Klisha Burns

• Assisted customers with inquiries, ensuring timely and accurate resolution of issues.
• Developed strong product knowledge to effectively address customer concerns and promote services.
• Utilized CRM software to track customer interactions and document service requests efficiently.
• Collaborated with team members to enhance service delivery and streamline operational processes.
• Provided exceptional customer service to patients, addressing inquiries and resolving issues efficiently.
• Respond to customer questions via telephone and written regarding insurance benefits, patient appointments, and eligibility. Analyze problems and provide information/solutions
• Develop and maintain positive customer relations and coordinate with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner.
• Research and analyze data to address operational challenges and customer service issues. Thoroughly document inquiry outcomes for accurate tracking and analysis.
• Answer Inbound calls to make appointments for the clients. To and from their destinations
• Make Outbound calls to the clients to remind them about their ride aand appointments

• Respond to customer questions via telephone and written regarding insurance benefits, patient appointments, and eligibility. Analyze problems and provide information/solutions
• Develop and maintain positive customer relations and coordinate with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner.
• Research and analyze data to address operational challenges and customer service issues. Thoroughly document inquiry outcomes for accurate tracking and analysis.
• Handle Medicaid and other private insurance referrals and hospital admissions/ precertification.
• Insurance verification and follow-up, to include update patient medical records.
• Patient registration.
• Patient inquiries for billing and collections; to include remittance and payment posting.
• Submit physician orders for prescribed tests, supplies, and procedures.
• Performs other objectives as assigned.

Respond to customer questions via telephone and written regarding insurance benefits, provider contracts, eligibility, and claims. Analyze problems and provide information/solutions.

▪ Develop and maintain positive customer relations and coordinate with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner.

▪ Research and analyze data to address operational challenges and customer service/claims issues. Thoroughly document inquiry outcomes for accurate tracking and analysis.

▪ Performs quality control of UB-92 and HCFA-1500 claims.

▪ Actively listen and respond to the needs and expectations of internal/external associates by answering day to day claims/operational questions. Providing guidance, senior knowledge to associates on specific procedures to maximize efficiency on WGS claims/operational tasks.

▪ Supervise aged UB-92/HCFA-1500 claim inventory by keying, processing and/or adjusting claims. ▪ Demonstrate superior and professional service to teammates by administering first hand day to day basis resources for operational, technical, and training related processes.

▪ Manage and conduct invasive/escalated telephone and written inquiries by researching, analyzing and initiating steps to formulate solutions regarding issues relating to the content or interpretation of benefits, policies and procedures, and adjudication of WGS/Networx Pricer/QCARE/ITS claims and/or customer care.

▪ Create and manage periodic spreadsheets for reporting of service/claims level, performance indicators while providing insightful analysis of the data showing productivity and accuracy.

▪ Operate WGS, Networx Pricer, ITS, and QCare systems to obtain and extract information; documents information, activities and changes in the database.

▪ Prepare daily work load for team members to include participation in team improvement.

▪ Review, analyze and process claims in accordance with policies and claims events to determine the extent of the company's liability and entitlement.

▪ Conducts investigation and review of customer grievances and appeals involving provision of service and benefit coverage issues. ▪ Contacts customers to gather information and communicate disposition of case; documents interactions.

Generates written correspondence to customers such as members, providers and regulatory agencies.

▪ Triages clinical and non-clinical inquiries, grievances and appeals, prepares case files for member grievance committees/hearings. Summarizes and presents essential information for the clinical specialist or medical director and legal counsel.

▪ Assist with training of staff but not limited to providing support and ensure effective collaboration and timely completion of tasks.

▪ Independent problem solver and decision-maker, and work without significant guidance.

Handled Medicaid and other private insurance referrals and hospital admissions/ precertification.

▪ Insurance verification and follow-up, including electronic and paper claims HCFA 1500, ICD-9/10, and UB92.

▪ Updated patient medical records.

▪ Patient registration.

▪ Patient inquiries for billing and collections; to include remittance and payment posting.

▪ Submitted physician orders for prescribed tests, supplies, and procedures.