidentiality.
Overview
24
24
years of professional experience
Work History
Sr. Customer Service Advisor
CareFirst BCBS
09.2020 - Current
- Developed dynamic ownership skills by resolving challenging situations and asking in-depth questions of customers.
- Collaborated with sales team members to stay current on inventory levels, complete accurate orders, and resolve item issues.
- Investigated and resolved accounting, service and delivery concerns.
- Promoted superior experience by addressing customer concerns, demonstrating empathy, and resolving problems swiftly.
- Delivered prompt service to prioritize customer needs.
- Followed-through on all critical inter-departmental escalations to increase customer retention rates.
- Took cash and credit card payments via phone, in person, and through email.
- Met customer call guidelines for service levels, handle time and productivity.
Clinical Administrative Coordinator
UnitedHealth Group
07.2018 - 08.2020
- Manage/update member cases that does not require clinical support
- Assembled charts for new patients, confirming inclusion of requested medical history and diagnostic information.
- Performs data entry, verification of eligibility, process claims and revolves issues relating to adjustments of patient care
- Responsible for transitioning cases with extended stay, to appropriate Care Coordinator
- Communicates/interacts professionally to internal/external customers/providers regarding non-clinical inquiries or problem resolution
- Coordinate with hospitals, as well as clinics to manage service request from providers
- Communicates the status of patient care starts to Patient educators
- Manage the cases of more than 30 members
- Validates patients insurance, conducts outreach, and educates members about program benefits/services.
Human Resources Specialist
Virginia Retirement System
03.2018 - 07.2018
- Managed approximately 150 incoming calls, emails/faxes per day from customers
- Conducted employee orientations and training programs, oversaw all facets of staff/client training objectives
- Instilled knowledge of federal, state and local policies/procedures
- Liaison between employees and senior leadership, thereby resolving any problems, addressing inquiries, and processing contracts.
- Fielded employee inquiries related to insurance, pension plan, vacation, sick leave and employee assistance.
- Helped clients make informed decisions about financial future.
HR, Case Manager
Phoenix House Mid-Atlantic
06.2017 - 11.2017
- Optimized traceability, developed confidential organizational filing systems for employee records and reports
- Advised leadership on, -related matters, such as vacation/sick leave, benefits, job services and employment discrepancies
- Automated office operations, record tracking, and data communication
- Interpreted compensation and benefits policies
- Scheduled appointments and produced itineraries
- Developed processes and metrics that supported achievement of organizational goals
- Reduced processing delays of personnel actions, awards, flags, legal incidents, sponsorship, and evaluations
- Implemented an environment that boost employee morale and to decrease the need for conflict
- Assessed the needs of homeless families during initial intake, then make appropriate referral
- Assisted families in enrolling child/children into new school system
- Created numerous housing stabilization plans
- Assisted clients in completing subsidized housing applications
- Provided assistance to individual with respect to job searches, budgeting skills and setting goals
- Helped families familiarize themselves with community resources, also performed home and office visits
- Transport clients to housing authorities and completed follow-up with housing authorities
- Act as an Advocate for clients; wrote referral letters and made accommodations for special needs clients
- Followed-up with families to ensure successfully completion of our program
- Created, maintained/updated client records via Prevail.
Customer Support Specialist
Owens & Minor, Toano
08.2016 - 02.2017
- Visited hospitals as required to determine customer's need
- Converted new customer's to Owens & Minor's products
- Scheduled meetings with department heads at hospital to encourage/negotiate conversion to Owens & Minor
- Acted as the liaison concerning the hospital/division department heads in order to ensure smooth conversion
- Streamlined operations/prioritized tasks, and increased revenue by 25%
- Scheduled meetings with material managers/buyers to ensure the accuracy and timeliness with purchases
- Researched and reviewed inventory to determine hospitals usage levels, and gathered information for additional needs
- Prepared cost comparisons of over 30 hospitals to justify distribution
- Acted as the liaison between the hospital and the manufacturers to ensure delivery accuracy of supplies.
Clinical Customer Care Rep
Magellan Health
10.2015 - 08.2016
- Performed prospective/retrospective drug utilization review, providing prior authorizations/appeals for over 100 members per State/Federal regulations
- Participated in distribution of clinical drug information, educated providers/staff regarding use of pharmaceutical treatment regimens and complied with all corporate /facility standard operating procedures, policies, guidelines, and work instructions
- Streamlined claim processes resulting in 27% recovery of claim over payments.
Patient Access Rep
VCU Health System
11.2014 - 05.2015
- Greeted and registered patients in accordance with protocol, completed the initial intake process
- Obtained complete referral information for the patients, coordinated services to be provided, and followed through discharge
- Finalized verification of insurance eligibility/benefits/referrals, identified financial resources for families to establish method of payment for services
- Scheduled patients for initial and on-going appointments within required treatment increments
- Communicated pertinent patient information with team members.
Benefits Analyst II
Anthem Blue Cross BlueShield
05.2009 - 08.2012
- Assisted in identifying business needs/translating into application software requirements to support operations/production via data analysis
- Collected/analyzed data concerning business the requirements
- Assisted in determining specific business software applications and ensures that requirements are incorporated into system designs/testing
- Built/entered standard benefit plans with appropriate plan provisions/state mandates for various medical products
- Researched/responded to standard inquiries from various departments
- Provided onsite support with a focus on customer satisfaction
- Educated in the understanding of state mandates/plan provisions contained in the certificate of insurance
- Prepared 837p /837I Medicaid encounter files for electronic file transfer/processing
- Processed 837p /837I Medicaid encounter files through compliance validation tool, evaluate/correct all HIPPA/critical business errors and developed solutions for mitigating errors.
Customer Care /Call Center Rep Trainer III
Anthem Blue Cross Blue Shield
07.1999 - 05.2009
- Focused on insuring all documented processes are followed consistently throughout the company
- Recommended process changes/assisted with the implementation of training changes related to operations, sales/administrative functions
- Scheduled training for Operations/Administrative staff on all documented processes
- Reviewed service failure reports, provided appropriate group/individual training to prevent recurrent service guarantee failures caused by employee error
- Research, compile /analyze data for claim processing
- Advocated on behalf of customers through the whole case method
- Provided full service to members, providers, group administrators, brokers
- Processed health care claims, handled inquiries and implemented membership
- Resolved any issues for members, providers, group administrators and brokers
- Manage inbound/outbound calls from members/providers, in consort with paper/electronic claims from members/providers
- Analyzed scope of project, to ensure a smooth transition and that no issues are encountered
- Applied knowledge of policies and procedures, products, legislation and claims workflow
- Utilized systems to ensure claims were paid or denied based on terms of contract
- Interpreted claims to determine primary or secondary liability
- Recognized and reached out to appropriate party when additional information was required
- Made decisions on claim payments while considering benefit status, provider status and impact on providers/members.
Education
Dean -
BBA - Business Administration
High School Diploma - undefined
Skills
- Conflict Resolution Skills
- Internal and External Communications
- Client Correspondence
- Client Relationship Management
- Performance Goals
- Standard Operating Procedure Updates
- Medical Terminology
- Microsoft Office Suite
- Project management
- PeopleSoft HRMS
- Workplace diversity cultivation
- Relationship Cultivation
- Client Base Retention
- Customer Needs Assessments
- Relational Skills
Timeline
Sr. Customer Service Advisor - CareFirst BCBS
09.2020 - Current
Clinical Administrative Coordinator - UnitedHealth Group
07.2018 - 08.2020
Human Resources Specialist - Virginia Retirement System
03.2018 - 07.2018
HR, Case Manager - Phoenix House Mid-Atlantic
06.2017 - 11.2017
Customer Support Specialist - Owens & Minor, Toano
08.2016 - 02.2017
Clinical Customer Care Rep - Magellan Health
10.2015 - 08.2016
Patient Access Rep - VCU Health System
11.2014 - 05.2015
Benefits Analyst II - Anthem Blue Cross BlueShield
05.2009 - 08.2012
Customer Care /Call Center Rep Trainer III - Anthem Blue Cross Blue Shield
07.1999 - 05.2009
Strayer University - Dean,
Strayer University - BBA, Business Administration
Caroline High School - High School Diploma,