Mercedes Wright

• Managing incoming calls and faxed claims. It entails determining contract and benefit eligibility, providing authorization for inpatient admissions, outpatient precertification, prior authorization, and post-service requests.
• Responsible for identification and data entry of referral requests into UM system as per plan certificate, verifying benefits for facility-based treatments, developing and maintaining positive customer relations.
• Coordination with various company functions to ensure customer requests and inquiries are addressed appropriately and promptly.
• Reducing wait times for essential services by effectively managing utilization review caseloads and prioritizing urgent requests.
• Serving as a liaison between patients, healthcare providers, and insurance companies to facilitate timely approvals of necessary treatments.

• Updated requested contractual and demographic information related to provider data in records systems.
  
• Ensured accurate financial claims payment and facilitated provider directory processes.
  
• Configured providers and networks while managing and maintaining positive provider relationships.
• Established professional relationships with service providers.
  Kept precise records of in-progress and completed referrals, guaranteeing data integrity throughout process.
  
• Handled high-volume referral requests by prioritizing tasks and keeping records organized.
  
• Detected opportunities for process enhancements within referral department, enhancing efficiency and precision.
  
• Reviewed and confirmed patient records to ensure completion of referral paperwork.

• Making requested contractual and demographic updates related to provider data in the systems of record
• Facilitate accurate financial claims payment and provider directory processes
• Configure providers and networks
• Manage and sustain positive provider relationships.
• Used database to research, gather, analyze and present data.
• Achieved client confidence and protected operations by keeping information confidential.
• Collaborated with cross-functional teams to ensure data quality and consistency throughout the company's systems.
• Ensured compliance with all applicable regulations through meticulous record keeping and adherence to established protocols.

• Place outbound calls to members identified for pilot program
• Documenting outreach in required system
• Appointment scheduling.
• Managed multiple projects simultaneously, ensuring deadlines were met and goals achieved.
• Conducted regular follow-ups with clients to ensure satisfaction and address any concerns that may arise.
• Continuously sought opportunities for professional growth by attending workshops, webinars, and training sessions relevant to current role

• Answer incoming claimant phone calls and take appropriate action for each
• Live chat
• Registering claimants and filing weekly certifications
• Use company policies to determine if there can be immediate resolution to a customer issue or if that issue requires managerial input and escalating when necessary.

• Handle incoming calls
• Sell products, including balance transfers and identity monitors
  Identify issues and escalate them to supervisors
  
• Provide customers with product and service information.
  

After being promoted to Escalation Specialist I, responsibilities included:

• Resolving escalated customer inquiries, issues, and complaints
  
• Consulting with other departments while establishing effective relationships with all call center departments through clear communication
  
• Training, coaching, as well as supervising entry-level representatives
  
• Developing rapport with customer base by professionally managing challenging issues
• Building customer loyalty by resolving issues on first call or by making follow-up calls for unresolved issues
  
• Addressing tier one online technical issues.

• Answer incoming calls
• Sell products, take orders, and payments
• Identify and escalate issues to supervisors
• Provide product and service information to customers.
• Investigated and resolved accounting, service and delivery concerns.
• Managed timely and effective replacement of damaged or missing products.
• Developed highly empathetic client relationships and earned reputation for exceeding service standard goals.
• Responded proactively and positively to rapid change.