Korie Wilson

• Delivery and drop off of library books within all 9 Jefferson County Libraries. Navigated delivery routes with GPS devices for faster delivery times.
• Enhanced overall team performance by providing constructive feedback on potential areas of improvement within the delivery process.
• Promoted positive brand image through courteous interactions with customers during both pick-up and drop-off processes.
• Maintained a clean and organized delivery truck, resulting in better efficiency during deliveries.

• Handles about 90 inbound calls from Providers and
• Members handling dental
• inquiries.
• • Confirming dental eligibility/ membership quoting group benefits and or
• Checking dental claims status.
• Trouble shooting website tech issues and password resets.
• • Providing benefit breakdowns of dental group coverage from 4 different
• plans.
• • Familiar with dental procedure codes and also denials codes
• • Performed quality control of the data entry system to verify that claims and
• payments were posted correctly. Meticulously tracked and resolved
• underpayments. Completed appeals and rerocessed submitted claims.
• Thoroughly reviewed remittance codes from EOBS/AR's. Evaluated the
• accuracy of provider charges, including dates of service, procedures, level of
• care, locations, diagnoses, patient identification and provider signature.
• Contacted insurance providers to verify correct insurance information and
• get authorization for proper billing codes.
• • Demonstrated knowledge of HIPAA Privacy and Security Regulations by
• appropriately handling patient information. Confirmed patient information,
• collected copays and verified insurance. Evaluated the accuracy of provider
• charges, including dates of service, procedures, level of care, locations,
• diagnoses, patient identification and provider signature.

• Be available to handle member inquiries
• Represent Health Plan by answering and documenting all incoming contacts to determine their nature, and respond to complex calls related to specialized product lines or queues
• Respond with empathy to complaints and concerns from members concerning health plan benefits, account status, payment history, and medical services
• Initiate contact with the appropriate health plan, medical group and facility personnel to obtain information relevant to the concern or inquiry as needed
• Evaluate data to determine and implement the appropriate course of action to resolve the complaint and/or coordinate service recovery
• Document according to procedure
• Assist department in reaching call handling goals, first contact resolution goals, complaint resolution compliance, member retention and making return contact as warranted
• Complete required training (including, but not limited to, annual certifications) and understand how to use tools available to recall necessary information
• Effectively diffuse anger, tension, and hostility, within regulatory guidelines, of members expressing concerns about KP
• Maintain awareness of the way performance and actions affect members and KP's financial stewardship
• Be open and receptive to feedback, and change behavior to improve performance
• Researches claims/bills for appropriate support documents and/or documentation
• Review scanned, EDI, or manual documents for pertinent data on claim/bill for complete and /or accurate information (eg, date of service, provider numbers, charged amounts, medical prodedure codes,fee codes, etc
• Ensures claims/bills meet eligibility, benefit and Medicare requirements
• Receives calls from members and or tracks on line communications, providers, explains reason( s ) claims/bills have been denied or pending, by utilizing benefit plan agreement, eligibility, possible coordination of benefits, workers compensation and policies and procedures
• Explain the appeal process if necessary
• Provide one on one customer service in obtaining and providing information to the member and or provider
• Documents and tracks online communications
• Responds to and researches vendor and member problems, questions and complaints using online systems
• In addition to defined technical requirements, accountable for consistently demonstrating behavior and principles defined by the Kaiser Permanente Service Quality Credo, the KP Mission as well as specific departmental organizational initiatives
• Also accountable for consistently demonstrating knowledge skills, abilities, and behaviors necessary to provide superior and culturally sensitive service to each other, to our members and to purchasers, contracted providers and vendors.
• Helped large volume of customers every day with positive attitude and focus on customer satisfaction. Appointment Center job details below:

Receives patients' appointment requests; ascertains type of appointment needed, by asking pertinent questions, medical provider and time preference; refers patients' appointment requests to other medical office locations as necessary. Must be able to follow and understand all medical offices booking guidelines. Refers to comment boxes for booking procedure.

Determines available appointment times; obtains and records patients' identification and appointment Information on automated scheduling system. Cancels and verifies appointments at the request of patients.

Answers inquires and provides information regarding appointment services and procedures, must be able to provide specialty referral information if required for specialty per patient's request; refers other inquiries to appropriate personnel.

Messages information or transfers calls to appropriate personnel if patient requests advice, an urgent appointment or according to protocol; schedules follow-up appointments as necessary.

Retrieves messages per protocol from appropriate sources (patient care or Medical Offices).

Communicates approved messages, test results, and patient care information per guidelines.

Provides directions to patients in order to get to medical facilities; provides information about our division to members; and gives instructions to members per protocol.

Maintains confidentiality and integrity of all computer data, appointment data, and information concerning departmental functions.

Facilitates making appointments for providers in TMC and Nurse Advice as requested.

Assists existing members in their selection of personal care physicians (PCP) by phone calls, reads one biography per call when requested by member (simple linking).

Updates the PCP Selection Tool for completion of personal care physician linkage in the designated system.

Email providers biographies to members when requested.

• Taking inbound calls Directv customers who need technical assistance for their Satellite Service
• Activation and Suspension of services upon customer request
• Also upgrading and downgrading DIRECTV products (receivers) and entertainment packages for customers
• Provided customers with polite, friendly, and helpful service
• Handles all escalation, specialty call types beyond customer service, and technical support
• Also provides customer retention and handles, Supervisory phone calls
• Documents all repeat issues related to previous calls for the continued improvement of customer care via agent coaching
• To serve as a point of contact providing mentorship to other departments, up to and including technical support.
• Assisted customers in identifying issues and explained solutions to restore service and functionality.