MELISSA HARRIS
USA
Summary
Motivated employee with strong work ethic and desire to take on new challenges. Exceptional interpersonal skills and adaptability make adept at working effectively unsupervised and quickly mastering new skills.
Overview
30
30
years of professional experience
Work History
Donor Specialist
MCI Telecommunications
10.2023 - 01.2025
- Assisted donors with contributions for Political Presidential Elections.
- Coordinated Election Day reminders for both incoming and outgoing calls.
- Reviewed essential aspects of Democratic, Republican, and Independent candidates.
- Recorded voter preferences in internal database for MCI and campaign parties.
Benefit Specialist Team Lead
Accenture via Collabera
10.2023 - 12.2023
- Develop and implement customer service policies and procedures
- Monitor customer service representatives' performance and provide ongoing coaching and feedback
- Resolve customer complaints and inquiries in a timely and efficient manner
- Analyze customer service trends and recommend improvements
- Train and onboard new customer service representatives
- Monitor customer service representatives' adherence to company policies and procedures
- Ensure customer service representatives maintain a high level of customer service
- Prepare and analyze customer service reports
- Foster an environment of collaboration and teamwork among customer service representatives
Benefit Specialist Team Lead
Molina HealthCare, Inc
10.2022 - 02.2023
- Effectively Communicate with customers to provide First Class Service
- Actively listen to ensure the members are helped with all appropriate information that is needed, for First Call Resolution.
- Gather all demographics and information needed and enter all information from start to end, with resolution and disposition used on call. Enter in to CRM
- Coding and Documenting with complete Accuracy
- Case Management and Service Coordination
- Update iServe Tickets and follow up with members
- Retro Terminations and Disenrollment Requests of members insurance
- ID Card Keys, requests and/or change
- Critical Incidents and Grievances, Appeals
- Eligibility and discrepancies, Out of Area Coverage
- Appropriately route calls to internal departments for assistance IE: Medical Records, Denial of Appeals, Provider Documents, Audits (after going over the research that I provided)
- Summary of Benefits (Molina Healthcare states that I covered are IL, MI, CA, NV, TX, OH, SC and ID)
- MMP Duals line (Medicare and/or Medicaid)
- Escalations
- Benefits with Type of Plan, to assist members in choosing the best plan for themselves & family needs
- Billing payments and/or questions and resolve on same call
- Pegasus, Legacy, Salesforce, QNXT
- Search Directory for Providers, Pharmacy, Specialist for IN and OON
- Language Line Transfers
- Behavioral Health Indicator
- Arrange Transportation
- Waiver Programs and/or Patient Assistance availability per Plan
- Home and Community Based Services locator and transfer
- Work with Drug Formularies, search for information as well as add/delete drugs for updated listings
- Alert for Adverse Events
- Strict HIPAA
Member Services Representative
BroadPath Healthcare Solutions (WFH)
11.2018 - 03.2020
- Affordable Care Act
- Assist members with their Insurance Portals
- Unlocking, enable a disabled account, reset passwords, etc
- Recognizing Behavioral Health Issues and assisting further
- Assist members with Medical and Pharmacy Claims
- Assisting Brokers on behalf of members
- Assisting Members with all Insurance benefits, including Out Of Pocket, Deductibles, Co-Pays
- Process payments for members Insurance Premiums
- Strict HIPAA awareness
Team Lead Patient Advocate
Abbvie, Inc via Liveops
03.2007 - 04.2019
- Lead a group of 27 agents
- Monitored for Quality and Performance Metric Standards
- Patient advocate for callers with questions or concerns about the medication, Humira
- Provide callers with financial options to make their pharmaceutical medication more affordable
- Support patients needs by providing complimentary services
- Completed outbound calls for clients, RN's, Pharmacies, and Providers' offices
- Product Quality Auditor for this recorded line with many legal compliance regulations, detailed
- HIPAA based work
Customer Service and Sales Supervisor
Liveops, Inc
03.2006 - 03.2018
- Handle high volume of inbound/outbound calls daily and provide exceptional one call customer service by offering one point of contact for problem resolution for multiple companies
- Respond to customers inquires about products and services and attempt to complete the sale
- Process orders online and document every phone conversation into electronic databases
- Offer up-sells that compliment the main product, subscription services, and other add-ons
- Review and explain all contractual details of purchase and ensure customer understanding of it
- Maintain strict confidentiality for clients, customers, and partners, including their financial, medical, and demographic information
Surgical Scheduler
Drs Margiotta and Joy
01.1995 - 01.1997
- Patient Communication to start process of surgery
- Insurance verification and authorization
- Pre-op scheduling
- Surgery scheduling
- Maintain all medical records pertaining to pre-op and post-op
- Schedule post-op visits
Education
AS - undefined
High school diploma - undefined
06.1988
Skills
- Remote Office
- Outbound calling
- Quality Metrics
- Microsoft Office
- Insurance verification
- Medicare
- CRM software
- Patient Advocacy
- Patient Care Coordinator
- Quality audits
- Patient Registrar
- 10 key typing
- Customer Service Excellence
- Oracle
- Sales
- Phone etiquette
- Communication skills
- Complaint Investigation
- Case management
- Multitasking
- Typing
- Salesforce
- OneNote
- HCPCS
- Behavioral health
- Product Knowledge
- Team Leadership
- One Call Resolution
- Alternative dispute resolution
- Databases
- Medical records
- Customer service
- Patient service
- EMR Systems
- Research
- HIPAA
- Medical Terminology
- Quality Assurance
Personal Information
Work Permit: Authorized to work in the US for any employer.
Timeline
Donor Specialist - MCI Telecommunications
10.2023 - 01.2025
Benefit Specialist Team Lead - Accenture via Collabera
10.2023 - 12.2023
Benefit Specialist Team Lead - Molina HealthCare, Inc
10.2022 - 02.2023
Member Services Representative - BroadPath Healthcare Solutions (WFH)
11.2018 - 03.2020
Team Lead Patient Advocate - Abbvie, Inc via Liveops
03.2007 - 04.2019
Customer Service and Sales Supervisor - Liveops, Inc
03.2006 - 03.2018
Surgical Scheduler - Drs Margiotta and Joy
01.1995 - 01.1997
Palm Beach State College - AS,
Atlantic High School - High school diploma,
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