Michelle Wise
Nottingham,MD
Summary
I have 20+ years of exceptional customer service/sales, Utilization Management/Care coordinator, collections, telemarketing and Team Lead experience handling HIGH-VOLUME inbound and outbound Remote/virtual call center work in Healthcare/Insurance, Credit/banking and Retail industries. My unique ability to “read” verbal ques allows me to adapt as needed to maintain control of the call, resulting in me being the top performer when placed in any stats or goal driven position. However, I am a huge team player so I really enjoy coaching my colleagues in any way possible.
Overview
13
13
years of professional experience
Work History
Utilization Management/Care Coordinator
CareFirst BCBS
Baltimore, MD
08.2024 - Current
- Utilized multiple systems at once (Epic, Guiding Care, onBase, Teams and outlook yo name a few)
- Provided case management services to ensure the delivery of quality care.
- Collaborated with physicians, social workers, and other healthcare providers to provide comprehensive care for patients.
- Monitored and evaluated patient progress, adjusting treatment plans as needed.
- Assessed safety risks associated with living environments or activities of daily living.
- Ensured compliance with state regulations related to healthcare service provision.
- Conducted initial assessments and evaluations of patient's needs.
- Supported clients during hospital admissions and discharges.
- Scheduled appointments for clients with appropriate medical specialists.
- Assisted in the development of discharge plans for clients transitioning out of care programs.
- Made post discharge calls w/in 24 hrs of case assignment.
- Made inpatient calls to asses care management needs.
Customer Service Rep. II - Remote/WFH
Kaiser Permanente
Fulton, MD
01.2023 - 07.2024
- Verify HIPPA, eligibility, benefits, claims and PA info for Medicare/Medicaid, Federal/DOD, employer and commercial/self pay plans
- Ensure callers clearly understand their plan deductibles, COPAYS, OOP(out of pocket) Max for IN/OON (out of network) services.
- Provide exceptional member experiences w/1 call resolutions while documenting w/detailed transaction/call summary
- Clear/close, correct or route CRM's daily
- Problem solve/explain complex claims, EOB and Appeal process for providers and members
- Locate, verify and provide Prior Auth status
- Multitask across 2 screens and numerous systems (EVS, Epic, OnBase, docgemUM, CBAS, Teams, chats)
- Assist with coaching/guiding the new hires.
- De-escalate irate callers using empathy then ensure all concerns get resolved efficiently
- Exceed dept. metrics while adhering to strict Quality and Compliance guidelines.
- Explain service/premium bills, process payments or set up payment plans.
- Answer inbound calls, chats and emails to facilitate outstanding customer service.
Customer Service Representative- Remote/WFH
Johns Hopkins Health Care
Hanover, MD
09.2018 - 01.2023
- Explain complex claims/denials, EOB’s and appeals to both providers and members.
- Problem solve both quickly and accurately while maintaining patience and empathy.
- Provide excellent customer service and remain professional while deescalating irate callers.
- Multi-task by using numerous systems to exceed team/dept. metrics and compliance/ Quality standards.
- Record details of inquiries, complaints, as well as actions taken to ensure 1 call resolution.
- Verified eligibility using EVS and EPIC and explain benefits for many plans (Medicare Advantage, Priority Partners, EHP, USFHP).
- Provide detailed benefits info such as Copays, deductible, cost share and OOP max.
- Resolved complex problems by working w/other depts. to meet customer needs.
- Demonstrated exceptional skills in high volume call center by answering inbound calls, chats and emails simultaneously.
Collections/Lead Customer Service Rep.- WFH
Lacoste - Independent Salesman
New York, NY
06.2014 - 09.2018
- Developed and implemented a collections strategy to ensure timely payments.
- Monitored customer account activities to identify delinquent accounts and initiate collection efforts.
- Provided outstanding customer support for all accounts.
- Updated customer demographics and ensured accounts were updated quarterly.
- Drafted monthly reports.
Customer Service Supervisor
EZ-Pass
Baltimore, MD
05.2012 - 04.2013
- Supervised and trained customer service staff to ensure excellent customer service delivery.
- Monitored team performance metrics.
- Identified areas of improvement in the customer service process and developed strategies to address them.
- Conducted regular team meetings with customer service staff to discuss issues or changes in policies and procedures.
- Resolved complaints promptly and ethically.
Education
High School Diploma -
Oak Hill Academy
Mouth Of Wilson, VA05-2001
Some College Credits (2 years) -
CCBC Essex
Skills
- Critical Thinking and Complex Problem-Solving
- Inbound/Outbound Call Center Operations
- Microsoft Office Suite and CRM Software
- Excellent De-Escalation/communication skills
- Utilization Management/Care Coordinator
- Exceptional Sales/customer service experience
- Professionalism and Ethics
- Record keeping proficiency
- Post Discharge Calls/case management
- Adjustment posting and Payment Processing
- Fast learner w/amazing time management skills
- HIPAA compliance/Healthcare operations
- Case management/Documentation proficiency
- Needs assessment/Patient advocacy
- Utilization of numerous systems ex: Epic, Guiding Care, Teams, Outlook, onBase more
Timeline
Utilization Management/Care Coordinator
CareFirst BCBS
08.2024 - Current
Customer Service Rep. II - Remote/WFH
Kaiser Permanente
01.2023 - 07.2024
Customer Service Representative- Remote/WFH
Johns Hopkins Health Care
09.2018 - 01.2023
Collections/Lead Customer Service Rep.- WFH
Lacoste - Independent Salesman
06.2014 - 09.2018
Customer Service Supervisor
EZ-Pass
05.2012 - 04.2013
High School Diploma -
Oak Hill Academy
Some College Credits (2 years) -
CCBC Essex