Madison Smith
Athens,AL
Summary
Seasoned Provider Relations Representative possessing in-depth knowledge of various insurance plans and policies. Expertise in handling high volume of calls and emails, efficiently resolving disputes and identifying ways to improve processes. Communicative and detail-oriented individual with excellent interpersonal abilities.
Overview
6
6
years of professional experience
Work History
Provider Relations Specialist
Carelon MBM - Elevance Health
07.2023 - Current
- Managed provider relations mailbox by triaging inquiries, facilitating resolution of incoming requests and forwarding requests to appropriate parties.
- Answered provider inquiries via email, telephone and written correspondence.
- Researched and resolved disputes, billing discrepancies, and claims efficiently to maintain customer satisfaction, boosting satisfaction ratings.
- Fostered strong, positive relationships with key providers by coordinating, facilitating and leading partnership meetings and identifying on-site enrollment opportunities.
Patient Enrollment Specialist
CareMore - Elevance Health
07.2022 - 07.2023
- Helped large volume of customers every day with positive attitude and focus on customer satisfaction.
- Adhered to company policies and scripts to consistently achieve call-time and quality standards.
- Actively listened to customers, handled concerns quickly and escalated major issues to supervisor.
- Detailed payment options and explained price, receipt and billing details to customers.
- Escalated complicated customer account issues to supervisors and help desk workers.
- Addressed customer account discrepancies and concerns.
- Placed outbound customer service or customer satisfaction calls to follow up on issues.
- Exhibited high energy and professionalism when dealing with clients and staff.
- Increased efficiency and team productivity by promoting operational best practices.
- Promoted superior experience by addressing customer concerns, demonstrating empathy, and resolving problems swiftly.
- Met customer call guidelines for service levels, handle time and productivity.
- Enhanced productivity levels by anticipating needs and delivering outstanding support.
- Collaborated with staff members to enhance customer service experience and exceed team goals through effective client satisfaction rates.
- Cross-trained and provided backup support for organizational leadership.
- Investigated and resolved customer inquiries and complaints quickly.
Phone Operations Sr. Coordinator
Pathway Eye
07.2019 - 07.2022
- Ensure phone calls for multiple branches are maintained in a timely manner which meets the clinics policy
- Performed credentialing requirements for health plan enrollment
- Validate patient medical and vision insurance
- Assist patients with all insurance and billing issues
- Educate the patient on deductibles and copays so the patient knows what to expect when arriving for their visits
- Maintain all incoming faxes are received and distributed to the appropriate office personnel
- Call patients who have upcoming appointments
- Maintain the departments training materials and train new office employees.
Front Desk Receptionist
Pathway Eye
07.2018 - 06.2019
- Assist patients with checking in for appointments and help answer questions the patient might have
- Helped patients schedule appointments
- Collect deductibles, as necessary
- Ensure patient information is current
- Maintain office supplies are categorized and ordered as needed.
Education
Some College (No Degree) -
John C Calhoun Community College
Decatur, ALHigh School Diploma -
West Limestone High School
Athens, AL05.2015
Skills
- Workflow Analysis
- Provider relationship management
- Decision-Making
- Problem-solving abilities
- Provider orientations
- Policy Interpretation
- Health plan operations
- Member enrollment
- Multitasking
- Time Management
- Reliability
- Written Communication
- Complaint Handling
Timeline
Provider Relations Specialist
Carelon MBM - Elevance Health
07.2023 - Current
Patient Enrollment Specialist
CareMore - Elevance Health
07.2022 - 07.2023
Phone Operations Sr. Coordinator
Pathway Eye
07.2019 - 07.2022
Front Desk Receptionist
Pathway Eye
07.2018 - 06.2019
Some College (No Degree) -
John C Calhoun Community College
High School Diploma -
West Limestone High School
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