Jamalha Byars
St Louis,MO
Summary
Dynamic professional with a proven track record at Elevance Health, excelling in customer service and critical thinking. Demonstrated expertise in enhancing customer satisfaction and streamlining operations. Skilled in teamwork and attention to detail, consistently delivering results beyond expectations. Adept at driving improvements and fostering professional relationships. Organized and dependable candidate successful at managing multiple priorities with a positive my attitude. Willingness to take on added responsibilities to meet team goals.
Overview
12
12
years of professional experience
Work History
Utilization Management Representative II
Elevance Health
11.2021 - Current
- Responsible for coordinating cases for precertification and prior authorization review
- Managing incoming calls or incoming post services claims work.
- Determines contract and benefit eligibility; provides authorization for inpatient admission, outpatient precertification, prior authorization, and post service requests.
- Refers cases requiring clinical review to a Nurse reviewer.
- Responsible for the identification and data entry of referral requests into the UM system in accordance with the plan certificate.
- Responds to telephone and written inquiries from clients, providers and in-house departments.
- Conducts clinical screening process.
- Authorizes initial set of sessions to provider.
- Checks benefits for facility based treatment.
- 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.
Health Program Representative II
Elevance Health
05.2017 - 11.2021
- Responsible for providing initial contact between distinct Care Management programs and specific identified members. Under general supervision handles inbound/outbound enrollment and engagement calls with eligible members to provide information regarding program features.
- Gathers and records appropriate member information in accordance with policies and procedures via telephone.
- Encourages members to participate in the Care Management programs by providing information about the program, outlining program features/value and explaining available services.
- Records call details and utilize call scripts as needed based on client requirements.
- Directs member inquiries to appropriate clinical staff.
- Initiates referrals and manages consults from clinicians for participants registered in Care Management.
- Gathers information from hospitals, health plans, physicians, patients, vendors and other referral sources.
- Contacts physician offices to obtain demographic information or related data as needed.
- Mentors less experienced Health Program Advocates
Night Auditor
Americas Best Value Inn & Suites
01.2016 - 04.2018
- Provide all guests with exceptional customer service.
- Professionally and accurately take guest reservations.
- Maximize revenue by making sales calls and ensure that all rooms are sold at peak times.
- Perform check in and check out duties.
- Complete daily front desk reports and various paperwork.
- Professionally train and develop coworkers.
- Perform general office duties (faxing, copying, etc.) Assist all guest with needs in order to ensure a
- positive experience and customer service.
- Accurately count, prepare, and deliver daily bank deposits.
- Ensure safety and security of all guest's day shift and overnight by monitoring hotel property and
- communicating with guests and security.
- Made reasonable procedure exceptions to accommodate unusual customer requests.
- Provided accurate and appropriate information in response to customer inquiries.
- Worked with upper management to ensure appropriate changes were made to improve customer
- satisfaction.
- Built customer loyalty by placing follow up calls for customers who reported product issues.
Alarm Monitor
Interface Security
St Louis, MO
11.2012 - 05.2015
- Responsible for proactive monitoring, diagnosing and responding to system alarms.
- Relay information to law enforcement and emergency personal.
- Determine response requirements and relative priorities of situations, and dispatch units in accordance with established procedures.
- Provide accurate information in response to customer inquiries.
- Maintain access to, and security of, highly sensitive materials kept all information confidential following legal policies and procedures.
- Opening service tickets for repairs and/or maintenance.
- Coordinating after hour response to clients by on call technicians.
- Troubleshooting to assist clients with resetting, bypassing and general help with their alarm system.
- Follow policies and procedures in UL handled accounts.
- Answer multiple phone lines and simultaneously documenting information into client history.
- Interface with all departments in the company in response to customer requests.
- Team Shift leader at Interface Security.
- As a team leader I professionally trained and developed new team members.
- I often had to multitask alarm handling and answer very critical questions all at once.
Education
High School Diploma - General Studies
University City High School
St Louis, MO05.2005
Skills
- HIPAA Compliance Understanding
- Critical thinking abilities
- Professionalism and Ethics
- Documentation accuracy
- Time management mastery
- Conflict resolution techniques
- Resourcefulness and Initiative
- Decision Making Aptitude
- Data Analysis Competence
- Teamwork and Collaboration
- Attention to Detail
Timeline
Utilization Management Representative II
Elevance Health
11.2021 - Current
Health Program Representative II
Elevance Health
05.2017 - 11.2021
Night Auditor
Americas Best Value Inn & Suites
01.2016 - 04.2018
Alarm Monitor
Interface Security
11.2012 - 05.2015
High School Diploma - General Studies
University City High School