Summary
Overview
Work History
Education
Skills
Reference
Timeline
Generic

Jovanna Pittman

Denver,CO

Summary

Highly motivated Customer Service Representative with 12+ years of experience providing excellent customer service and support. Proven track record of resolving customer complaints and increasing customer satisfaction by 20%. Possess excellent communication, problem-solving, data entry/ research, and organizational skills, as well as an aptitude for quickly learning new technologies.

Overview

14
14
years of professional experience

Work History

Referral Processor II

Kaiser Permanente, ON CALL
07.2023 - Current
  • Working, and authorizing/ denying in and out of network referrals using Epic Database
  • Inputting data in a fast paste and accurately
  • Ability to read/interpret provider orders and to apply medical coding procedures using CPT-4 and ICD-9
  • Medical Terminology
  • Processes complex outside medical referrals; reviews referral for completeness and requests additional information as necessary; verifies member eligibility, ensures appropriate review nurse approval is obtained when necessary (codes diagnoses and procedures) and enters information into system.
  • This position knows and complies with all Kaiser Permanente quality, safety, and emergency policies and procedures.
  • Demonstrates quality and effectiveness in work habits and clinical practice in every interaction with patients, colleagues, providers, and leadership.
  • Ensures patient safety in the preparation and provisioning of care related to but not limited to medications, procedures, infection prevention, fall prevention, including consistent use of two patient identifiers and procedural time outs.
  • Reports safety hazards, accidents and incidents, and unsafe working conditions promptly
  • Maintains relationships with vendors, physicians and members with regard to questions and problems with referrals, including keeping outside providers updated with pertinent information to process referrals (Research each referral to ensure service requested is a benefit for the member
  • Gathers data on interregional members and verifies eligibility status by contacting member's home region.)
  • Performs other duties as assigned by management
  • Demonstrated customer service skills, customer focus abilities and the ability to understand Kaiser Permanente customer needs.

Membership Rep II

Anthem Blue Cross Blue Shield
01.2012 - 07.2023
  • Maintained department inventory, produced member correspondence, completed extensive research on difficult issues including Market place/exchange issues, reached out to provider regarding claims discrepancies or additional document needed to process claims
  • Completed members follow up to gather additional information or to provide status and/or resolution on different issues
  • Provide customer service to members and employer groups for enrollment and billing, claims and benefits, resolving issues and educating callers
  • Verify enrollment status, made changes to records, research, and resolve enrollment system rejections; performed error resolution and processed discrepancies, addressed a variety of enrollment questions and/or concerns received by phone, mail, or e-mail
  • Maintained proper billing procedures, collects premiums, and reconciles payments
  • Working knowledge of claims and products, including the grievance and appeals process
  • Thoroughly documented inquiry outcomes for accurate tracking and analysis
  • Inputting data in a fast paste and accurately
  • Being able to multitask and work through different spreadsheets, and different assignments/ ques
  • Working through different ques/ assignment for that day
  • Inputting data/ days of work on spreadsheets
  • Project Team/Escalation rep answered questions from my peers regarding various policies, procedures, enrollment, billing, claims and benefits
  • Handled escalated/supervisor calls with a win-win outcome.

Customer Account Executive

Comcast
07.2009 - 07.2010
  • Interacted with customers via telephone and email to assist with a variety of customer inquiries and issues
  • Technical troubleshooting with Comcast cable/video equipment and answered any billing inquiries and researched billing discrepancies
  • Recognizes, conveyed, promoted, and up-sell products and service value
  • Remained up-to-date on products and services to ensure customer satisfaction and to maximize sales opportunities (e.g
  • Marketing matrix, new product information)
  • Maintains excellent oral and written communication skills, with ability to convey relevant information and directions in an organized and concise manner
  • Promote Comcast products and services based on a relationship to the customer's needs and interests
  • Enters sales, confirm sales and supports other lines of business as call volume dictates
  • Consistently demonstrates ability to meet higher performance expectations (increased KPI/MPS).-Achieved overall performance goals of the organization.

Education

Associates of Science - Business Administration

Colorado Technical University
Denver, CO
05.2018

Received High School Diploma -

Englewood High School
Englewood, CO
05.2006

Skills

  • Adaptability
  • Active Listener
  • Leadership
  • Research Proficiency
  • Document Control
  • Information Protection
  • Data Entry
  • Customer Service
  • Critical Thinking
  • Recordkeeping Expertise
  • Contract Amendments
  • Records Management
  • Efficient Routing
  • Process Auditing
  • Customer Inquiries
  • Reading Comprehension
  • Maintaining Clean Work Areas
  • Correcting Errors
  • Employee Training
  • Attention to Detail
  • Compliance Monitoring
  • Teamwork and Collaboration
  • Special Projects
  • Contract Preparation
  • Customer Transactions
  • Template Reading
  • Quality Inspections
  • Experienced in Microsoft office applications Anthem systems knowledge Mainframe(Star & WGS), CCB, Client Console, Web to Cash, On Demand, Ultera, Content Framework, Mas Toolbar, EPIC Database, BPM, WEM, MAPS, BOA, Blue2, TransCentra, , Genesys, Doculivery, Vision, CIRS, MAGI, WDE, CED, Solution Central

Reference

Available upon request

Timeline

Referral Processor II

Kaiser Permanente, ON CALL
07.2023 - Current

Membership Rep II

Anthem Blue Cross Blue Shield
01.2012 - 07.2023

Customer Account Executive

Comcast
07.2009 - 07.2010

Associates of Science - Business Administration

Colorado Technical University

Received High School Diploma -

Englewood High School

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Jovanna Pittman