Client- Focused Representative with 10(+) years of providing solutions to customers. Proficient at building and maintaining professional relationships. Encouraging manager and analytical problem-solver with talents for team building, leading and motivating, as well as excellent customer relations aptitude and relationship-building skills. Proficient in using independent decision-making skills and sound judgment to positively impact company success. Dedicated to applying training, monitoring and morale-building abilities to enhance employee engagement and boost performance.
Overview
18
18
years of professional experience
Work History
Benefits Payment Control/Fraud Unit(Remote)
Adecco/Accenture
San Andreas, CA
09.2021 - 03.2022
Managed research on current benefit trends and regulatory and legislative requirements and presented findings and recommendations to leadership.
Conducted thorough review of benefit election complaints and appeals submitted to benefits division.
Evaluated and modified existing compensation and benefits programs, policies and procedures in coordination with human resources department.
Partnered with benefits analyst and resolved data and system issues pertaining to claimant benefits.
Analyzed large amounts of data to find patterns of fraud and anomalies.
Collaborated with team members to discuss fraud trends and brainstorm methods to combat this type of crime.
Gathered evidence, which included recorded and written statements, financial documentation and audio materials for examination.
Front desk clerical with assisting incoming clients across LabCorp corporations
Handle incoming calls with state pickups and Routine pickups of specimens across states
Outbound calls to hospitals and doctor offices reporting specimens that were insufficient
Handling ICD9 codes
Test codes, cost and lab results
Worked closely with doctor office and clients about patients with critical lab results if there was a spike in patients glucose, potassium and etc.
Transplant screening and testing
Transplant monitoring and disease association
Offer variety of drug testing services and web-based application for employers, third-party administration, and Medicare review offices
Detailed attention with reading lab results
Making clear judgment of resulting lab results by state regulatory
Deliver high quality diagnostic’s insights, bringing innovative medicines to patient faster, and developing technology-enable solution to change how care is provided
Monitoring Leads in patients’ blood then reporting to required states by end of each business day
Weekly and monthly reporting
Medicare medical necessity
Offer local coverage
Determination (LCD’s) issued by insured centers for Medicare administrative contractors(MAC) and national coverage determination
Patient Care Advocate/Patient Service Client/340B program/ Concierge/ Liaison
Patient Care Advocate/Concierge/Liaison/Team Lead
Express Scripts
Dublin, OH
07.2013 - 01.2019
(remote home) - Drug manufacturing to provide outpatient drugs to eligible health care organizations and covered entities at significantly reduced prices
Specialty Liaison and concierge for escalated patients accounts, Conflict resolution specialist
Maintain client relationships; submit weekly end reports to Account Sales Directors within the company and outside clients
Worked directly with account sales directors to build relationships with hospitals account director and directly with patient and insured clients
Team lead-level staff for escalations and resolution.
Identified issues, analyzed information and provided solutions to problems
Participated in continuous improvement by generating suggestions, engaging in problem-solving activities to support teamwork
Developed team communications and information for meetings
Prepared variety of different written communications, reports and documents
Created plans and communicated deadlines to complete projects on time
Deb Collector
GCS
Columbus, OH
09.2010 - 07.2013
Negotiated with account holders to devise repayment plans and minimize collection receivables
Persistently reached out to customers with extremely past due account to recover lost revenue
Investigated account with balance errors using account software
Managed delinquency cycle, including past due collections calls, skip tracing, outside agency coordination and litigation activities
Online Banking/Internet support
Collaborated with team members to achieve target results
Resolved problems, improved operations and provided exceptional service
Proved successful working within tight deadlines and fast-paced atmosphere
Offered friendly and efficient service to customers, handled challenging situations with ease
Online Banking Support/Customer Service
National City/ PNC Bank
Whitehall, OH
07.2006 - 07.2010
Upheld stringent bank standards for loans, money handling, and legal considerations
Provided base level IT support to non-personnel within the business
Represented bank at community events to establish strong ties and promote business
Resolved customer issues in a clear, courteous and straightforward manner.
Carried out day-to-day duties accurately and efficiently
Identified issues, analyzed information and provided solutions to problems
Participated in continuous improvement by generating suggestions, engaging in problem-solving activities to support teamwork
Exceeded goals through effective task prioritization and great work ethic
Prepared variety of different written communications, reports and documents
Responded to customer requests, offering excellent support and tailored recommendations to address needs
Medical Office Receptionist
Dayton Job Corps
Dayton, OH
07.2004 - 06.2006
Responsible for timely submission of medical claims for healthcare providers including hospitals, physician's office, clinics, laboratories
Obtain referrals and pre-authorizations as required procedures
Knowledge of insurance guidelines, including HMO/PPO, Medicare, and state Medicaid.
Verified and updated demographic and other personal information for clients with respect to personal boundaries when asking for important details
Used computer programs and registration systems to schedule patients for routine and complex procedures
Used computerized data management systems to organize immense datasets and coordinate care details for large patient bases
Assessed and forwarded procedure and service details to correct coding staff to best categorize for insurance purposes
Checked patient insurance, demographic and health history to keep information current
Completed and filed financial documentation for accounting purposes
Adhered to strict HIPAA guidelines to protect patient privacy
Cashier/Customer Service
Dairy Queen
Westerville, OH
10.2001 - 11.2003
Demonstrated integrity and honesty while interacting with customers, team members and managers
Maintained high standards of customer service during high-volume, fast-paced operation
Prepared quality with maintaining proper food safety practices, portion control and presentation within service goal times
Prepared a variety of foods according to customer's orders and supervisors instructions, following approved procedures.
Restocked and organized merchandise in front lanes.
Worked closely with shift manager to solve problems and handle customer concerns.
Promoted customer loyalty and consistent sales by delivering friendly service and knowledgeable assistance.
Collected and authorized payments of guests.
Mentored new team members on POS system operation, customer service strategies and sales goals.
Completed inventory counts and ordered merchandise.
Worked flexible schedule and extra shifts to meet business needs.
<ul><li>Advised 20+ leaders on complex employee relations issues like performance management and workplace investigations, ensuring full compliance with Panamanian labor law and minimizing legal risks.</li><li>Keeping an Open-Door policy for the employees. Investigations regarding employee issues and complaints. Collaboration with the Security and Employee Relations departments in investigations.</li><li>Review and approval of disciplinary actions. Completed more than 500 terminations according to Panamanian labor law.</li><li>Requesting, reviewing and approving of HRIS updates, transfers, benefits payments, intercompany and schedules changes.</li><li>Led the foreigner workers contract terminations according to the established Labor Law and company policies.</li><li>Participated in the Health and Safety Committee and inspections of the Social Insurance Institution, obtaining a passing score on every inspection. Developed the accidents events guidelines and form.</li><li>Participated in projects and tasks together with other areas such as HRIS and HR Corporate, for instance, the creation of the employee knowledge database to feed the chatbot for employees questions/answers.</li><li>Reporting and KPIs examination, including attrition and exit interviews results.</li><li>Review of policies, guidelines and procedures. Creation and updates of processes and control spreadsheets such as job abandonment process and form and the Oracle Manager Self Service control.</li><li>Implemented the onboarding program for new hires.</li><li>Developed HR Topics training plan for Operations staff.</li><li>Provided on the job training to the local HR members, developing skills and empowering the team.</li><li>Managed the HR providers purchase orders and payment requests.</li><li>Maintained close collaboration with the payroll department on claims and other employees inquiries, as well as support with compliance documents.</li></ul> at ALORICA<ul><li>Advised 20+ leaders on complex employee relations issues like performance management and workplace investigations, ensuring full compliance with Panamanian labor law and minimizing legal risks.</li><li>Keeping an Open-Door policy for the employees. Investigations regarding employee issues and complaints. Collaboration with the Security and Employee Relations departments in investigations.</li><li>Review and approval of disciplinary actions. Completed more than 500 terminations according to Panamanian labor law.</li><li>Requesting, reviewing and approving of HRIS updates, transfers, benefits payments, intercompany and schedules changes.</li><li>Led the foreigner workers contract terminations according to the established Labor Law and company policies.</li><li>Participated in the Health and Safety Committee and inspections of the Social Insurance Institution, obtaining a passing score on every inspection. Developed the accidents events guidelines and form.</li><li>Participated in projects and tasks together with other areas such as HRIS and HR Corporate, for instance, the creation of the employee knowledge database to feed the chatbot for employees questions/answers.</li><li>Reporting and KPIs examination, including attrition and exit interviews results.</li><li>Review of policies, guidelines and procedures. Creation and updates of processes and control spreadsheets such as job abandonment process and form and the Oracle Manager Self Service control.</li><li>Implemented the onboarding program for new hires.</li><li>Developed HR Topics training plan for Operations staff.</li><li>Provided on the job training to the local HR members, developing skills and empowering the team.</li><li>Managed the HR providers purchase orders and payment requests.</li><li>Maintained close collaboration with the payroll department on claims and other employees inquiries, as well as support with compliance documents.</li></ul> at ALORICA