Junestta Potts

• Answer incoming phone calls from health care providers (i.e., physician offices, clinics) and members; identify the type of assistance the provider needs (e.g., benefit and eligibility, billing and payments, authorizations for treatment, explanation of benefits)
• Review claims status with the ability to identify if a claim requires reconsideration
• Focus on resolving issues on the first call, navigating through complex computer systems to identify the status of the issue and provide appropriate response to caller
• Deliver information and answer questions in a positive manner to facilitate strong relationships with providers and their staff
• Complete the documentation necessary to track provider and member issues and facilitate the reporting of overall trends.

• Scheduled customers COVID-19 and Monkey pox vaccination appointments
• Assist customers over the phone and through chat with questions regarding vaccinations.

• Responds to all customer contacts via phone
• Identify potential behavioral health situations and follow contract specific protocol to assist callers.

• Verifies entered customer and account data by reviewing, correcting, deleting, or
• Reentering data
• Reviewing client's documents submitted to qualify for a business grant
• Contacting clients to inform them of missing documentation needed to process their application for a grant.

• Resolve customer queries and complaints via multiple contact channels, including Phone, Email, and via Chat.
• Use problem solving skills to analyze more complex customer service issues and obtain solutions that benefit both the customer and the company.

The Provider Communications Representative is primarily responsible for, but not limited to responding to incoming provider hotline inquiries as they relate to benefit and eligibility verification, claim status (with the ability to identify if a claim requires reconsideration), authorization status, and complaints, accurate documentation recording of all provider calls; effective follow-up of provider calls, as required; and proper electronic routing with effective documentation skills.

• Contact Providers to verify and update demographic information.

• Keeping records of customer interactions, transactions, comments, and complaints
• Taking customer payments for toll charges over the phone
• Account resolution, de-escalation of upset customers while advancing through each call within the required matrix.

• Answered incoming calls regarding patient eligibility
• Scheduled eligibility appointments.

• Scheduled patient visits, physician appointments, diagnostic tests, procedures and treatments
• Communicated pertinent information regarding appointments, scheduling, prepayment and financial counseling to patients, families, physicians, team members, and other patient care individuals
• Interpreted and coordinated physician orders in reference to patients.

• Check in patients for their appointments, Schedule/reschedule appointments, and reminded patient of their appointments
• Answered multi-line phone system, routing calls, delivering messages to staff and greeting visitors.
• Entered new patient diagnosis information and copay amounts into system
• General Check in procedure.
• Executed record filing system to improve document organization and management.
• Received and sorted incoming mail and packages to record, dispatch or distribute to correct recipient.
• Scheduled office meetings and client appointments for staff teams.