Madinah Parker
Greensboro
Summary
Detail-oriented individual with exceptional communication and project management skills. Proven ability to handle multiple tasks effectively and efficiently in fast-paced environments. Recognized for taking proactive approach to identifying and addressing issues, with focus on optimizing processes and supporting team objectives.
Overview
16
16
years of professional experience
Work History
Customer Care Claims Agent
Alight
03.2022 - 03.2024
- Managed high call volume with professionalism and empathy, ensuring timely resolution of customer concerns.
- Presenting relevant information that assisted in opening claims for short and/or long term disability for FMLA, LOA and personal leave of absence
- Ensured accuracy of reserves established for open claims through regular review and adjustment as needed based on emerging facts.
- Prepared insurance claim forms or related documents and reviewed for completeness.
- Developed in-depth understanding of insurance policies and procedures.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- Managed high volume caseload, in fast-moving work environment effectively prioritizing tasks to meet deadlines with minimal supervision.
- Answering, screening and redirecting 100 or more calls daily with professionalism and efficacy
- Accountable for problem resolution of patient issues and to communicate resolution to appropriate parties
- Maintained detailed records of all claims activities, ensuring confidentiality compliance according to protection guidelines
- Promoted positive working environment by fostering collaboration among team members and encouraging open communication channels.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Provided exceptional customer service by addressing claimant concerns promptly and providing clear explanations of policy coverage.
- Identified potential fraud cases through careful analysis of claim data, collaborating with special investigation units when necessary.
Customer Care Field Support Specialist Manager
Daily Management
01.2013 - 08.2021
- Collected relevant information from Primary, Secondary, or Tertiary Insurances, which include calling Commercial and Government Insurance companies, Doctor’s offices or Patients
- Review documentation and gather information that was provided by both the Doctor's office and the insurance agencies per the client’s request
- Maintained knowledge of payer requirements and practices by phone or directly through the insurance company's portal and followed up on all pending PA's within 48 hours
- Initiated re-authorizations that are set to expire 30 days prior to the term date
- Made clinical outreach to complete prior authorizations
- Reviewed case from start to finish to confirm complete accuracy of case
- Reviewed and corrected outgoing approval or denial letters based on gathered information on the patient’s case
- Coached case Managers on correct format, verbiage, and verbal outreach to doctor’s offices and medical insurance agencies
- Worked closely with program managers on projects such as re-verification on cases, missing information, and training
- Increased productivity for field teams with efficient coordination, scheduling, and prioritization of service requests.
- Maintained accurate documentation on all cases, ensuring compliance with regulations and confidentiality requirements.
- Conducted thorough assessments of clients'' situations, identifying issues, goals, and necessary interventions.
Customer Care Support Specialist Case Manager
Daily Management
08.2011 - 01.2013
- Followed up and completed verification of Benefits and Eligibility for all referrals from patients, HCPs, health plans and pharmaceutical manufacturers
- Completed Investigations of benefits and eligibility by phone and/or internet to determine coverage choices patient has in starting therapy
- Used Epic system daily to access medical records
- Participated in Call Center Activities, triage and respond to incoming calls from patients, insurance companies, physicians, Sales Reps, pharmacies
- Acted as single point of contact for an assigned group of prescribers
- Maintain accurate and complete documentation of all inquiries
- Reviewed Case from start to finish to confirm complete accuracy of case
- Reviewed and Corrected outgoing approval or denial letters based on gather information on the patient's case
- Made clinical outreach to complete prior authorizations
- Work closely with program managers on projects such as re-verification on cases, missing information, and training
- Retrieved customer data, presented relevant product information, and assisted in making payment arrangements
- Oversaw the daily operations of 3 customer service representatives
- Trained new employees in customer service
- Script recitation, conflict resolution, and data entry practices
- Answered, screened, and redirected 100 or more calls with professionalism and efficacy
- Received source data such as customer names, addresses, phone numbers, and credit card information and entered data into various customer service software
- Practiced a high level of confidentiality
- Improved efficiencies by 27% by billing and sending out correspondence via emails
- Provided detailed personalized friendly and polite service to ensure customer retention
- Managed high call volume with professionalism and empathy, ensuring timely resolution of customer concerns.
- Enhanced patient satisfaction by addressing inquiries and resolving issues related to medical appointments, billing, and insurance.
- Handled sensitive patient information with confidentiality, adhering to HIPAA regulations at all times.
Enrollment Specialist Patient Advocate
MLX
09.2008 - 09.2010
- Ensured patient rights were protected and respected in all interactions and decision-making processes
- Served as a patient liaison, facilitating communication between patients and healthcare providers
- Handled insurance claims and submissions in a timely and accurate manner
- Maintained and organized medical records according to established protocols
- Demonstrated strong communication skills when interacting with patients, families, and medical staff
- Guided patients in navigating the complex healthcare system to access the services and resources they needed
- Ability to manage multiple projects and roles simultaneously
- Gathered patient information by secured email, fax, or mail
- Received and reviewed documents such as; Insurance policies, bank account statements, enrollments forms, ICD 10 codes, and social security letters for patient's reimbursement requests
- Approved and denied reimbursement claims based on documentation provided
- Completed 50-100 cases a day
- Efficiently answer inbound calls in the program condition groups: General, Neurology, Autoimmune, and provide individualized and professional customer service to all callers with quick and knowledgeable responses to all inquiries, issues, or requests
- Conducted outbound call campaigns to effectively communicate program enrollment and program adherence
- Proficiently manage a patient book of business to ensure patient adherence and program compliance
- Determine problems or issues faced by program participants, partners, customers, and propose solutions for program enhancements
- Appropriately update Salesforce to reflect the current status of program participants, including but not limited to all written or verbal communications, issues, and application submissions
- Regularly provide feedback on the effectiveness and soundness of program policies and procedures
- Perform special projects on an as-needed basis
- Met and exceeded monthly metrics for quality, hold times, and average call duration
Education
Bachelor - Psychology
Florida Atlantic University
Boca Raton, FL05.2018
Associates - Art
Broward College
Davie, FL05.2016
Certified Nursing Assistant -
06.2003
Skills
- Case management
- Case evaluation
- Medical documentation
- Claims management
- Disability management
- FMLA claims management
- Effective verbal and written communication
- ICD-10
- Insurance Verification
- De-Escalating Calls
- Excellent Customer Service
- Typing 50 WPM
- Microsoft Excel
- Call center experience
- Complaint and Conflict resolution
- Escalation management
- Critical thinking
Timeline
Customer Care Claims Agent
Alight
03.2022 - 03.2024
Customer Care Field Support Specialist Manager
Daily Management
01.2013 - 08.2021
Customer Care Support Specialist Case Manager
Daily Management
08.2011 - 01.2013
Enrollment Specialist Patient Advocate
MLX
09.2008 - 09.2010
Associates - Art
Broward College
Certified Nursing Assistant -
Bachelor - Psychology
Florida Atlantic University
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