Michelle Raynes
Medical Billing, Customer Service , Remote working, 10 hours per week, the ability to be flexible with my work
Peoria,AZ
Summary
Dynamic and results-driven professional with extensive experience at Humana, excelling in customer service and problem-solving. Proven ability to enhance patient outcomes through effective communication and critical thinking. Recognized for reducing wait times and improving customer satisfaction, while demonstrating adaptability in high-pressure environments. Proficient in data entry and committed to delivering exceptional service.
Overview
28
28
years of professional experience
Work History
Customer Service Representative
Humana
10.2021 - 02.2022
- Expedited prescription refills with timely coordination between patients, prescribers, and insurance companies.
- Collaborated with pharmacists to resolve drug therapy issues, optimizing patients'' overall health outcomes.
- Reduced wait times with accurate and efficient prescription processing, ensuring a seamless customer experience.
- Contributed to increased pharmacy revenue through proactive promotion of over-the-counter products and services.
- Delivered exceptional service during high-volume periods, maintaining composure under pressure while managing multiple tasks simultaneously.
- Improved patient adherence to medication regimens by offering personalized counseling on proper usage and potential side effects.
- Demonstrated adaptability through cross-training in various roles within the pharmacy setting to better serve customers as needed.
- Ensured regulatory compliance by diligently adhering to pharmacy policies, procedures, and applicable laws during daily operations.
Registered Nurse Case Manager
Encompass Health Rehabilitation Hospital
08.2017 - 03.2018
- Administered medications and treatments as prescribed by physicians.
- Evaluated healthcare needs, goals for treatment, and available resources of each patient and connected to optimal providers and care.
- Advocated for patients by communicating care preferences to practitioners, verifying interventions met treatment goals and identifying insurance coverage limitations.
- Provided timely feedback to healthcare providers regarding patient concerns, facilitating prompt resolution of issues and contributing to a positive patient experience.
- Completed initial assessments of patients and family to determine and address individual home care needs. ·
- Assessed and examined patients and documented history of current and previous conditions, diseases and injuries along with medications currently being taken.
- Conducted regular re-evaluations to address changes in needs and conditions, introducing revisions to care plans.
- Reduced unnecessary medical interventions by monitoring high-risk patients closely, intervening as needed based on clinical expertise.
- Implemented evidence-based nursing interventions, contributing to improved quality of care and patient satisfaction scores.
- Mentored new nursing professionals during orientation periods, fostering a collaborative team dynamic that supported the delivery of high-quality care.
- Authored clinical notes and updates to be reviewed by patient's primary physician.
- Conducted regular audits of clinical records to identify areas for improvement in documentation accuracy and compliance with regulatory standards.
- Worked with suppliers and vendors on provision of medical equipment, items and services.
- Administered physical examinations and documented history of current and previous conditions, illnesses and injuries.
- Authored initial assessments of patients and family to develop plans for individual home care needs.
Registered Nurse, Medical-Surgical Unit
Dignity Health
07.2016 - 10.2017
- Administered medications safely according to established guidelines while closely monitoring for side effects or adverse reactions requiring intervention.
- Prevented the spread of infections by consistently adhering to strict infection control protocols and educating patients on proper hygiene practices.
- Utilized critical thinking skills to prioritize nursing interventions based on patients'' acuity levels and individual needs.
- Enhanced patient satisfaction by providing compassionate, holistic nursing care that addressed physical, emotional, and spiritual needs.
- Assisted in the training and mentorship of new nursing staff members, contributing to a positive work environment and high-quality patient care.
- Provided support for patients'' families during difficult medical decisions or end-of-life care, serving as a liaison between the healthcare team and loved ones.
- Collaborated with interdisciplinary teams to develop comprehensive treatment plans for complex patients with multiple comorbidities.
- Conducted thorough patient assessments to identify changes in condition, promptly notifying physicians and initiating appropriate interventions when necessary.
- Improved patient outcomes by implementing evidence-based nursing interventions and individualized care plans.
- Advised patients and caregivers of proper wound management, discharge plan objectives, safe medication use, and disease management.
- Contributed to interdisciplinary team meetings by presenting relevant clinical data about patients'' progress toward reaching established goals of care.
Registered Nurse
Registry
05.2015 - 05.2016
- Administered medications safely according to established guidelines while closely monitoring for side effects or adverse reactions requiring intervention.
- Prevented the spread of infections by consistently adhering to strict infection control protocols and educating patients on proper hygiene practices.
- Utilized critical thinking skills to prioritize nursing interventions based on patients'' acuity levels and individual needs.
- Enhanced patient satisfaction by providing compassionate, holistic nursing care that addressed physical, emotional, and spiritual needs.
- Assisted in the training and mentorship of new nursing staff members, contributing to a positive work environment and high-quality patient care.
- Provided support for patients'' families during difficult medical decisions or end-of-life care, serving as a liaison between the healthcare team and loved ones.
- Collaborated with interdisciplinary teams to develop comprehensive treatment plans for complex patients with multiple comorbidities.
- Conducted thorough patient assessments to identify changes in condition, promptly notifying physicians and initiating appropriate interventions when necessary.
- Improved patient outcomes by implementing evidence-based nursing interventions and individualized care plans.
- Advised patients and caregivers of proper wound management, discharge plan objectives, safe medication use, and disease management.
- Contributed to interdisciplinary team meetings by presenting relevant clinical data about patients'' progress toward reaching established goals of care.
- Skillfully managed challenging patient situations using de-escalation techniques, crisis intervention strategies, and therapeutic communication skills.
Registered Nurse Cardiology
Banner Del E. Webb Medical Center
05.2010 - 03.2015
- Administered medications safely according to established guidelines while closely monitoring for side effects or adverse reactions requiring intervention.
- Prevented the spread of infections by consistently adhering to strict infection control protocols and educating patients on proper hygiene practices.
- Utilized critical thinking skills to prioritize nursing interventions based on patients'' acuity levels and individual needs.
- Enhanced patient satisfaction by providing compassionate, holistic nursing care that addressed physical, emotional, and spiritual needs.
- Assisted in the training and mentorship of new nursing staff members, contributing to a positive work environment and high-quality patient care.
- Provided support for patients'' families during difficult medical decisions or end-of-life care, serving as a liaison between the healthcare team and loved ones.
- Collaborated with interdisciplinary teams to develop comprehensive treatment plans for complex patients with multiple comorbidities.
- Conducted thorough patient assessments to identify changes in condition, promptly notifying physicians and initiating appropriate interventions when necessary.
- Improved patient outcomes by implementing evidence-based nursing interventions and individualized care plans.
- Advised patients and caregivers of proper wound management, discharge plan objectives, safe medication use, and disease management.
- Contributed to interdisciplinary team meetings by presenting relevant clinical data about patients'' progress toward reaching established goals of care.
- Skillfully managed challenging patient situations using de-escalation techniques, crisis intervention strategies, and therapeutic communication skills.
- Implemented evidence-based fall prevention strategies, resulting in a significant decrease in patient falls within the unit.
- Served as a preceptor for nursing students during their clinical rotations, providing valuable real-world experience and guidance to foster professional growth.
- Facilitated patient transitions between different levels of care, ensuring continuity of services and minimizing disruptions in treatment plans.
Medical Billing Specialist
Banner Del Webb Medical Center
05.2005 - 08.2008
- Provided exceptional customer service to both patients and insurance representatives, resolving inquiries quickly and professionally.
- Located errors and promptly refiled rejected claims.
- Filed and updated patient information and medical records.
- Examined patients' insurance coverage, deductibles, insurance carrier payments and remaining balances not covered under policies when applicable.
- Posted and adjusted payments from insurance companies.
- Monitored changes in payer requirements, adjusting billing practices accordingly to minimize disruptions in the revenue cycle.
- Liaised between patients, insurance companies, and billing office.
- Researched CPT and ICD-9 coding discrepancies for compliance and reimbursement accuracy.
- Precisely completed appropriate claims paperwork, documentation and system entry.
- Educated colleagues on best practices in medical billing, providing ongoing training sessions as needed.
- Ensured timely submission of claims to various insurance carriers, resulting in prompt payment for services rendered.
- Conducted regular audits of patient accounts for potential underpayments or overpayments due to incorrect coding or billing practices.
- Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers.
Medical Billing Specialist
St Joseph’s Hospital
03.2004 - 08.2004
- Provided exceptional customer service to both patients and insurance representatives, resolving inquiries quickly and professionally.
- Located errors and promptly refiled rejected claims.
- Filed and updated patient information and medical records.
- Examined patients' insurance coverage, deductibles, insurance carrier payments and remaining balances not covered under policies when applicable.
- Posted and adjusted payments from insurance companies.
- Monitored changes in payer requirements, adjusting billing practices accordingly to minimize disruptions in the revenue cycle.
- Liaised between patients, insurance companies, and billing office.
- Researched CPT and ICD-9 coding discrepancies for compliance and reimbursement accuracy.
- Precisely completed appropriate claims paperwork, documentation and system entry.
- Ensured timely submission of claims to various insurance carriers, resulting in prompt payment for services rendered.
- Developed customized reports for management review, highlighting trends in key performance metrics such as claim denial rates and days outstanding for accounts receivable balances.
Senior Personal Banker
Bank of America
05.1997 - 04.2004
- Assisted in developing and implementing branch sales goals, motivating team members to achieve targets and drive business growth.
- Ensured compliance with all regulatory requirements, protecting both the bank''s reputation and its customers'' interests.
- Participated in community outreach events to promote the bank''s brand and foster local business partnerships.
- Strengthened client relationships through consistent follow-ups and proactive communication.
- Collaborated with branch team members to ensure seamless execution of daily operations and optimal customer experience.
- Streamlined account opening processes for improved efficiency and reduced waiting times.
- Delivered comprehensive financial advice to clients based on their unique situations, helping them achieve long-term financial success.
- Optimized operational efficiency within the branch by implementing process improvements and updating internal procedures as needed.
- Collaborated with mortgage lenders to facilitate timely loan approvals for homebuyers seeking financing options.
- Mentored junior personal bankers, sharing industry knowledge and best practices for career development.
- Increased loan portfolio growth by identifying client needs and recommending appropriate financial products.
- Conducted financial reviews for customers, identifying opportunities for cross-selling additional products and services.
- Managed high-net-worth clients, ensuring their financial goals were met with tailored banking services.
- Navigated challenging economic conditions, effectively managing risk while meeting sales targets consistently.
- Resolved complex customer inquiries, demonstrating exceptional problem-solving skills and customer service expertise.
Customer Service Representative
Bank of America
05.1997 - 05.1998
- Resolved customer complaints with empathy, resulting in increased loyalty and repeat business.
- Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
- Enhanced customer satisfaction by promptly addressing concerns and providing accurate information.
- Responded to customer requests for products, services, and company information.
- Handled escalated calls efficiently, finding satisfactory resolutions for both customers and the company alike.
- Maintained detailed records of customer interactions, ensuring proper follow-up and resolution of issues.
- Developed strong product knowledge to provide informed recommendations based on individual customer needs.
- Developed rapport with customers through active listening skills, leading to higher retention rates and positive feedback from clients.
- Assisted customers in navigating company website and placing online orders, improving overall user experience.
- Collaborated with team members to develop best practices for consistent customer service delivery.
- Contributed to sales growth by upselling products and services based on individual customer requirements.
- Exceeded performance metrics consistently, earning recognition as a top performer within the team.
- Provided coaching and mentoring to new hires, contributing to their successful integration into the team.
- Participated in training programs to enhance product knowledge and customer service skills.
- Participated in cross-functional teams to discuss ways to improve overall customer satisfaction across company.
- Updated company's FAQ section to include answers to common customer questions, reducing inquiry volume.
- Implemented rewards program that encouraged repeat business and strengthened customer relationships.
- Boosted team morale by consistently recognizing colleagues' contributions and achievements.
- Addressed customer inquiries to ensure satisfaction and foster positive service experience.
- Trained new Customer Service Representatives on company policies, procedures, and best practices.
- Collaborated with product team to communicate customer feedback, resulting in product enhancements.
- Resolved escalated customer issues, restoring confidence in company's commitment to service excellence.
Bank Teller
Bank of America
05.1994 - 03.1996
- Managed high-volume transactions during peak hours while maintaining attention to detail, ensuring seamless customer experience.
- Educated customers on banking products, enabling them to make informed decisions about their finances.
- Balanced cash drawers accurately at the end of each shift, minimizing discrepancies in financial records.
- Processed customer transactions promptly, minimizing wait times.
- Answered customer inquiries regarding account balances, transaction history, services charges, and interest rates.
- Completed highly accurate, high-volume money counts via both manual and machine-driven approaches.
- Built and strengthened customer relationships by leveraging excellent interpersonal and communication skills.
- Provided exceptional customer service, resulting in increased client retention and loyalty.
- Supported branch management in achieving operational excellence through adherence to regulatory guidelines and internal procedures.
- Counted and packaged currency and coins.
- Conducted daily audits of cash drawer, ensuring accuracy and compliance with bank policies.
- Enhanced branch sales through cross-selling bank products and services to customers.
- Increased efficiency within the teller line by sharing best practices among colleagues, leading to shorter wait times for customers.
- Educated customers on use of banking website and mobile apps.
- Participated in ongoing professional development programs offered by the bank, staying up-to-date with industry trends and enhancing job performance.
- Processed loan payments accurately, contributing to the overall efficiency of branch operations.
- Audited fellow teller currency to contribute to dual-control procedures.
- Learned about customer's financial needs, established trust, and optimized sales opportunities resulting in quality customer service.
- Removed mutilated currency from circulation.
- Established trust with clients by maintaining confidentiality and protecting sensitive financial information.
- Sold and cross-sold bank products to new and existing customers.
- Collaborated with team members to achieve monthly sales targets and provide exceptional service to customers.
Education
Associate of Applied Science - Nursing
Mesa Boswell, School of Nursing
Sun City, AZ05.2010
Skills
Customer service
Problem-solving
Active listening
Product knowledge
Adaptability and flexibility
Complaint resolution
Data entry
Time management
Call center experience
Customer relations
Data collection
Problem resolution
Critical thinking
Team collaboration
Computer proficiency
Accomplishments
Nominated as Secretary in Nursing School and retained that role for the entire four blocks of Nursing School.
Timeline
Customer Service Representative
Humana
10.2021 - 02.2022
Registered Nurse Case Manager
Encompass Health Rehabilitation Hospital
08.2017 - 03.2018
Registered Nurse, Medical-Surgical Unit
Dignity Health
07.2016 - 10.2017
Registered Nurse
Registry
05.2015 - 05.2016
Registered Nurse Cardiology
Banner Del E. Webb Medical Center
05.2010 - 03.2015
Medical Billing Specialist
Banner Del Webb Medical Center
05.2005 - 08.2008
Medical Billing Specialist
St Joseph’s Hospital
03.2004 - 08.2004
Senior Personal Banker
Bank of America
05.1997 - 04.2004
Customer Service Representative
Bank of America
05.1997 - 05.1998
Bank Teller
Bank of America
05.1994 - 03.1996
Associate of Applied Science - Nursing
Mesa Boswell, School of Nursing