Kiara Lee
Plumas Lake,CA
Summary
Motivated Responsible Customer Service Specialist with over 10 years experience in a fast-paced, team-based environment. Customer & Administrative driven to exceed sales goals and build long term relationships with customers. Delivers positive experiences through high-quality customer care. Goal-driven healthcare professional with advanced administrative experience including ability to deliver superior, personalized client service, cultivate strong business relationships, make real-time decisions, and resolve issues in a way that propels innovation and growth. Excellent team player who listens, thrives on collaborating with diversely talented team members, and integrates their divergent thoughts, opinions, and perspectives into meaningful action. Energetic, competitive achiever, with the ability to perform well under pressure in a fast-paced, rapidly changing environment. Exceptional verbal interpersonal communication skills, experience with communication breakdown and the understanding of how to communicate with people from various cultures, ages and genders through wisdom and high level understand. Thrives in fast-paced environments. Self-starter with excellent written and communication skills. Highly-trained individual and skilled communicator effectively interacts with patients, staff and other healthcare professionals. Patient-focused brings extensive experience in medical office management. Well-versed. Courteous candidate with evidence of experience providing quality patient care and administrative services. Proven track record of success in streamlining operations, developing protocols and improving patient outcomes. Strong commitment to exemplary Administrative Assisting and maximizing patient safety and satisfaction.
Overview
9
9
years of professional experience
Work History
UC Davis Transplant Center
Administrative Assistant III
08.2021 - Current
- Coordinate Kidney transplant
- Schedule Evaluations for patients and Surgery
- Call donors to follow up on applications
- Send authorizations to Kaiser and Travel and Lodging
- Request medical records via Ehealth
- Demonstrate project management skills to provide support for multiple meetings and competing deadlines
- Demonstrated analytical research, and problem solving
- Excellent typing, writing, editing and proof-reading skills to produce correspondence and other written materials quickly and accurately
- Extensive Calendaring experience, as well as Microsoft Office
- Communicate with other teams such as Financial, Referrals team, Medical Records
- Correspond with Nurse and Doctor daily as an assistant to ensure all tasks have been completed as requested.
UC Davis Cancer Center
MOSCII
01.2020 - 08.2022
- Experience with processing and reviewing referrals
- Utilizing EPIC & EMR for scheduling
- PC Proficiency in using multiple computer system applications
- Scheduling appointments, triaging escalated calls
- De-escalating matters where needed
- Helping with patients critical needs, routing encounter requesting medication refills
- This position required the skills and ability to manage the level of responsibility and accountability necessary to provide specialized duties for the department/clinical team for which it is assigned
- Office duties, per operational needs.
Lead Representative
Centene Health Net
10.2017 - 12.2019
- Investigate and resolve complex claims matters in coordination with health plan and/or corporate departments
- Coordinate the day-to-day work functions, acting as a go-to person and investigating and resolving complex issues
- Reference current materials to answer escalated and complex inquiries from members and providers regarding claims, eligibility, covered benefits and authorization status matters
- Provide first call resolution and own the process by working with appropriate internal/external resources and ensure the closure of all inquiries
- Collaborate with other departments on cross-functional tasks and projects
- Maintain performance and quality standards based on established call center metrics including turn-around times
- Provide encouragement to team members, including communicating team goals and identifying areas for new training or skill checks
- Develop strategies to promote team member adherence to company regulations and performance goals
- Take Member/Provider calls during peak/overflow periods.
Broker Services Representative
Health Net/Centene
05.2015 - 10.2017
- The providing comprehensive support in all aspects of broker management and communications
- The Broker Relations Department provides a wide spectrum of support and services such as Agent/Broker Contracting, Licensing Administration, DOI appointments and terminations, E-Mail communications, assisting with billing and commission inquires assistance with application status, quoting benefits and rates, provider searches and web support etc
- Answers and responds to incoming calls from active and prospective brokerage firms, Producers, General Agents, Employer Groups and Health Net Sales Associates regarding Agent/Broker agreements, commission inquiries, DOI appointments, billing and commission inquiries for Individual and Family Plans as well as Group business, product information
- Handles quote requests, etc
- Reviews Agent/Broker agreements requesting company appointment to ensure accuracy
- Once verified, assigns region code and submits to Broker Commissions for processing
- Agent/Broker agreement Administration also includes ensuring we maintain a copy of the Broker’s DOI Life Agent License at all times (which renews every two years)
- Agent/Broker agreements and license information is maintained in an electronic database
- Assists with verification of all Broker of Record changes using Health Net’s Automated Business System (ABS) and other automated tools
- Production of various correspondences sent via US mail, E-Mail, and/or via Fax Broadcast
- Communications pertain to Broker of Record appointments, provider network changes, announcements, etc
- Assists in developing and maintaining training materials to aid the team or to train new agents to the team
- Educates brokers on use of Sales materials and fulfills supply orders following department and company guidelines
- Maintains relevant files and legal documentation
- Coordinates miscellaneous projects including broker meetings, Sales contests, litigation research, etc
- Other duties as assigned
- Trained reps with process of procedures in training class
- Helped write curriculum and Policy and Procedure for Brokers processes.
Customer Care Representative
Health Net
12.2014 - 04.2015
- Examining Claims advising billed amount for dues, sending claim back for further review if needed
- Knowledge of RA’s handled Billing Disputes with contracted medical groups with high volume demand
- Experience with heavy duty call volume, work well under pressure
- Proficient oral and written communication skills
- Research claims under review appeal status
- Send out acknowledgement letters and case number to providers
- Submitting Appeals and Grievances Reporting member regarding any conflict not meeting compliance and regulations
- Answers and responds to incoming calls from active and prospective providers and members
- Quoting Benefits and Eligibility include members verification coverage status and other important info such as co-payments, coinsurance deductible amounts
- Rep
- Advised current and previous eligibility, assigned providers and medical groups
- Reactivating Eligibility for members after checking AEVS
- Use DOFR to inform providers who’s at risk for billing purposes
- Contact Medical Groups as needed regarding prior authorizations on behalf of members
- Submit Transportations Requests
- File transition of care and continuity of care
- Assist members with medication denials by using API
- Providing Authorizations status and referrals advising information on determination to providers fixing and issues causing conflict in members account, data entry may be required to keep track of member’s accounts and any changes to their policy
- Reviews partner agreements and contracts, ensuring accuracy and that agreements and contracts contain all proper supporting documentation and are entered into the appropriate tracking system
- Providing Authorizations status and referrals advising information on determination to providers fixing and issues causing conflict in members account, data entry may be required to keep track of member’s accounts and any changes to their policy
- Utilize HIPAA CAHPS OHI EPIC ICD-10
- Recorded on a spreadsheet daily report requested for members and providers.
Education
Sacramento City College
Sacramento, CACosmetology -
Federico Beauty Institute
Sacramento, CA01.2014
High School Diploma -
Stagg High School
Stockton, CA01.2008
Skills
- Empathy and Compassion
- Confidentiality and Ethics
- Time Management Abilities
- Post-Operative Care
- Organizational Skills
- Problem Solving Abilities
- Communication and Interpersonal Skills
- Quality Improvement Initiatives
- Electronic Health Records Management
- Support Services
Core Proficiencies
- Administrative/Clerical Duties
- Collaborations
- Communication
- Operations
- Policy & Procedures
- Scheduling
- Time Management
- Project Coordination
- Trusted key holder
- Creative problem solver
- Exceptional communication skills
- Quick learner
- Spreadsheet/Data Entry
- Multi-tasker
- Multi-line phone talent
- Training development aptitude
- Strong client relations
- MS Windows proficient
- Excel
- Work well under pressure
Jesus Culture Core Value
Casts the vision. Provides leadership for and actively participates in worship, education, discipleship and evangelism for the spiritual life and growth of members.
Timeline
UC Davis Transplant Center
Administrative Assistant III
08.2021 - Current
UC Davis Cancer Center
MOSCII
01.2020 - 08.2022
Lead Representative
Centene Health Net
10.2017 - 12.2019
Broker Services Representative
Health Net/Centene
05.2015 - 10.2017
Customer Care Representative
Health Net
12.2014 - 04.2015
Sacramento City College
Cosmetology -
Federico Beauty Institute
High School Diploma -
Stagg High School
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