KAYSHAWNA SADLER
Summary
Efficient Retention Representative with over 7 years’ experience in providing assistance with account and services by identifying solutions to client inquires. Capable of accurately tracking interactions with clientele within the line of protocol. Experience with case management and service coordinator positions.
Overview
8
8
years of professional experience
Work History
Rep
Health Information Management
06.2021 - Current
- Processes requests for information from insurance companies, attorneys, patients, PRO, physicians, federal and state agencies, etc., as assigned
- Opens and date stamps requests in a timely fashion, determines if requests are proper (i.e
- Valid authorization with a valid date, etc.); initiates a return letter if authorization is inappropriate
- Determines if special consent forms are necessary depending on the type of patient illness (i.e
- Psychiatric, HIV, etc.)
- Ensures that requests are processed accurately and in a timely fashion Performs on-going follow-up of outstanding requests and informs the manager of request status when necessary
- Performs other duties as assigned
- Prints copies of requested information as needed
- Distributes printed information (or digital files) to authorized individuals
- Appropriately grants access to electronic records
- Identifies missing or incomplete medical information and complies with departmental procedures for following-up on missing or incomplete documents
- Responds to inquiries from patients and staff members and instructs them in the appropriate methods for requesting records
- Forwards authorizations to appropriate areas
- Enters requests accurately into ROI systems
- Maintains accurate electronic files of requests and updates systems as needed
- Scans authorization forms and related documentation into patient chart
- Scans requested records into ROI systems and ensures that quality images are captured.
Customer Service Representative
Centene
New York City
09.2017 - 03.2021
- Resolve customer inquiries via telephone and written correspondence in a timely and appropriate manner
- Reference current materials to answer escalated and complex inquiries from members and providers regarding claims, eligibility, covered benefits and authorization status matters
- Provide assistance to members and/or providers regarding website registration and navigation
- Educate members and/or providers on health plan initiatives Provide first call resolution working with appropriate internal/external resources, and ensure closure of all inquiries
- Document all activities for quality and metrics reporting through the Customer Relationship Management (CRM) application
- Process written customer correspondence and provide the appropriate level of follow-up in a timely manner
- Research and identify processing inaccuracies in claim payments and route to the appropriate team for claim adjustment
- Identify trends related to member and/or provider inquiries that may lead to policy or process improvements that support excellent customer service and impact quality and performance standards
- Work with other departments on cross functional tasks and projects
- Maintain performance and quality standards based on established call center metrics including turn-around time
Customer Care Agent
Global Contact Service
01.2016 - 05.2017
- Demonstrates the appropriate skill sets to perform their daily activities in a high volume reservations and customer care call center environment
- Customer Care Associate is responsible for efficiently and in a high quality customer service oriented manner, receiving calls from customers on behalf of the New York City Transit Authority’s (NYCTA) Paratransit Services Team
Education
undefined
Current
Psychology
City University of New York
May 2016, February 2021
Associate - undefined
Thurgood Marshall Academy, arts, Fulton- Montgomery Community College
May 2013
Skills
- Proficient in
- Adobe Acrobat, Epic (EpicCare Link, Inspector Key, etc), Microsoft Office Suite, OnBase, Citrix, OBIX, Cisco (Finesse, Jabber, Webex, etc), and portals such as IPRO, Centene, GlobalScape, Availity, MedReview, EXL Health, etc
Timeline
Rep
Health Information Management
06.2021 - Current
Customer Service Representative
Centene
09.2017 - 03.2021
Customer Care Agent
Global Contact Service
01.2016 - 05.2017
Psychology
City University of New York
Associate - undefined
Thurgood Marshall Academy, arts, Fulton- Montgomery Community College
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