Leslie Hayes
Matthews,NC
Summary
To bring my strong sense of dedication, motivation, and responsibility to a reputable organization and enhance my educational and professional skills in a stable and dynamic workplace.
Overview
27
27
years of professional experience
Work History
Customer Advocate
Blue Cross of Kansas City
05.2023 - 03.2024
- Responsible for responding to a variety of inquiries from members and their dependents, hospitals, providers, attorneys, and agents
- Responsible for interpreting multiple contracts in response to benefit and claim inquiries
- Research membership database and billing history to resolve membership issues
- Medix (Contract)
Scheduler
Statlinx
12.2021 - 03.2023
- First point of contact interacting with patients over the phone from my home office with high-speed internet
- Responsible for taking high volume of inbound calls to schedule patient visits and procedures for multiple providers
- Speak with patients to assess their needs through actively listening to their concerns and questions
- Adhere to many departments and their clinical protocols
- Respond to questions and concerns and directs them to appropriate location or department
- Multitask between several different software systems to complete functions and facilitate patient interactions
- Collects and enters all necessary demographic, clinical and insurance information from patients or responsible parties
- Provides patient education by explaining preps and patient instructions for the scheduled procedure following scheduling protocols
- Communicates effectively with physicians and physician staff
- Provide outstanding customer service to callers through listening, empathy and understanding the needs of each individual patient
- Escalate calls appropriately to clinical office staff
- Adhere to the HIPAA (Privacy Act) as it relates to the confidentiality of information released
- Performs other duties as assigned by leadership
- Remaining educated and updated on company policies and procedures
- Ability to stay connected through video calls, phone calls and emails
- (Remote Work)
Claims Service Specialist
Allstate Insurance Company
08.2015 - 08.2021
- Reach and maintain goals while living into the branded leadership principles
- Responsible for taking inbound calls regarding the first notice of a loss from insured customers, other involved parties, attorneys and third-party carriers
- Answered customer calls and questions from my home office with high-speed internet access
- Log customer information, verify coverage details and determine allowable benefits or compensation
- Provide customer with instructions on proceeding with auto repair process
- Answer questions concerning previously established claims, input relevant data and pass important information to other areas of Allstate and obtain other pertinent information from Allstate employees
- Contact involved parties to obtain missing information
- Issue payment on lesser claim balances
- Assure fair and equitable treatment of customers while making certain that claims are legitimate and reasonable while performing dispute resolution
- Remaining educated and updated on company policies and procedures
- Displaying interpersonal and communication skills to serve customers in a tactful and diplomatic manner
- Ability to stay connected through video calls, phone calls and emails
- (Remote Work)
Patient Account Representative
Novant Health
09.2013 - 09.2014
- Analyze patient accounts
- Reach and maintain productivity levels and A.R
- Goals
- Perform follow up and collection activities
- Investigate and detect payer issues that will assist in claim processing
- Provide customer support assistance for patients and medical insurance carriers
- Maintain work ques as assigned
- Analyze insurance policies for accurate claim processing
- Patient Registration
- Address correspondence from patients, physicians, and third-party payers
Account Assistant IV/Front Desk
Yale University Yale Medical Group
01.1997 - 01.2012
- Receive inbound calls regarding account inquires
- Provide customer support service for patients and medical insurance carriers
- Special projects as assigned in order to improve operational workflow
- Review medical charts for factual information and to confirm charges
- Counsel patients regarding financial billing
- Patient Registration
- Set payment agreements with insurance companies, attorneys, and patients
- Maintain correspondence from patients, physicians, and third-party carriers
- Contacting patients via telephone/correspondence regarding outstanding debts
- Review insurance policies for accurate claim processing
- Report and identify carrier issues that will assist in claim processing
- Maintain formal payment arrangements in accordance with Yale Medical Group
- Recommend referral of delinquent accounts to outside agencies
- Report and identify carrier issues that will assist in claim processing/resolution
- Schedule/Cancel patient appointments for specialist
Education
Social Work
Southern Connecticut State University
New Haven, CT01.2008
Skills
- Efficient, quality performance while working remotely
- Remote collaboration tools: VPN, Zoom, Google Chat, Hangouts, GoToMeeting, SharePoint, GoToWebinar, Dropbox, Slack
- Empathy and collaborative problem-solving
- Adaptability and time management
- Digital Literacy Oral Communication
- Facets; Interaction Dessktop; Inkling; Windows 11 Microsoft 365; email and internet capability; NextGen, Noble Composer; Avaya One-X Communicator; Patient Plus; Electronic Document Cabinett; Epic; Emdeon; IDX; GE Centricity Business; SDK; STAR; PICIS; Ncall; PBX; leadership capabilities
- Works independently; highly self-motivated; widespread understanding of simple social skills; well-developed communication and organizational skills; excellent customer service skills
- CPT/ICD9 Coding knowledge
- Ability to work independently, resolve complex A/R problems, organize and prioritize work assigned in order to meet goals and deadlines
- Possess a strong ability to process high volume workload, accurately and professionally
- Provide high level customer support Efficient time management Flexibility and the ability to adapt to a fast-changing environment
Timeline
Customer Advocate
Blue Cross of Kansas City
05.2023 - 03.2024
Scheduler
Statlinx
12.2021 - 03.2023
Claims Service Specialist
Allstate Insurance Company
08.2015 - 08.2021
Patient Account Representative
Novant Health
09.2013 - 09.2014
Account Assistant IV/Front Desk
Yale University Yale Medical Group
01.1997 - 01.2012
Social Work
Southern Connecticut State University
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