Johanna Veras
Philadelphia,PA
Summary
- Highly enthusiastic customer service professional with 15 years client interface experience.
- Enthusiastic customer service/telesales representative with in-depth knowledge of sales, account management and training.
- Dedicated Customer Service Representative motivated to maintain customer satisfaction and contribute to company success.
- Customer Service Representative with extensive knowledge of the health care business. Energetic, outgoing and driven to reach company goals.
- Accurate Customer service Representative versed in database management. Strong organizational, technical and analytical skills.
- Highly effective at handling confidential information and identifying system improvements with ease.
- Customer Service Representative who successfully manages multiple data entry projects at once. Transcription expert focused on delivering high quality results in a timely manner.
Overview
5
5
years of professional experience
Work History
Customer Service Representative
VRI Cares
06.2020 - Current
- Responsible for Calming angry and distressed callers in difficult or emergency situations.
- Wide breadth of emergency dispatch experience
- Sound grasp of public safety principles and practices
- Strong expertise in determining emergency nature and location
- Superior ability to prioritize multiple emergency calls and dispatch appropriate services
- Excellent facility with a wide variety of communications equipment
- High oral and written communication skills
- Good problem-solving and organizational abilities Respond to and resolve customer service inquires on the first call
- Research complex issues using multiple databases
- Submit pre-authorizations or pre-determination requests
- Meet the performance goals established for the position in the areas of: efficiency, call quality, customer satisfaction, first call resolution and attendance
- Ensure that claims are processed and audit for accuracy
- Provide solutions for Emergencies calls.
- Route dispatch calls to police and fire departments as appropriate.
- Determine locations and severity of campus emergencies.
- Coordinate and monitor emergency response activity.
- Maintain and update all activity logs and video cameras.
- Ensure security and confidentiality of all incident logs and equipment.Investigate issues and document steps taken to achieve resolution
- Investigate and handle retro-certification activities, as required for resolution of customer issues
- Respond to customers regarding status of formal emergencies.
Claims Representative
AmeriHealth Caritas Of Pennsylvania
04.2020 - 03.2022
- Provide excellent customer service and product support in assisting with the process and selection of high quality Claims
- Meet established productivity, schedule adherence, and quality standards
- Respond to complex customer calls regarding their claims
- Effectively listen and respond to customer questions and challenges in order to provide the best possible solutions
- Provide order entry, payment collection and communication of FDA requirements
- Provide outbound calls to provide product recommendations and complete the order
- Assist with technical difficulties with the website.
Provider Services Representative
Amida Care
12.2018 - 07.2020
- Request Applications, enrollment forms for claim submitted
- Conducts provider outreach by providing training and guidance to enable network providers to become more self-sufficient in confirming eligibility, claims submission, and payment by use of available tools. Schedules, conducts, and documents training with each participating provider and office/support staff within established department guidelines. Must document training provided and respond to subsequent requests for follow-up training in a timely manner. Responsible for training office/support staff in use of all web-based information systems including security guidelines.
- Responsible for demonstrating an understanding of basic managed care concepts and principles including Medicaid Managed Care, CHIP, Medicare, Commercial HMO/EPO benefit programs. Must be able to communicate effectively and efficiently both verbally and in writing with providers, peers, and others about day to day issues and concerns.
- Review Enrollment forms for correct Beneficiary
- Send the claim forms out to Informants or Beneficiaries
- Build Claim in USSI (United Systems Software Inc.)
- Run follow-up report weekly
- Send out follow up claim forms -Assist with Special projects
- Maintain a log for daily loss reports and backlog
Education
Bachelor of Science - Technical Management And Criminal Justice
Devry University
New York, United States03.2017
Associate of Arts - Liberal Arts And Sciences
La Salle University
Philadelphia PA03.2011
GED -
Temple University
Philadelphia 07.2005
Skills
- Time management
- Microsoft Office proficiency
- Excellent communication skills
- Strong problem solver Resourceful
- Strong interpersonal skills
- Customer service-oriented
- Critical thinker
- Claims appeal procedures
- HIPAA compliance
- High customer service standards
- Service solutions expert
- Call center management experience
- Training manual contributor
- Proficient with Microsoft Outlook, Excel & PowerPoint, Access,
- Energetic work attitude
- Customer service expert
- Adaptive team player
- Troubleshooting skills
- Strong problem solving ability
- Devoted to data integrity
- Conflict resolution proficiency
- Dedicated to process improvement
Accomplishments
Customer Service
- Researched, calmed and rapidly resolved client/provider conflicts to prevent escalated calls
- Managed call flow.
- Investigated any necessary information for proper billing for, patients and providers such as proper billing codes.
- Researched and resolved billing problems
Sales
- Consistently generated additional revenue through skilled sales techniques.
Received 3 Bravo awards from current Manager and Regional Vice President of Claims
Skills
- Customer Service
- Critical Thinking
- Telephone Skills
- Time Management
- Professional and friendly
- Multi-tasking
- Prioritization
- Attention to detail
Timeline
Customer Service Representative
VRI Cares
06.2020 - Current
Claims Representative
AmeriHealth Caritas Of Pennsylvania
04.2020 - 03.2022
Provider Services Representative
Amida Care
12.2018 - 07.2020
Bachelor of Science - Technical Management And Criminal Justice
Devry University
Associate of Arts - Liberal Arts And Sciences
La Salle University
GED -
Temple University