Kyara Ferrell

• A point of contact for processing post determination reviews and appeal requests received via phone, fax, or email in accordance with regulatory requirements and health plan guidelines.
• Conduct research and analysis of case documentation, claims data, and medical records to ensure case files are complete. Contacts providers when additional information is needed.
• Manage workload effectively by moving cases through the appropriate stages timely to ensure service level agreements are met.
• Maintain accurate documentation and tracking in internal systems to support the appeal workflow, reporting, and compliance.
• Generate acknowledgement letters for delegated appeals in accordance with regulatory standards.
• Meet established department guidelines related to productivity, quality and timeliness.
• Processing Health Plans Overturns, ReReviews, Reconsiderations and Reopens, physician appeal recommendations, claim retro reviews
• Electronic Faxing
• Converting documents
• Inbound and outbound calls to Health Plans, Members and Doctors
• Collaborated with healthcare providers and patients/members to ensure continuity of care and health plan resource allocation.
• Educated patients and families on options and health management strategies.
• Facilitated case conferences to discuss complex cases and develop collaborative solutions.
• Maintained accurate documentation on all cases, ensuring compliance with regulations and confidentiality requirements.
• Monitored ongoing cases closely, adjusting case management strategies as needed based on evolving circumstances or new information.
• Improved client satisfaction by efficiently addressing concerns or grievances in a timely manner.
• Participated in regular professional development opportunities to stay current on best practices within the field of case management.
• Advocated for clients in legal settings, ensuring their rights were protected and voices heard.
• Provided leadership, guidance and support to staff members.
• Established and maintained relationships with key stakeholders.
• Coordinated care plans with interdisciplinary teams to enhance patient outcomes.
• Reduced errors in data entry, instituting rigorous quality control checks.

• This position is part of an operations team that strives to provide first call resolution to a specified set of customers. This position primarily answers incoming calls for new and existing authorizations. Responsibilities include documenting in the appropriate systems and ensuring high quality and accurate information is provided to callers. This role is expected to meet or exceed operations production and quality measures.
• Investigated and resolved customer inquiries and complaints quickly.
• Exhibited high energy and professionalism when dealing with clients and staff.
• Met customer call guidelines for service levels, handle time and productivity.
• Responded to customer requests, offering excellent support and tailored recommendations to address needs.
• Promoted superior experience by addressing customer concerns, demonstrating empathy and resolving problems swiftly.
• Maintained up-to-date knowledge of product and service changes.
• Answered average of 60 calls, emails and faxes per day, addressing customer inquiries, solving problems and providing product information.
• Enhanced customer satisfaction by promptly addressing inquiries and resolving issues related to provider services.
• Assured compliance with company policies and procedures, as well as applicable federal, state, and local regulations regarding provider services.
• Contributed to a higher level of service quality by conducting routine audits of enrolled providers'' credentials and documentation.
• Reduced response times with effective management of high-volume incoming calls, emails, and correspondence from providers seeking assistance or information.

• This position is part of an operations team that strives to provide first call resolution to a specified set of customers. This position primarily answers incoming calls for new and existing authorizations. Responsibilities include documenting in the appropriate systems and ensuring high quality and accurate information is provided to callers. This role is expected to meet or exceed operations production and quality measures.
• Investigated and resolved customer inquiries and complaints quickly.
• Exhibited high energy and professionalism when dealing with clients and staff.
• Met customer call guidelines for service levels, handle time and productivity.
• Responded to customer requests, offering excellent support and tailored recommendations to address needs.
• Promoted superior experience by addressing customer concerns, demonstrating empathy and resolving problems swiftly.
• Maintained up-to-date knowledge of product and service changes.
• Answered average of 60 calls, emails and faxes per day, addressing customer inquiries, solving problems and providing product information.

• Used EPMS to document and maintain patient information and health background.
• Performed general chair-side duties for general dentistry, endo procedures and oral surgery.
• Leading and Training Dental Assistant: conducted morning group huddles, trained newly hired dental assistants, ensured smooth work flow in office, oversee sterilization and infection control, supervision, inventory management.
• Patient Record management
• Billing and insurance
• Sterilized rooms and prepped equipment and instruments for 15 procedures daily.
• Sanitized trays, instruments and surfaces for clean dental office setting and patient safety.
• Scheduled appointments for new and existing customers, factoring in provider availability and scheduling loads.
• Explained treatment procedures and instructed patients on home care guidelines.
• Administered desensitizing agents by applying numbing gel to prepare patients for anesthetic injections.
• Educated patients on postoperative care and best practices for protecting dental work and boosting healing process.
• Helped dentists restore teeth by applying permanent and temporary fillings and crowns.
• Assisted dentists, hygienists and other personnel by handing appropriate tools and supplies needed for procedures.

• Reviewed each step of patient care and made proactive adjustments to avert issues.
• Completed documentation of care, hospital actions and patient activities.
• Upheld confidentiality requirements and regulatory compliance guidelines in all areas.
• Resolved problems, improved operations and provided exceptional service.
• Actively listened to customers, handled concerns quickly and escalated major issues to supervisor.
• Answered patient assistance calls, assessed needs and offered qualified support.
• Coordinated charitable, government and community resources for patients.
• Handled prescription refill requests.
• Collected co-payments or full payments from customers.
• Performed various pharmacy operational activities with strong commitment to accuracy, efficiency and service quality.
• Reviewed and verified customer information and insurance provider information.
• Answered incoming phone calls and addressed questions from customers and healthcare providers.
• Set up and modified patient profiles in Cloud to include current information such as medications and insurance details.

• Greet members,
• Operate cash register,
• Engage with members by unpacking carts loading merchandise on conveyor belt and packing it back inside of the cart
• Attend gas station
• Fold clothing
• Decorated cakes and cupcakes
• Zoned freezer cooler
• Wrapped foods in bakery and put them out on the floor
• Cooked and served food in the cafe
• Restocked, arranged and organized merchandise in front lanes to drive product sales.
• Checked identification for proof-of-age and refusing alcohol and tobacco sales to underage customers.
• Reviewed and resolved differences between accounting information and cash drawer.
• Helped customers complete purchases, locate items and join reward programs to promote loyalty, satisfaction and sales numbers.

• Reviewed and monitored programs regularly and coordinated resources and materials.
• Conducted surveys and analyzed data and prepared and maintained reports and records.
• Contributed to work plans, reports, success stories and other deliverables.
• Addressed issues immediately and worked with other stakeholders to find the most effective solutions available
• Registered,qualified, and Enrolled students in an online public school
• Reset passwords
• Transferred calls
• Updated enrollment and academic documentation
• Salesforce
• Directed software design and development across multifaceted team to meet client needs for functionality, timeline and performance.

• Handle cash
• Zoned
• Operate cash register
• Engaged with customers in conversation
• Bagging merchandise and putting it in their carts
• Pick-Up: i fulfilled and dispensed online orders for customers, went throughout the store found the merchandise scanned it in then stored it in the appropriate bin until customer came for pick up then dispensed it
• Performed customer service tasks: processing returns, cashed checks, filled money orders

Successfully assisted the dentist by performing four-handed dentistry

Correctly mixed compounds for cleaning or filling teeth.

• Recorded patients' health histories, documented current symptoms and pulled up records from prior visits for dentists to view and evaluate.
• Prepared patient X-rays and images for review by dentist.
• Helped assistants complete routine and advanced procedures by preparing patients and instruments for expected needs.
• Explained treatment procedures and instructed patients on home care guidelines.
• Performed general chair-side duties to assist with various procedures, including general, endo and oral surgery.

• This position is part of an operations team that strives to provide first call resolution to a specified set of customers. This position primarily answers incoming calls for new and existing authorizations. Responsibilities include documenting in the appropriate systems and ensuring high quality and accurate information is provided to callers. This role is expected to meet or exceed operations production and quality measures.
• Investigated and resolved customer inquiries and complaints quickly.
• Exhibited high energy and professionalism when dealing with clients and staff.
• Met customer call guidelines for service levels, handle time and productivity.
• Responded to customer requests, offering excellent support and tailored recommendations to address needs.
• Promoted superior experience by addressing customer concerns, demonstrating empathy and resolving problems swiftly.
• Maintained up-to-date knowledge of product and service changes.
• Answered average of 60 calls, emails and faxes per day, addressing customer inquiries, solving problems and providing product information.