Kiauna Taylor
Jacksonville
Summary
Dynamic Customer Care Representative with over 20 years of experience at LaserShip, adept at enhancing service delivery and training new hires. Proven ability to analyze data trends and maintain HIPAA compliance, while delivering exceptional customer service. Skilled in multitasking and fostering strong client relationships, ensuring efficient operations and satisfaction.
Overview
16
16
years of professional experience
Work History
Customer Care Representative/Operations Supervisor
LaserShip
Jacksonville
02.2022 - 06.2024
- Resolved customer inquiries with patience and clear explanations.
- Collaborated with team members to enhance service delivery processes.
- Monitored shipment status and communicated updates to customers promptly.
- Delivered fast, friendly, and knowledgeable service for routine questions and service complaints.
- Provided training support for new hires related to customer service processes and procedures.
- Performed administrative duties such as filing paperwork, maintaining records, updating databases.
- Analyzed trends in call volume data in order to anticipate peak periods and adjust staffing accordingly.
- Communicated with dispatch regarding delivery status and any issues.
- Followed scheduled routes to ensure timely deliveries to clients.
Clinical Operations Coordinator
Prime Therapeutics LLC
Remote
10.2020 - 01.2023
- Determines appropriateness for medications. Communicates decision to physicians, physician`s office staff, medical management staff and/or pharmacists.
- Researches, resolves and documents prior authorization outcomes in pharmacy system.
- Communicates selected prior authorization criteria, pharmacy benefit coverage and formulary alternatives to physicians, physician`s office staff, medical management staff and/or pharmacists.
- Escalates requests to Pharmacist when request requires extensive clinical review or denial.
- Researches, resolves and documents physician or client inquiries and grievances and provides verbal or written results to client, prescriber, provider and/or management.
- Performs other duties as required.
- For CPTs assigned to work the fax queue, responsibilities will also include:
- Clinically reviews coverage determinations with attention to detail, for medications via Fax. Communicates decision to physicians, physician`s office staff, medical management staff and/or pharmacists within SLA (service level agreement) guidelines
- Performed administrative tasks such as scheduling appointments and ordering supplies.
- Provided support for research projects by collecting, organizing, and analyzing data.
Prior Authorization Specialist
Express Scripts
Remote
04.2018 - 11.2020
- Reviewed medical records thoroughly before submitting them for preauthorization review process
- Interviewed applicants to obtain and verify information to determine eligibility for supportive services
- Responded to inquiries regarding eligibility of health care benefits and claim inquiries
- Developed effective relationships with internal and external customers through consistent communication and follow-up.
- Utilize CMS and InterQual criteria to establish authorizations for members requiring medical services for a Medicare advantage insurance company.
- Manage quality communication, patient support and service representation with patients and providers to establish equipment/procedures statuses and expedite orders.
- Work with staff to ensure proper CPT codes are submit on authorization request.
- Demonstrate compassion while obtaining patient demographics and personal health information.
- Escalate issues to Medicare contractors per current business practices.
- Review of medical records for appropriate ICD-9, ICD-10, HCPCS codes.
- Monitor DDE system for contract adjustments, payments, and error corrections.
Call Center Representative
ADT Security Services
Remote
05.2017 - 04.2018
- Verifies, responds to, and dispatches on emergency signals.
- Answers incoming calls.
- Must be proficient in the verification and dispatching of alarms to police/fire agencies
- Knowledge with the different types if signals and the SOP’s for each signal.
- Met minimum productivity standards set.
- Notifies customers of non-emergency signals.
- Notifies responders on emergency signals after dispatch.
- Processes basic data changes to customer accounts.
- Handled signals from one location/area and TTY stations.
- Adhered strictly to all applicable laws and regulations pertaining to customer privacy rights.
- Attended regular training sessions on updates and changes within the industry or organization.
- Answered incoming calls from customers and provided assistance with product inquiries, billing questions, and other customer service related issues.
Medical Assistant/
Spinal Injury Centers
Jacksonville
05.2014 - 05.2017
- Registered new patients, updated existing patient's demographics, and collected co-payments if applicable
- Verified customers' insurance eligibility status and coordination of benefits
- Served as a referral coordinator by contacting primary care physicians for referrals and medical records
- Performed patient triage, documented chief complaints, and escorted patients to the designated examination rooms
- Updated patient medical records and medications lists
- Conducted therapeutic exercises; EMS stimulation and muscle therapy
- Documented patients' therapy progress
- Set up rooms for procedures and assisted the physician with medical procedures as needed.
Fraud Analyst/Lead Engineering Technician
Citibank
Hybrid
08.2008 - 06.2014
- Identified fraudulent transactions and cancelled them from further processing
- Interacted with customers to validate information, confirm or cancel authorizations, and resolve critical customer inquiries concerning fraudulent abuse
- Transferred calls on a multi-line phone system when applicable
- Tracked and monitored activity that came through customer accounts
- Flagged suspicious accounts.
- Performed detailed analysis of financial transactions to identify suspicious activity.
- Assessed customer and client data to detect potential fraud risks.
- Monitored customer accounts and identified any discrepancies or irregularities in account activity.
Education
High School Diploma -
West Phoenix High School
Phoenix, AZ05-2006
Skills
- In-depth knowledge of sales and marketing software
- Ability to remain calm and professional in stressful situations
- Ability to multitask by reading, typing, and navigating through applications while speaking with customers
- 20 years Customer Service Experience
- Dependable and consistent
- History of good attendance
- Document Control
- FDA Regulations
- Clinical Research
- Data Management
- HIPAA Compliance
- Business Development Process
- Improvement Operations
- Management
- Knowledge of Microsoft Office Suite
- Interpersonal Relations
- Policy Interpretation
- Data Entry Skills
- Client Advocacy
- Marketing Knowledge
- Excellent Phone Demeanor Typing (45WPM)
- Customer Service Experience Experience in mail pharmacy CRM Software
- Excellent oral communication skills: clear diction, tone and knowledge/use of proper grammar
- Knowledge with technical troubleshooting
- Familiar with HealthCare Systems ( CRM, SaaS, Avaya) HIPPA
- Contact Center Experience
- Interviewing Techniques
- Outbound Calling
- Payroll processing
Languages
1
Timeline
Customer Care Representative/Operations Supervisor
LaserShip
02.2022 - 06.2024
Clinical Operations Coordinator
Prime Therapeutics LLC
10.2020 - 01.2023
Prior Authorization Specialist
Express Scripts
04.2018 - 11.2020
Call Center Representative
ADT Security Services
05.2017 - 04.2018
Medical Assistant/
Spinal Injury Centers
05.2014 - 05.2017
Fraud Analyst/Lead Engineering Technician
Citibank
08.2008 - 06.2014
High School Diploma -
West Phoenix High School
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