Michelle Cole

• Reviewed and approved or denied applications and re-enrollments for medication assistance.
• Provided exceptional customer service through phone, email, and chat, to address inquiries and concerns in a timely manner.
• Verified benefits / eligibility and prior authorizations.
• Accurately documented all interactions and updated records.
• Managed high volume of incoming calls and de-escalated callers, received employee award for having no transfers to supervisors.
• Met customer call guidelines for service levels, handle time and productivity, with no after call work time.

• Provided exceptional customer service to patients by answering inquiries, scheduling appointments, and addressing concerns in an empathetic and professional manner.
• Collaborated with healthcare providers to advise of patients benefits and verify prior authorizations.
• Managed high call volumes, prioritized urgent cases, and resolved issues effectively to maintain patient satisfaction.
• Promoted to assist chat for new hires and worked one on one with trainees needing extra help.

Hired as a temporary claims processor for the merger of Western Highlands and Smoky Mountain MCO.

• Researched and processed claim denials, for the Medicaid Network, and created spreadsheets for adjudication.
• Keyed CMS 1500 and processed UB04 claims.

Was promoted to Credentialing Specialist in 2014 to Smoky Mountain Center

• Reviewed and recommended or denied provider enrollment forms.
• Conducted thorough credentialing checks on healthcare providers, ensuring compliance with regulatory standards and sustaining up-to-date provider databases.
• Communicated with providers and facilities to obtain missing information and assist with submissions.